Do You Need Pelvic Floor Physiotherapy?

Pelvic floor dysfunction affects so many people, but most Canadians aren’t getting the proper medical attention due to shame and the fear of embarrassment. If you suffer from pelvic floor dysfunction, know that you are not alone. Conditions associated with pelvic floor dysfunctions are common and treatable.

With a team of highly experienced pelvic physiotherapists, the Chiro-Med Rehab Centre is proud to offer leading Pelvic Floor Physiotherapy services within our clinic. Through our comprehensive rehabilitation program, patients can find relief from pain and symptoms associated with pelvic floor injuries or dysfunction. With all health care insurance and WSIB accepted, there’s nothing stopping you from starting your journey to recovery and comfort today.

Learn more about the types of pelvic floor dysfunction and our approaches for recovery & rehabilitation below. Ready to book your appointment for Pelvic Floor Physiotherapy? Call us today at (905) 918-0419

What Is Pelvic Physiotherapy?

Pelvic Floor Physiotherapy, also known as pelvic therapy, is the assessment and treatment of various conditions involving the pelvic floor muscles and the surrounding areas. These group of muscles are important for bladder and bowel control, sexual function, healthy pregnancies, spine stability, and more. Pelvic therapy can help treat the various conditions that cause pain and discomfort in the pelvic area of the body.

Pelvic physiotherapists are specially trained to evaluate the bones and muscles of your lower back, your hips, your sacroiliac joint, as well as your pelvic floor muscles. These rehabilitative health care professionals develop individualised care plans for their clients, to provide treatment and exercise programs that help manage pain and discomfort in the pelvic region.

Pelvic physiotherapy may also be part of a treatment plan that involves your primary care physician, sex therapists, and mental health therapists.

Pelvic Floor Dysfunction

Most pelvic floor dysfunction conditions are a result of pelvic floor muscles either being too weak (hypotonicity) or too tight (hypertonicity).

Hypotonic Pelvic Floor Dysfunction

Hypotonic pelvic floor muscles are muscles that are too weak. When a man or woman has weak pelvic floor muscles, it means that the muscles are not providing enough support for the bowels, bladder, and/or uterus.

There are two main conditions that usually cause weak pelvic floor muscles: urinary incontinence and pelvic organ prolapse (POP).

Urinary Incontinence

Urinary Incontinence is the involuntary loss of urine. Depending on the type and severity, some individuals can experience minor leaks while others lose small to moderate amounts of urine more frequently. If you suffer from urinary leakage, please know that it is very common – approximately 3.3 million Canadians suffer from incontinence.

There are 5 different types of urinary incontinence:

• Stress Incontinence: Involuntary leakage occurs when an increased pressure is put on the intra-abdominal muscles from such activities as: coughing, sneezing, laughing, lifting, and exercise.
• Urge Incontinence: An overwhelming urge to urinate, but unable to make it to the bathroom in time.
• Overflow Incontinence: The bladder does not empty normally (for example, dribbles) and becomes very full as a result.
• Functional Incontinence: Urinary leakage associated with health issues or environmental factors that prevent you from going to the washroom. These factors may include cognitive or physical concerns, psychological unwillingness, or physical barriers to the toilet.
• Mixed Incontinence: Urine leakage from both stress incontinence and urge incontinence. It is very common to have mixed incontinence as opposed to pure stress or urge incontinence.

Urinary incontinence can be diagnosed by using a variety of tests, including a urinalysis to check for abnormalities, post-void residual measurement to measure urine output and leftover urine in the bladder, or through the use of a bladder diary to track your frequency of urination.

Pelvic Organ Prolapse (Pop)

Pelvic Organ Prolapse (POP) is a disorder in which women experience a protrusion (bulge) at or near the vaginal opening. The protrusion may be accompanied by perineal pressure (pressure between the vagina and anus). There are other types of prolapses that can protrude into the vaginal canal as a result of weak pelvic floor muscles.

These include:

• Cystocele: prolapse of the bladder
• Rectocele: prolapse of the rectum
• Urethrocele: prolapse of the urethra
• Uterine prolapse: prolapse of the uterus
• Vaginal vault prolapse: prolapse of the top of the vagina after a hysterectomy
• Enterocele: prolapse of the intestines

Women that have POP often experience difficulty initiating urine flow and may strain to have a bowel movement. In men, a pelvic organ prolapse will occur in the rectum. The individual will feel like he needs to have a bowel movement, but is unable to go.

Two of the main tools used to diagnose a pelvic organ prolapse are a speculum and Pelvic Organ Prolapse Quantification (POP-Q) tool.

Hypertonic Pelvic Floor Dysfunction

Hypertonic pelvic floor muscles are muscles that are too tight. Your pelvic floor muscles need to be able to contract in order to maintain continence, and relax to allow for urination and bowel movements. When these muscles are too tight and have too much tension (hypertonic), they may cause pelvic pain and discomfort. There are many conditions caused by hypertonic pelvic floor dysfunction which can greatly benefit by seeing a pelvic floor physiotherapist, including: dyspareunia, vaginismus, vulvodynia, pudendal neuralgia, and chronic prostatitis.

Dyspareunia

Dyspareunia is the medical term for pain associated with intercourse. Surgery or trauma can cause injury to the pelvic floor muscles, and conditions like dyspareunia can result from the painful, hypertonic muscles. Individuals suffering from dyspareunia will often feel aching pain or burning during intercourse. The pelvic floor muscles will then need rehabilitation, which may include pelvic relaxation exercises instructed by a pelvic physiotherapist in addition to medication, and sometimes counselling.

Vaginismus

Vaginismus is a condition where during intercourse, a medical exam, or the insertion of a tampon, the vaginal muscles will squeeze or spasm and cause discomfort and possibly pain. These hypertonic spasms can affect the pelvic floor muscles and create too much muscle activity in the pelvic region. Vaginismus occurs during penetration and usually goes away after withdrawal, although not always.

Some women develop vaginismus when estrogen levels drop off after menopause, or after a surgery or trauma. This condition has also been linked to psychological issues from past sexual abuse or trauma, both physical and emotional.

Vulvodynia

Vulvodynia is a chronic discomfort of either the vestibule, or “entrance” of the vagina, clitoris, or the superficial tissues of the vulva. There are many causes for vulvodynia including injury to the nerves surrounding the vulvar region, connective tissue tightness, or pelvic floor muscle hypertonicity (present in 80% of patients with vulvodynia).

The most common signs and symptoms of vulvodynia include burning, aching, and itching that can last anywhere from months to years. Pain and irritation can occur during physical exercises like walking or biking, while inserting a tampon, or even while sitting.

To help diagnose vulvodynia, your doctor may do a cotton swab test. By using a moist cotton swab to place pressure on various parts of the vulva, your doctor will be able to identify the location and intensity of your pain, to help determine the best course of action.

Pudendal Neuralgia

Pudendal Neuralgia is a condition that causes pain, discomfort, or numbness in the pelvis or genitals as a result of major nerve damage to the lower body and/or pudendal nerve. The pudendal nerve runs from the back of the genitals and branches off into other nerves. There are many ways that the pudendal nerve can get damaged, resulting in pelvic floor dysfunction; it can happen while birthing, from an infection, or during certain types of exercises, like biking. The sharp pains or numbness resulting from damage to the pudendal nerve may intensify if you sit down, and may spread to the sides of your body, your belly button, legs, and buttocks. It can also result in the sudden and frequent urge to urinate. To determine if your pelvic floor dysfunction is associated with pudendal neuralgia, your doctor may perform a physical exam by placing their finger on the pudendal nerve. They may also suggest an MRI test to better determine if damage has occurred, or recommend a pudendal nerve block to numb the nerve and see if this helps reduce symptoms.

Chronic Prostatitis

Chronic Prostatitis is the inflammation of the prostate. It’s often painful and can affect sexual function and the ability to urinate. The prostate is a small gland that sits under the bladder and surrounds the urethra. This is the leading cause of urinary tract issues for men under the age of 50 and is the third most common urinary tract issue for men over the age of 50.[5] Often, chronic prostatitis stems from issues with the pelvic floor muscles. When the pelvic floor muscles are too tight or strained, they can irritate the surrounding nerves and cause radiating pain.

The pain and discomfort associated with any one of these pelvic floor conditions can be extremely limiting upon your lifestyle, preventing you from confidently engaging in the activities you love.  Our Pelvic Floor Physiotherapy program uses a customized approach to examine, educate, strengthen, and re-train muscles for long lasting freedom from discomfort.

What To Expect From Our Pelvic Floor Rehabilitation Program?

Our pelvic rehabilitation program will involve an exam of the muscles and connective tissues of the abdomen, buttocks, and inner thighs, and often an internal exam to assess the tone, strength and endurance of the pelvic floor group of muscles. It has been said that assessing the pelvic floor without an internal exam is like an orthopaedic surgeon examining the knee through a pair of jeans—highly inefficient, and it would be difficult to determine how those tissues are working. An internal examination of the pelvic floor muscles is the gold standard.

The individualized treatment may also involve:

• Comprehensive education
• Soft tissue release of internal pelvic floor muscles
• Muscle re-education
• Bladder retraining
• Strengthening of the pelvic floor muscles
• EMG/bio-feedback or electrical stimulation as required

By treating and educating patients in pelvic health dysfunction and targeted pelvic floor physiotherapy, we hope to empower individuals to find real-life, conservative solutions for pelvic pain, pelvic girdle problems, painful intercourse, bladder and bowel incontinence and pelvic organ prolapse. To book an appointment or to learn more about our comprehensive approach to Pelvic Floor Physiotherapy, reach out to a member of the Chiro-Med team today.