Pelvic Floor Rehab

 

Pelvic floor rehabilitation is an approach to improving the strength and function of the muscles that support the bladder, urethra and other organs within the pelvis.

 

Pelvic floor muscles become weak, too tight or painful for many reasons. This is not all due to ageing. Pelvic floor problems often start with pregnancy and childbirth and they are also common in young athletes. Men, women and children of all ages need a healthy pelvic floor. Pelvic floor rehabilitation has proven to be effective in treating and preventing many conditions:

 

  • To strengthen or relax pelvic floor muscles
  • Bladder and bowel symptoms
  • Prolapses
  • Sexual satisfaction
  • Childbirth preparation and recovery post birth
  • Rehabilitation before and after surgery
  • Core stability and back problems

 

Common problems with Pelvic Floor Muscles

Like any other muscles in our body, the pelvic floor muscles can become too weak or too tight. They can also be overstretched or torn with injury or traumatism.

 

Weak pelvic floor muscles
Low-tone Pelvic floor muscles can lead to stress incontinence and pelvic organ prolapse.

USI or Urinary Stress Incontinence is when you leak when coughing, sneezing, running or laughing.

Organ prolapse happens when the too loose pelvic floor muscles and their surrounding fascia do not hold sufficiently the pelvic organs leading to a descent of the bladder, uterus or rectum.

The good news is that the training and strengthening of pelvic floor muscles have shown to be effective in many conditions. Your physiotherapist will prepare a specific exercise programme to train and strengthen pelvic floor muscles. Other approaches may be used such as manual therapy, biofeedback and electrotherapy technique.

 

Tight or overactive pelvic floor muscles
Muscles are not only about strength. Their ability to relax and lengthen is as important. A stiff neck can bring neck pain or headaches. Short, tight or hypertonic pelvic floor muscles can bring many problems which are often misdiagnosed such as:

  • Urinary frequency and urges or the inability to empty completely your bladder or bowels.
  • Sexual pain during or after intercourse. When muscles are too tight, intercourse can be very difficult. Pelvic pain such as pain in the genitals area (vulva, vestibule or penis) or around the rectum and the coccyx. Tight pelvic floor muscles can lead to unexplained chronic back or hip pain.
  • Constipation and pain with straining when emptying bowels.

 

Tight does not mean strong muscles!
When pelvic floor muscles are in spasm or unable to relax, strengthening exercises may just exacerbate the symptoms. Pilate core type exercises which focus on tightening the pelvic floor muscles would not be appropriate. We must first treat the tension and then only the weakness. It is difficult to initiate or activate hypertonic pelvic floor muscles if they are not able to relax towards the basic resting tone.

Physiotherapy treatment for hypertonic pelvic floor muscles usually includes “hands on” manual therapy, diaphragm breathing, awareness exercises, biofeedback and down-training approaches to relax and lengthen the pelvic floor.

 

Lack of awareness, coordination and control
Pelvic floor muscles are not easy to work out simply because women and men are often not aware of the pelvic area and simply due to the difficulty of seeing them!

 

Scar tissues and adherences
Scar tissues, adherences and nerve damages can cause pelvic floor tension and pain. Childbirth, perineal tears, surgery, endometriosis or radiation can affect abdominal and pelvic function.

 

Lack or excessive local sensitivity
Sensitivity issues may lead to difficulty in feeling and controlling the muscles, lack of sexual sensation or pelvic and sexual pain.

The goals of Pelvic Floor Re-education are to help you regain a functional pelvic floor.

After a full, detailed evaluation and a physical assessment which might include manual vaginal or rectal examination, a programme of treatment is agreed, based on the findings, individual needs, goals and progress desired.

Pelvic Floor Rehabilitation may include pelvic floor retraining, manual therapy, bladder or bowel training, biofeedback, electrotherapy, education and advice.