Physiotherapy & Pelvic Health

Physiotherapy is a primary care, autonomous, client-focused health profession dedicated to:

  • Improving and maintaining functional independence and physical performance,
  • Preventing and managing pain, physical impairments, disabilities and limits to participation; and
  • Promoting fitness, health and wellness.

(from the Canadian Physiotherapy Association)

PELVIC HEALTH PHYSIOTHERAPY is a unique branch of Physiotherapy that evaluates the pelvic floor muscles and treats pelvic floor dysfunctions.

Pelvic floor problems are diagnosed by specially trained physiotherapists who are using internal palpation and manual techniques to evaluate the function of the pelvic floor muscles (PFM). In Ontario these therapists need to have a certification and to register in the roster list of the regulatory College (College of Physiotherapists of Ontario).

There is a constantly growing evidence in support of the effectiveness of Pelvic Health Physiotherapy in the treatment of a large range of pelvic floor conditions.

The Cochrane Collaboration 2010 concluded that Physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to retrain the pelvic floor muscles) should be the first line of defense, before surgical consultation, for stress, urge and mixed incontinence in women.

Pelvic floor physiotherapy and acupuncture should be considered for the treatment of the following conditions:

Pregnancy and Post-partum:

  • Pelvic pain during pregnancy
  • Pre-natal and post-partum stress incontinence
  • Constipation during pregnancy
  • Diastisis Recti
  • Pelvic organ prolapse secondary prolonged pushing
  • Scar tissue from episiotomies or Cesarean section
  • Dyspareunia (pain during sex)

Bladder Dysfunction:

  • Urinary incontinence
  • Urge
  • Stress
  • Mixed
  • Urinary urgency/frequency
  • Painful Bladder (Interstitial Cystitis)
  • Urinary hesitancy
  • Incomplete emptying or retention

Pelvic Pain

  • LevatorAni Syndrome
  • Pudendal neuralgia
  • Non-bacterial prostatitis
  • Urethral pain
  • Groin pain
  • Vulvar pain
  • Anorectal pain
  • Sacroiliac pain
  • Coccyx pain
  • Pain with penetration
  • Tampon use
  • Medical exam
  • Sexual activity
  • Scrotal or Testicular pain
  • Genital Pain

Sexual Function

  • Pain with orgasm
  • Difficulty achieving orgasm
  • Inability to have intercourse
  • Vaginismus
  • Erectile Dysfunction

Bowel Dysfunction

  • Fecal incontinence
  • Fecal urgency
  • Constipation
  • Irritable Bowel Syndrome
  • Diarrhea

Evidence-Based Physiotherapy Treatment for Pelvic Floor Dysfunctions may include but is not limited to:

  • Supervised, palpation-based, pelvic floor muscle retraining for strength, endurance, proprioception, and coordination
  • Progress to more advanced core strengthening exercises
  • Bowel and bladder retraining
  • Manual therapy techniques: may include scar and connective tissue massage as well as trigger point release
  • Kegels/Reverse Kegels
  • Acupuncture
  • Stretching and strengthening exercises
  • Stress management and relaxation strategies including Yoga, Meditation, Deep Breathing, Qi Gong
  • Electrical stimulation
  • TENS,
  • Education on diet
  • Therapy may also be directed at the:Hips, Lumbar spine, Sacro-iliac joints and pubic symphysis

WHEN TO CONSULT A PELVIC HEALTH THERAPIST DURING PREGNANCY?

  • If you experience pain in your pubic bone, groin, back, pelvis, buttocks, or legs
  • If you are leaking urine, gas, or stool when you laugh, cough, sneeze, or walk
  • If you have pain with intercourse
  • If bulging or tenting of your abdomen when you lift your head off a pillow
  • If you experience difficulties doing your everyday tasks such as rolling over, walking, or getting in/out of a vehicle
  • If you have vaginal varicose veins
  • If you have any questions about preparing for labour and delivery

What does the research say about Pelvic Floor muscle training during pregnancy?

Women who did pelvic floor muscle training (PFMT) between 20 and 36 weeks of pregnancy had:a lower rate of prolonged second stage labour than women who did no training, less pregnancy-related low back and pelvic pain than those who did no training, less likely to have urinary incontinence at 36 weeks of pregnancy and 3 months post-partum

—The National Institute for Health and Clinical Excellence (UK, 2006) recommends that all women should be taught by a therapist how to perform pelvic floor exercises during their first pregnancy.

—  Postnatal Pelvic Floor muscle training significantly reduces urinary incontinence compared to routine postnatal care(Glazener et al 2001, Chiarelli and Cockburn 2002)

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Through a personalized, holistic approach, Emiliana can help you resolve pelvic dysfunction using various aspects of physiotherapy, yoga, acupuncture and more.