By Cora Tomowich, MScPT, Hons B Kin
Well hello there and welcome to my little discussion of the pelvic floor and pelvic floor physiotherapy. Like many others out there, when I first heard the term “pelvic floor”, I had no clue what that meant. At first I thought it was some sort of Yoga pose, then I thought it was some kind of prosthetic, and then I thought maybe it had something to do with exercises that should be done while sitting on the floor. So please know that there is no judgment on you if you thought / are thinking the same thing… but let me see if I can clear things up a bit.
What is the Pelvic Floor?
Essentially, the pelvic floor is a group of muscles that line the base of the abdomen and pelvis. When we think about the pelvic floor, we really need to consider any muscle that exists in the area between the lower ribs and the knees as they can all play a role in compensating for or referring pain into the pelvic region. The pelvic floor has five primary functions:
- Support – the pelvic floor is like a basket of muscles that hold our internal organs up against gravity and changing intra-abdominal pressures. Without a healthy pelvic floor, our organs would fall victim to gravity creating what we call a “pelvic organ prolapse”
- Sphincteric – the pelvic floor is responsible for controlling the opening of the urethra, the vaginal canal, and the rectum in order to maintain normal functioning of bladder, bowel, and vagina. Sometimes issues can arise from an overly weak or restricted pelvic floor causing people to experience pain, leakage, or retention in these areas
- Sexual – the pelvic floor plays a huge role in regulating blood flow to sexual organs and providing tone in the vaginal and rectal canals. Patients who are unable to have an erection or experience an orgasm may have decreased blood flow or altered tone in pelvic floor muscles
- Stability – by nature of its orientation, the pelvic floor assists in unloading the spine by stabilizing the major joints of the hips and pelvis, including the sacroiliac (SI) joints, the pubic symphysis, and the tailbone. If the pelvic floor is overly weak or restricted, patients can experience pain or dysfunctional movements in these areas
- Sump-Pump – the pelvic floor helps to regulate the flow of blood and lymph in the pelvis. If there is decreased sump-pump action, patients can experience pelvic congestion which can lead to many issues involving improper bowel and bladder emptying
So, what is Pelvic Floor Physiotherapy?
Many people assume that pelvic floor physiotherapy is only ever about doing daily Kegel exercises, which is not the whole truth. In fact, there are many cases where doing Kegel exercises can be more damaging to the pelvic floor and, even when they are required, are not performed properly.
Pelvic floor physiotherapy is a specific form of manual therapy that often involves internal and external, hands-on techniques to evaluate and treat pelvic floor muscle functioning and its interaction with other deep core muscles. As I mentioned before, this form of therapy must also include the assessment and treatment of the joints and muscles in the low back, hips, thighs, and SI region.
Pelvic floor physiotherapy can be used as the first line of defense against many issues, such as:
- Rectus diastasis or “Mummy Tummy” – Piriformis syndrome
- Incontinence or leakage – Pain during intercourse
- Low back or pelvic pain – Erectile dysfunction
- Pelvic organ prolapse – Pudendal nerve irritation
- Constipation or retention – Sciatica
And the list goes on and on…
Pelvic floor physiotherapy has some of the highest quality research evidence to support its use in practice. In 2010, for example, researchers found that internal techniques for pelvic floor muscle training were paramount in the treatment and prevention of stress and urge incontinence. In 2012, experts saw that internal pelvic floor myofascial therapy was more effective than generalized massage therapy in treating chronic bladder / pelvic pain.
Pelvic floor physiotherapy has also proven to be vital in pre- and post-partum care. In France, women are encouraged to see a pelvic floor physiotherapist for post-partum recovery in order to prevent muscle imbalance and weakness; which can eventually lead to other functional issues. In Britain, any patient with prolapse or incontinence must first undergo several weeks of internal pelvic floor physiotherapy prior to becoming a surgical candidate.
It really can be a life-changing form of therapy. Many people who experience issues with the pelvic floor have reported huge improvements and even elimination of their symptoms after only a few sessions of pelvic floor physiotherapy! If you have any specific questions related to the pelvic floor or the role of physiotherapy, please feel free to contact or visit us here at Darou Wellness. Cheers!
- Faghani, N. Pelvic Health Solutions [website] http://pelvichealthsolutions.ca
- Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. 2010 Jan 20
- Boyle R, Hay-Smith J, Cody J, Morkved S. Pelvic floor muscle training for prevention and treatment of urinary and faecal incontinence in antenatal and postnatal women. 2012 Oct 17;10