Common Pelvic Floor Problems
There are a number of ways the pelvic floor can become dysfunctional. Like any muscle, the PFM can become tense and tight, or the can become weakened and ineffective. They can develop trigger points and scar tissue, can contribute to nerve entrapment, and can become hypersensitive to touch. Below is a list of just some of the types of pelvic floor dysfunction that women and men experience, all of which are treatable with physiotherapy.
Incontinence refers to the involuntary loss of urine or feces, in varying amounts, in varying contexts. For some, this is the small amount of leakage when they cough or sneeze; for others, it is a loss of urine following a strong "urge" to pee. Both of these scenarios describe dysfunction of the muscles of the pelvic floor, and both are very treatable with physiotherapy.
The PFM are largely responsible for the complete passage of our bowel movements. A successful bowel movement requires the PFM to lengthen and relax, and individuals with pelvic tension often experience difficulty with bowel movements. Constipation is also a contributor to further PFM dysfunction, as chronic pushing and straining can weaken the pelvic floor and increase risk for pelvic organ prolapse and other symptoms.
Sometimes referred to as Diastasis Rectus Abdominus, Diastasis Recti refers to the separation of the two halves of the “six-pack” muscles. The muscle is normally held tightly together with connective tissue (aka the “linea alba”) but can become separated for a variety of reasons including chronic straining, and pregnancy. This condition is rarely painful, but is typically noticeable as a visible bulging of the abdomen between the two muscles - especially during tasks that require use of the abdominal muscles, like a sit-up. Studies have shown that strengthening the PFM is most effective at “closing the gap”.
Urgency and Overactive Bladder
Feeling the need to urinate more than 5-7 times in 24 hours is considered greater than normal, and might mean that you have an “overactive bladder”. If your urge to pee comes on very strongly and suddenly and is difficult to ignore (which may or may not lead to leakage), it might mean you suffer from urinary urgency. These conditions are very treatable with guidance from a physiotherapist.
Pre- and Postnatal Physiotherapy
Although pregnancy is a natural (and wonderful!) state of the female body, and our bodies are built to accommodate a growing baby, it can be a time of increased strain on the musculoskeletal system. Pelvic girdle pain (including pain in the tailbone, lower back/SI joints, pubic bone, as well as hips and thighs) is a common complaint among pregnant women and can be alleviated greatly with pelvic floor physiotherapy. Prenatal physiotherapy is also effective at optimizing labour/delivery by maximizing strength while also teaching women how to relax and release PFM tension to support vaginal delivery.
Pelvic Organ Prolapse
Prolapse describes the descent of one or more of the pelvic organs (bladder, uterus, or rectum) toward the vaginal opening. Prolapse is rarely painful, but often feels like a heaviness or pressure near the perineum, and can interfere with the ability to empty the bowels and/or the bladder fully. Physiotherapy is the number 1 recommended treatment for prolapse (ahead of surgery), as it is supported by the best available evidence.
The most common type of sexual dysfunction associated with the PFM is pain with intercourse (aka “dyspareunia”) which is very common among postpartum and perimenopausal women, but can affect women and men at any life stage. It is often the result of excessive muscle tension in the PFM (so kegels may not be the right exercise for you!) and can be helped with various physiotherapy treatments.
Because the pelvis is home to some very important organs and soft tissues, it is also home to a wide array of pain conditions. Common pelvic pain conditions include Painful Bladder Syndrome (sometimes diagnosed as Interstitial Cystitis), Pudendal Neuralgia, Coccydynia (tailbone pain), Vaginismus/Vulvodynia/Vestibulodynia (pain and contraction inside the vagina; pain around the vulvar or vaginal opening), endometriosis pain, chronic non-bacterial prostatitis, and post-surgical pain. All of these conditions are either rooted in or exacerbated by PFM dysfunction and can be greatly improved with pelvic physiotherapy. Treatments of persistent pain involves tissue-focused work as well as attention toward nervous system changes that occur in response to persistent pain. Pelvic Health therapists have a wealth of knowledge around pain science and are passionate about taking a whole-person approach to treatment.