Pelvic Floor Physiotherapy

Welcome to our comprehensive resource on pelvic floor physiotherapy, pelvic floor health and wellness. We’re here to guide you every step of the way.

Millions of people struggle with pelvic floor disorders, discover how pelvic floor physiotherapy can transform your life and unlock your body’s natural potential for strength and stability.

What Is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy is a specialized branch of physiotherapy that focuses on assessing and treating disorders related to the pelvic floor muscles and surrounding structures. It involves evaluating and addressing issues such as urinary incontinence, pelvic pain, sexual dysfunction, and pelvic organ prolapse in both men and women.

This type of therapy can benefit individuals across different life stages from childhood to old age. It can also help during pregnancy, postpartum, menopause, and after pelvic surgeries. The goal is to restore optimal pelvic health and improve overall quality of life.

Now lets learn more about what is pelvic floor and its anatomy and its disorders.

Pelvic Floor Anatomy

The pelvic floor is a group of muscles and ligaments that form a supportive sling at the base of the pelvis. These muscles support the pelvic organs including the bladder, uterus (in females), prostate (in males), and bowel.

The pelvic floor muscles stretch from the pubic bone at the front to the tailbone at the back and from side to side. They contain openings that allow passage for the urethra, vagina (in females), and anus.

The pelvic floor muscles play a crucial role in maintaining continence, supporting the pelvic organs, and allowing for healthy sexual, bowel and bladder function. When contracted, the pelvic floor muscles close the openings and provide an upward lift to prevent incontinence and organ prolapse.

Relaxation of the pelvic floor is necessary for urination, bowel movements, sexual intercourse, and childbirth. Weakness or excessive tightness in the pelvic floor muscles can lead to various pelvic floor disorders.

Common Pelvic Floor Disorders

Pelvic floor disorders are a group of conditions that affect the muscles, ligaments, and connective tissues that support the pelvic organs. Some of the most common types of pelvic floor disorders include:

Bladder Dysfunction
Bowel Dysfunction
Chronic Pelvic Pain
Constipation
Diastasis Recti Abdominis
Dysmenorrhea
Dyspareunia
Endometriosis
Incontinence
Inflammatory Bowel Disease
Bladder Pain Syndrome (Interstitial Cystitis)
Irritable Bowel Syndrome
Overactive Bladder
Pelvic Congestion Syndrome
Pelvic Floor Dysfunction

Pelvic Girdle Pain
Pelvic Inflammatory Disease
Pelvic Organ Prolapse
Pelvic Pain in Men
Pelvic Pain In Women
Post gynecological surgery
Pregnancy and Postpartum Conditions
Pregnancy low back pain
Pregnancy pelvic girdle pain
Pubic Symphysis Dysfunction
Sacroiliac Joint Pain
Sexual Dysfunction
Vaginismus
Vestibulodynia
Vulvodynia

Pelvic floor disorders become more common as women age, affecting about 10% of women ages 20-39, 27% of women ages 40-59, 37% of women ages 60-79 and nearly 50% of women over age 80. However, they are not a normal part of aging and can significantly impact quality of life. Fortunately, many pelvic floor disorders are treatable with options like pelvic floor physiotherapy, lifestyle changes, and in some cases, surgery.

Pelvic Floor Disorder Symptoms

Pelvic floor disorders can cause a range of symptoms that vary depending on the specific condition. Some common signs and symptoms of pelvic floor dysfunction include:

Urinary issues like feeling a frequent or urgent need to urinate, pain while urinating, or leaking urine when coughing, laughing or exercising.
Bowel problems such as leaking stool, difficulty controlling gas, or constipation and straining during bowel movements.
A heavy feeling, pressure, pain, or aching in the vagina or rectum that worsens throughout the day.
Muscle spasms or pain in the pelvic region, genitals, or rectum.
Discomfort or pain during sexual intercourse (in women).
Seeing or feeling a bulge or “something coming out” of the vagina.
Lower back pain.
Difficulty emptying the bladder completely

Some women with pelvic floor disorders may not have noticeable symptoms at first. Many are reluctant to discuss their symptoms due to embarrassment, or believe the problems are a normal part of aging. However, pelvic floor disorders are treatable and should be addressed with a healthcare provider.

Pelvic Floor Therapy Benefits

Pelvic floor physiotherapy can provide many benefits for people experiencing pelvic health issues. Some of the key benefits include:

Improved bladder control

Pelvic floor exercises can help strengthen the muscles that control urination, reducing or eliminating urinary incontinence and leakage.

Reduced pelvic pain

Manual therapy techniques and relaxation exercises can help relieve pelvic pain, including pain with intercourse.

Better bowel function

Pelvic floor training can improve coordination and control of bowel movements, helping with conditions like fecal incontinence and constipation.

Faster postpartum recovery

Pelvic floor physiotherapy can aid in healing and restoring strength and function after childbirth, reducing problems like pelvic organ prolapse and painful sex.

Enhanced sexual function

By improving pelvic muscle tone and reducing pain, pelvic floor therapy can lead to increased sexual sensation and satisfaction.

Preventing pelvic surgery

In many cases, pelvic floor physiotherapy can successfully treat pelvic floor disorders, helping patients avoid more invasive options like surgery.

Improved quality of life

By alleviating distressing symptoms and restoring normal pelvic function, pelvic floor physiotherapy can significantly enhance overall well-being and quality of life for patients.

Who is Pelvic Floor Therapy for?

Pelvic floor physiotherapy can benefit a wide range of people experiencing pelvic health issues. Some of the key groups who may find this therapy helpful include:

Pregnant and postpartum women

Pregnancy and childbirth place significant strain on the pelvic floor muscles, leading to issues like incontinence, pelvic pain, and pelvic organ prolapse. Pelvic floor therapy can help prevent and treat these problems, aiding in a smoother recovery after delivery.

Menopausal and post-menopausal women

Hormonal changes during menopause can weaken the pelvic floor muscles, causing symptoms like urinary urgency, frequency, and leakage, as well as vaginal discomfort and prolapse. Pelvic floor physiotherapy can help alleviate these issues and improve quality of life.

Men with pelvic health concerns

While often thought of as a women’s health issue, men can also experience pelvic floor dysfunction. This may include chronic pelvic pain, erectile dysfunction, and urinary issues, particularly after prostate surgery. Pelvic floor therapy can be an effective treatment option for these conditions.

People with chronic pelvic pain

Conditions like interstitial cystitis, endometriosis, vulvodynia, and chronic prostatitis can cause persistent pelvic pain. Pelvic floor physiotherapy can help manage pain through techniques like manual therapy, relaxation exercises, and biofeedback.

Individuals with bowel disorders

Pelvic floor dysfunction can contribute to bowel problems like fecal incontinence, constipation, and difficulty emptying the bowels completely. Pelvic floor muscle training can improve coordination and control of bowel movements.

Athletes and fitness enthusiasts

High-impact activities and sports that involve running, jumping, and heavy lifting can place extra stress on the pelvic floor muscles. Pelvic floor physiotherapy can help prevent and treat exercise-related pelvic floor problems, as well as improve core stability and athletic performance.

Children with pelvic issues

Children who struggle with bedwetting (nocturnal enuresis) may benefit from pelvic floor therapy to improve bladder control. Pediatric pelvic floor therapy can help children with constipation by teaching them how to properly use their pelvic muscles during bowel movements.

Anyone with pelvic floor symptoms

Even if you don’t fall into one of the other categories, if you’re experiencing symptoms like pelvic pressure, pain, or leakage, you may benefit from pelvic floor physiotherapy. These issues are common but not normal, and seeking treatment can greatly improve your overall well-being and quality of life.

Pelvic Floor Evaluation Process

A pelvic floor assessment typically begins with a detailed medical history, discussing symptoms, lifestyle factors, and any relevant health conditions.

The physical exam starts with an external evaluation of posture, breathing patterns, and movement of the hips, legs, and low back. The therapist will also palpate externally for any areas of tension or tenderness in the abdomen, hips, and pelvic region.

With the patient’s consent, an internal vaginal and/or rectal exam is performed to assess the pelvic floor muscles more thoroughly.

During the internal assessment, the therapist evaluates muscle tone, strength, endurance, and coordination of the pelvic floor muscles using manual palpation. The patient may be asked to contract and relax the muscles or simulate functional tasks like coughing.

Additional assessment tools may include:

Pelvic floor questionnaires to gather info on symptoms and quality of life.
Biofeedback devices to measure muscle activity and strength.
Ultrasound imaging to visualize pelvic floor structure and function.

The therapist will explain the assessment process and findings, answer any questions, and work with the patient to develop an individualized treatment plan. The assessment provides valuable information to guide effective, evidence-based treatment of pelvic floor dysfunction.

Pelvic Floor Therapy Techniques

Pelvic floor physiotherapy uses a variety of techniques and exercises to improve pelvic floor function and alleviate symptoms. Some common treatment approaches include:

Manual therapy: Hands-on techniques like myofascial release, trigger point therapy, and joint mobilization can help relax tight muscles, improve flexibility, and reduce pain in the pelvic region.
Biofeedback training: Using sensors placed on the pelvic floor muscles or a probe inserted into the vagina or rectum, biofeedback devices provide visual or auditory feedback to help patients learn to contract and relax the muscles correctly.
Electrical stimulation: Small electrodes are placed on the skin near the pelvic floor or a probe is inserted into the vagina or rectum to deliver electrical currents that can help strengthen weak muscles and alleviate pain.
Pelvic floor muscle exercises: Specific exercises to strengthen and improve control of the pelvic floor muscles, such as Kegels, quick flicks, and reverse Kegels, are a core component of most pelvic floor physiotherapy programs.
Relaxation techniques: Deep breathing, progressive muscle relaxation, and visualization can help reduce tension in the pelvic floor muscles and promote overall relaxation.
Bladder and bowel retraining: Techniques like scheduled toilet trips, urge suppression strategies, and dietary modifications can help retrain the bladder and bowels to function more effectively.
Education and lifestyle advice: Pelvic floor physiotherapists provide guidance on topics like optimal toilet posture, avoiding straining, managing constipation, and modifying physical activities that may stress the pelvic floor.

Treatment is tailored to each individual’s specific needs and may involve a combination of in-clinic sessions and home exercises. Regular practice of techniques and exercises is important for achieving the best possible outcomes in pelvic floor physiotherapy.

Pelvic Floor Strengthening Exercises

Pelvic floor strengthening exercises are vital for maintaining and improving the function of the pelvic muscles. These exercises can help alleviate issues such as incontinence, improve sexual health, and enhance core stability.

Pelvic floor muscle training techniques:

Pelvic floor muscle training involves exercises that strengthen and improve control over the muscles that support the pelvic organs. A few key techniques include:

Kegel exercises: Probably the most well-known pelvic floor exercise, Kegels involve contracting and relaxing the pelvic floor muscles. To do a Kegel, hold the pelvic floor muscles in for 5 seconds, then slowly relax for 5 seconds. Repeat 10 times, at least 3 times per day.
Quick flicks: Quick contractions of the pelvic floor muscles can help activate them faster and stronger to prevent leaks when coughing or sneezing. Exhale and quickly contract and release the pelvic floor muscles for 1 second, repeating 10 times. Do 2-3 sets.
Heel slides: Lying on the floor with knees bent, inhale, then exhale and draw the pelvic floor up. Slide one heel away from you, only as far as you can maintain the pelvic floor contraction. Inhale and return to the starting position. Repeat 10 times on each leg.
Marches: Also called toe taps, marches help with core stability while contracting the pelvic floor. Lying with knees bent, inhale, then exhale and lift the pelvic floor. Slowly lift one leg to tabletop position, then lower, alternating legs. Do 12-20 reps total.
Reverse Kegels: A technique to mindfully relax the pelvic floor muscles. Focus attention on the pelvic floor and imagine the muscles lengthening and relaxing.
Diaphragmatic breathing: Encourages coordination between the diaphragm and pelvic floor. Inhale deeply, allowing the belly to expand. Exhale slowly, gently drawing the pelvic floor up. Repeat for 5-10 breaths.
Finding the right muscles is key: imagine trying to stop urine flow or holding back gas. Exercises can be progressed by changing positions, from lying down to sitting to standing.

By regularly practicing these exercises, individuals can achieve better control over their pelvic muscles, leading to improved overall well-being and quality of life. Pelvic floor training is most effective when individually tailored, so consult with a pelvic health physiotherapist for guidance.

Preventative Measures and Lifestyle Changes

Some of the preventative measures and lifestyle changes that can help maintain pelvic floor health and prevent pelvic floor disorders:

Maintain a healthy weight: Being overweight or obese puts extra pressure on the pelvic floor muscles, increasing the risk of pelvic organ prolapse and incontinence. Losing excess weight through a balanced diet and regular exercise can reduce strain on the pelvic floor.
Practice good toilet habits: Avoid straining during bowel movements, as this can weaken the pelvic floor over time. Use proper toileting posture, allowing the knees to be higher than the hips (e.g. using a footstool). Don’t rush, and avoid pushing or holding your breath.
Stay active with low-impact exercise: Regular physical activity helps maintain a healthy weight, reduces constipation, and improves overall muscle tone. Low-impact exercises like walking, swimming, and cycling are gentle on the pelvic floor. High-impact sports involving running or jumping can strain the pelvic floor, so consider modifying exercise as needed.
Perform pelvic floor muscle exercises: Doing regular Kegel exercises and other pelvic floor strengthening techniques can help prevent pelvic floor weakness and associated disorders. Aim to practice daily, gradually increasing repetitions and hold times.
Avoid smoking: Smoking can lead to chronic coughing, which strains the pelvic floor and increases the risk of incontinence. Quitting smoking is an important step in preventing pelvic floor problems.
Eat a fiber-rich diet and stay hydrated: Consuming plenty of fruits, vegetables, whole grains, and water can prevent constipation and reduce the need to strain during bowel movements, which helps protect the pelvic floor.
Use proper lifting techniques: Lifting heavy objects incorrectly can put excessive pressure on the pelvic floor. When lifting, engage your pelvic floor muscles, exhale, and use your legs rather than your back.
Seek treatment for chronic cough: Persistent coughing from allergies, colds, or other respiratory issues can damage the pelvic floor over time. Managing these conditions can help minimize coughing and its impact on pelvic health.

By incorporating these preventative measures and lifestyle habits, you can take proactive steps to keep your pelvic floor functioning optimally and reduce your risk of developing pelvic floor disorders. If you have concerns about your pelvic health, don’t hesitate to consult with a pelvic floor physiotherapist or other qualified healthcare provider for guidance.

Preventative Measures and Lifestyle Changes

Home Pelvic Floor Exercises

Some of the pelvic floor exercises you can do at home to strengthen your pelvic floor muscles:

Kegel exercises: Kegels are the most well-known pelvic floor exercise. To do a Kegel, contract the pelvic floor muscles for 5 seconds, then slowly relax for 5 seconds. Aim to do 10 repetitions, 3 times per day. Make sure you are isolating the pelvic floor and not contracting your thighs, buttocks or abdominals.
Squats: Stand with feet wider than hip distance apart. Bend your knees and lower into a squat, keeping your heels on the floor if possible. In the squatting position, inhale and lift your pelvic floor muscles, drawing them up. Hold while exhaling and inhaling once, then release gradually. Repeat as needed.
Heel slides: Lie on your back with knees bent and feet flat. Inhale, then exhale and draw your pelvic floor up. Slide one heel away from you, only as far as you can while maintaining the pelvic floor contraction. Inhale and return to start. Do 10 slides on each leg.
Marches: Also called toe taps, marches target the core and pelvic floor together. Lie with knees bent. Inhale, then exhale, lift the pelvic floor and slowly raise one leg to tabletop position. Lower the leg, then repeat on the other side. Alternate for 12-20 reps total.
Diaphragmatic breathing: Lie down and inhale deeply, allowing your belly to expand. Exhale slowly, gently drawing the pelvic floor muscles up. Continue for 5-10 breaths, focusing on coordinating the pelvic floor with your breath.
Pelvic floor contractions: can also be practiced in different positions like sitting, standing, or walking. The key is to find the correct muscles (the ones you use to stop urine flow) and avoid contracting other muscles like the thighs or buttocks.

It’s best to have an assessment with a pelvic floor physiotherapist who can evaluate your technique and tailor an exercise program specific to your needs. Doing the exercises incorrectly can be ineffective or even harmful. If you experience pain or have difficulty with the exercises, stop and consult with a pelvic health professional

Signs to See a Specialist

If you’re experiencing symptoms like urinary dysfunction, constipation, pelvic pain, or pain during sexual intercourse, it may be time to seek help from a pelvic floor physical therapist. An unusual bulge in the lower pelvic region can also be a reason to see a professional, though a bulge alone may not necessarily be cause for concern.

Pelvic floor disorders are common but often go untreated because many people feel uncomfortable discussing personal topics like incontinence or sexual dysfunction. However, millions of people face the same issues, and treatment can dramatically improve quality of life.

Pregnant women in particular have a high risk of developing pelvic floor dysfunction and should talk to their OB/GYN about pelvic floor therapy options. Pelvic floor disorders affect about 25% of women overall, with rates increasing with age – 10% of women 20-39, 27% of women 40-59, 37% of women 60-79 and nearly 50% of women over 80.

If your primary care doctor doesn’t treat pelvic floor issues regularly, ask for a referral to a specialist like a colorectal surgeon, urologist, urogynecologist or pelvic floor physical therapist. These experts can diagnose the underlying cause of your symptoms and recommend the most effective treatment plan, which may include pelvic floor muscle training, biofeedback, medications or surgery in some cases.

Don’t hesitate to seek professional care for pelvic floor disorders. With proper treatment from experienced, compassionate providers, the vast majority of patients see significant improvement in their symptoms and are able to enjoy a much better quality of life.

Pelvic Floor Therapy Expectations

What to expect during pelvic floor physiotherapy sessions?

A pelvic floor physiotherapy session typically involves an in-depth assessment followed by education and treatment tailored to your specific needs. Here’s what you can expect:

Detailed history and discussion of symptoms: Your physiotherapist will ask about your medical history, pelvic health concerns, bladder and bowel habits, sexual function, and any pain or discomfort you’re experiencing. Be prepared to answer personal questions, but know that the information you share is confidential and important for developing your treatment plan.
Physical examination: The therapist will assess your posture, breathing, and movements of your spine, hips, and pelvis. This may include observing functional activities like sitting, standing, and squatting to see how your pelvic floor is working.
Internal examination: With your consent, the physiotherapist may perform an internal vaginal and/or rectal exam to evaluate your pelvic floor muscles. During the exam, you’ll lie comfortably on your back with knees bent. The therapist will assess muscle tension, strength, coordination, and reflexes. You may be asked to contract and relax your pelvic floor muscles or cough. The internal exam provides valuable information but is optional if you’re not comfortable with it.
Explanation of findings and treatment plan: After the assessment, your physiotherapist will explain their findings, answer your questions, and discuss a personalized treatment plan. This may include recommendations for exercises, lifestyle modifications, and hands-on techniques to address your specific needs and goals.
Education and exercises: Your physiotherapist will teach you about your pelvic anatomy and how different factors may be contributing to your symptoms. They’ll guide you through pelvic floor exercises and techniques to practice at home between sessions.
Manual therapy and modalities: Treatment may include hands-on techniques like myofascial release, trigger point therapy, joint mobilizations, and visceral manipulation to relieve tension and pain. Modalities like biofeedback and electrical stimulation may also be used.

Progress and Follow-Up

Remember that you are in control of your session and can ask questions or stop at any point if you’re uncomfortable. Pelvic floor physiotherapists are professionals who aim to help you achieve better pelvic health in a safe, supportive environment.

Pelvic floor physiotherapy requires commitment and regular follow-up sessions to monitor progress and adjust the treatment plan as needed. Over time, you should notice improvements in symptoms and overall pelvic health.

Preparing for Your Appointment

How to prepare for your first pelvic floor therapy session?

To prepare for your first pelvic floor physiotherapy appointment, consider the following tips:

Write down your symptoms and any questions you have. Keeping a log of when you experience urinary leakage, pain, or other symptoms can help your physiotherapist better understand your condition. Bring a list of your concerns to discuss during the appointment.
Wear comfortable, loose clothing that allows easy access to your pelvic area. You may be asked to undress from the waist down for the physical exam, so consider wearing a long shirt or dress for additional coverage. Avoid tight or restrictive garments.
Be prepared to discuss sensitive topics openly and honestly. Your physiotherapist will ask detailed questions about your bladder, bowel, and sexual function to gather important information for diagnosis and treatment. Remember that they are professionals who treat pelvic floor disorders every day.
Understand that an internal pelvic exam may be part of the assessment. If you have concerns about the internal exam, discuss them with your physiotherapist beforehand. The exam is optional and can be stopped at any point if you feel uncomfortable.
Arrive with a full bladder if you are experiencing urinary symptoms. This allows the physiotherapist to assess your pelvic floor function and observe any leakage during the exam. You’ll be able to empty your bladder prior to the internal assessment.
Bring any relevant medical records or imaging results. If you have had previous surgeries, injuries, or pelvic health diagnoses, this information can help guide your treatment plan.
Plan ahead for the appointment. Arrive a few minutes early to complete any necessary paperwork. Consider your transportation options and parking availability to reduce stress on the day of your visit.

Remember that the goal of pelvic floor physiotherapy is to help you improve your symptoms and quality of life. Your physiotherapist is there to support you in a confidential, caring environment. Preparing for your appointment can help you feel more at ease and get the most out of your session.

Take Control of Your Pelvic Health

Maintaining pelvic health is essential for overall well-being and quality of life. It’s also important to seek medical advice if you experience discomfort or symptoms related to pelvic health. Taking proactive steps can help you manage and prevent issues, ensuring you stay active and comfortable in your daily activities.

If you’re experiencing symptoms of pelvic floor dysfunction, don’t suffer in silence. Pelvic floor physiotherapy can help you regain control, reduce pain, and improve your quality of life. Contact a qualified pelvic floor physiotherapist to learn more and schedule an assessment. With the right treatment and support, you can restore strength, function, and confidence in your pelvic health.