Pelvic Floor Physiotherapy is an area of Physiotherapy that has recently gained increased momentum and attention that involves the thorough assessment and treatment of the pelvic floor structures by a trained and certified Physiotherapist. The pelvic floor is a group of muscles, ligaments, and connective tissue that form a hammock-like structure at the base of the pelvis between the hip bones and the sacrum.

Why is the Pelvic Floor Important? 

1. It helps control urination and defecation, preventing embarrassing leaks and incontinence.
2. A strong pelvic floor is essential for overall core strength, posture, and balance.
3. Proper pelvic floor function contributes to sexual satisfaction and prevents pain or discomfort during intercourse.
4. It supports the internal organs.
5. Assists in the movement of lymphatic fluid (collection of extra fluid that drains from body’s cells) from the legs back to the heart.

When the Pelvic Floor is not working optimally, various conditions can be manifested in our bodies which include;

• Urinary incontinence (leaking urine)
• Overactive Bladder
• Constipation
• Pelvic pain, discomfort, or pressure
• Pelvic Organ Prolapse
• Pain during sexual activity (Dyspareunia)
• Postpartum issues, such as diastasis recti or pelvic pain
• Painful periods (dysmenorrhoea)
• Lumbar spine and/or hip pain
• Vulvar pain
• Pudendal neuralgia

During a typical Pelvic Floor Physiotherapy session, your therapist will ask many questions regarding your symptoms in order to take a detailed history. This may include items such as how long you have had the problem, previous treatments sought and how the issue affects your quality of life. Based on the information received, the assessment will be formulated to detect areas of pain, weakness and dysfunction within the pelvic floor and surrounding tissues. This may involve an internal digital examination  (via the insertion of one finger –  nil speculums or tools are used) of the vagina. For those patients who are not comfortable with this aspect, this part can be omitted or performed at a later date. While the internal exam is not always necessary it does help to provide a clearer picture which may enhance the treatment plan for a quicker recovery. Other areas that will be assessed include the lumbar spine, hips, abdomen and thighs. The findings of the assessment will then guide the treatment selection which is specific to each individual and may involve a combination of any of the following;

• Pelvic floor exercises for relaxation or strength
• Manual therapy techniques
• Biofeedback and electrical stimulation
• Lifestyle and dietary guidance
• Education on pelvic health and anatomy

Pelvic floor physiotherapy can alleviate various pelvic pain conditions, including pelvic pain syndrome and aid women during pregnancy and postpartum recovery by addressing issues like diastasis recti and postpartum pelvic pain.

Many women sadly do not discuss their pelvic health enough whether it is with their friends or medical care practitioners whether it is from embarrassment or shame and thus silently suffer for months or years with issues that can be addressed such as nocturia (frequent urination during the night), urgency, constipation and incontinence. Many women even accept these things as “normal” part of ageing and post-partum individuals. And while they are indeed common, they are not normal and can be treated successfully.

There are even some common habits that we are guilty of that can increase the chances of developing pelvic floor dysfunctions such as;

• standing to urinate (for women) such as in the shower or hovering over a toilet
• resisting the urge to urinate for long periods on a regular basis
• resisting the urge to have a bowel movement for long periods on a regular basis
• rushing to go to the bathroom
• urinating when there is no urge to i.e. “just in case”