Pelvic Health Physiotherapy: Addressing Pelvic Pain and Incontinence

Pelvic Health Physiotherapy is a specialized area of Physiotherapy which addresses dysfunction in the pelvic area by assessing and treating the muscles, ligaments and connective tissue in that area. Pelvic pain and incontinence are common, but can be under-reported issues affecting individuals of both genders and all ages. Many people feel uncertain or ashamed and opt not to discuss these troubling symptoms with their health care providers, some assuming symptoms like incontinence are a normal and expected part of aging. These conditions can negatively affect quality of life as they can cause physical discomfort, emotional distress, social isolation, and reduced participation in daily activities.

Pelvic Pain

Pelvic Pain can have multifactorial causes including musculoskeletal dysfunction, which typically can involve hypertonic (overly tight) muscles or nerve irritation (such as the pudendal or obturator nerve) by surrounding tissues, trauma (such as birth) or post-surgical issues. Two commonly experienced pelvic pain conditions reported are vaginismus and dyspareunia. Both can involve painful penetration of the vagina by objects such as tampons. Other causes of pelvic pain can include fibroids, endometriosis, piriformis syndrome, pelvic organ prolapse and coccydynia.

Incontinence

Incontinence is the inability to hold your urine in your bladder and let it out only when you are ready such that leakages occur which can potentially result in socially embarrassing situations. There are four main types of urinary incontinence;

-stress urinary incontinence: this results in leakage from the bladder with an increase in intraabdominal pressure such as with coughing, laughing, jumping or lifting heavy objects.
-urge urinary incontinence: this results in leakage associated with a strong uncontrollable urge to urinate. Persons are often unable to make it to the bathroom before leakage occurs.
-mixed urinary incontinence: this is a combination of the above two forms of incontinence
-overflow urinary incontinence: this occurs when urine is kept in the bladder for extended periods such that the bladder is no longer able to manage with the volume of urine inside of it and leakage occurs.
Some common contributing factors to incontinence include pregnancy, childbirth, aging, surgery, neurological disorders and even lifestyle habits such as diet.

Role of Physiotherapy

Physiotherapy involves various areas that can help with these dysfunctions. First, a comprehensive consultation is performed in which details regarding the symptoms, previous treatments (if any) and relevant medical history are taken. Then a detailed assessment is performed which may include assessment of posture, range of motion, special tests, palpation (of external and internal structures) and pelvic floor muscle function.

Depending on the assessment findings, therapy may include;
1) Evidence-based exercises to either strengthen or stretches to relax the pelvic floor muscles
2) Manual techniques such as soft tissue release
3) Acupuncture and / or dry needling for pain management and muscle relaxation
4) Education and advice on lifestyle modification is key to making long term progress. Many persons are unaware that some of their daily habits can negatively affect their pelvic floor function such as standing to urinate such as hovering over the toilet and going to urinate “just-in-case” in the absence of an actual urge or need to empty the bladder (we have all done these things!). Education and guidance on bladder training and posture adjustments for sexual intercourse may also be necessary.
5) Modalities such as electrical muscle stimulation and biofeedback devices may also be used.

Pelvic Floor Physiotherapists can work alongside gynecologists, urologists and other medical progressionals to improve patient outcomes and provide patient centered care which empowers them with the knowledge and techniques to improve their symptoms. In summary, Pelvic Floor Physiotherapy is a safe and effective approach to managing pelvic pain and incontinence and thereby improving patient quality of life.