Whether you are male or female, young or old, active or inactive, your pelvic floor health can affect the quality of your life. At MelioGuide, we offer a range pelvic floor physiotherapy services to address pelvic health dysfunctions.
In this article, we will cover some of the causes of pelvic floor problems, what are the symptoms, and how to treat the problems through pelvic floor physiotherapy. Let’s start with a description of the pelvic floor for both men and women.
The pelvic floor is composed of a set of muscles, located underneath the pelvis, that fulfill several important functions:
- Provide support for the pelvic organs — specifically, the badder and intestines, and in women, the uterus.
- Maintain continence of the urinary and anal sphincters.
- Support the birth process by keeping the vagina in place and guiding the fetus through the birth canal.
- Support movement of the legs, the pelvis, the torso.
- Enable important sexual functions such as erections and orgasms.
- Aid in the circulation of blood between the legs and the trunk.
In women, the pelvic floor muscles start to the base of the spine, around the rectum, vagina and bladder and connect to the pubic bone. The pelvic floor muscle layer provides three passages in women: one for the urethra, one for the vagina, and the other for the anus.
In men, the pelvic floor muscles run from the base of the spine, around the rectum, under the prostate (and bladder) to public bone (see the diagram). The pelvic floor muscle layer provides two passages in men: one for the urethra and the other for the anus.
Pelvic Floor Muscles
To fulfill their role, the pelvic floor muscles, like most muscles in the body, should be limber, flexible and strong. When needed, they should contract and relax without causing any strain or pain.
Problems arise if there is damage to the pelvic floor that make the pelvic floor muscles too weak to provide support. Sometimes, pelvic floor muscles are so tight that they cannot function properly.
Pelvic floor dysfunction can happen in women who have not experienced constipation, have not had a baby, and have no history of obesity. They can experience incontinence because they do not know how to use the muscles properly. Pelvic floor physiotherapy can play an important role in training the pelvic floor to work properly whether their has been trauma to the pelvic floor muscles or not.
Even though the pelvic floor muscles are not readily visible, they can trained (through pelvic floor physiotherapy) and conditioned to counteract the affects of the pelvic floor dysfunction. Before we get into pelvic floor training and pelvic floor physiotherapy, we will cover some of the causes of pelvic floor dysfunction in the next section.
Pelvic Floor Dysfunction
There are several causes of pelvic floor dysfunction. In both men and women, pelvic floor dysfunction can occur if they strain while using the toilet (possible because of constipation), experience chronic coughing, and do not incorporate proper breathing technique while exerting or lifting. In addition, obesity can cause pelvic floor dysfunction.
Women can experience pelvic floor dysfunction after hysterectomy surgery and from a c-section birth. In both cases, incontinence can occur because they weaken the core muscles and the pelvic floor, and create lots of scar tissue.
Pelvic Floor Dysfunction Frequency
Pelvic floor dysfunction is more common than most people think. A 2014 publication in Obstetrics & Gynecology (1) indicated that 25% of women in the United States experience pelvic floor syndrome symptoms; the majority experience moderate-to-severe urinary incontinence, followed by fecal incontinence, and then incidence of prolapse.
Keep in mind that the 25% number is the average of the population. If you have had a baby, are older, or have been obese sometime during your life, your risk profile for a pelvic floor syndrome symptom could be higher than the reported 25% and you should strongly consider proactive steps to avoid the onset of one, or more, of the pelvic floor syndrome symptoms.
Pregnancy and Pelvic Floor
The pelvic floor muscles play an important role during the birthing process. They keep the vagina and uterus in place and actively direct the fetus through the birth canal. As a result, a woman can have pelvic floor dysfunction after pregnancy.
Additional stress and pelvic floor dysfunction can be caused by the use of forceps during delivery, a long delivery process, and the effects of an episiotomy.
Unfortunately, many women complete the birthing process and do not receive the appropriate medical therapy or instruction to counteract the affects of a weak pelvic floor from pregnancy. This could lead to severe pelvic floor syndrome symptoms that could have been addressed before their onset.
Now that we have covered the causes, lets discuss some important pelvic floor syndrome symptoms.
Pelvic Floor Syndrome Symptoms
The three major pelvic floor syndrome symptoms that can occur as a result of pelvic floor dysfunction are:
- Pelvic incontinence
- Pelvic prolapse
- Pelvic floor pain
Pelvic incontinence occurs when you are unable to adequately control either your bladder (urinary incontinence) or bowels (fecal incontinence). There are several types of incontinence that you can experience.
Types of Incontinence
There are five types of incontinence — specifically related to urinary incontinence. The five are:
- Stress incontinence occurs when there is an increase in intra-abdominal pressure due to coughing, sneezing, having a good laugh, participating in vigorous exercise, or lifting heavy objects. In most cases, only a small amount of urine “leaks” from your bladder.
- Urge incontinence occurs when you experience that sudden (and uncomfortably strong) urge to urinate but cannot hold it. It is no longer an urge, it is an urgency. Urine loss can be small or large. Also, you may find that with urge incontinence, you need to visit the bathroom frequently during the night (commonly known as nighttime incontinence) — which leads to disturbed sleep patterns.
- Overflow incontinence occurs when your bladder feels very full and you are unable to empty it like you used to. You also experience an ongoing loss of a small amount, or dribble, of urine.
- Functional incontinence happens when you are unable to make it to the toilet on time because of a physical impairment or mental condition. For example, you might have a physical impairment such as a broken leg or hip that restricts your movement, or you might have a mental condition such as dementia that causes you to ignore signals to use the bathroom.
- Mixed incontinence occurs when you experience a combination of the other four types of incontinence.
It is important to understand which of the types of incontinence, described above, that you have. When you work with us, we will spend time helping you identify the incontinence type and how to deal with it.
Living With Incontinence
Living with incontinence can reduce the quality of your life. Here are several ways incontinence can be disruptive to your day-to-day routine.
- Nighttime incontinence will affect the quality of your sleep and cause detrimental spill over effects onto your mental and physical health and lifestyle.
- Urge incontinence can cause older adults to rush to the toilet and, potentially, increase their risk of a debilitating fall or fracture.
- Incontinence can affect your social life. You might not want to go to your gym class anymore because stress incontinence and frequent movement causes embarrassing leaks.
- Shopping trips require more planning than before because urge incontinence means that a bathroom needs to be readily accessible at any moment.
- Coffee with friends at Starbucks? Forget it — unless the place is empty when you are there and the bathroom is always free. And how often does that happen?
- Urge incontinence often lead to urgency incontinence at the wrong time. Have you ever returned home from an outing and had an embarrassing “accident” while fumbling to get your keys in the front door keyhole to unlock the house?
Later, we will discuss the diagnosis and treatment of incontinence. But now, lets discuss the second pelvic floor syndrome symptom, pelvic prolapse.
The second pelvic floor syndrome symptom is pelvic prolapse. Pelvic prolapse (or pelvic organ prolapse) is a herniation of the pelvic organs. A pelvic prolapse occurs when the pelvic floor muscles are unable to support a woman’s pelvic organs, causing the organs to drop lower than the pelvis, thus creating a bulge in the vagina.
The most common organ to prolapse is the bladder. Other organs that can prolapse include the vagina, uterus, urethra (in men), the small bowel and the rectum.
Stages of Pelvic Organ Prolapse
There are five different stages of pelvic organ prolapse. These are:
- First stage: No prolapse.
- Second stage: Your pelvic organs are well supported but there are early signs of some prolapse.
- Third stage: Your pelvic organs are still inside your vagina but they are starting to drop.
- Fourth stage: Your pelvic organs are starting to bulge to the opening of your vagina and might be slipping outside your vagina.
- Fifth stage: Your pelvic organs have advanced outside of your vagina and are hanging between your legs.
Pelvic Organ Prolapse Treatment
There are a number of treatment options available to address pelvic prolapse.
- A pelvic health physiotherapy prescription of pelvic floor physical therapy exercises for prolapse can help address the problem. These are specific pelvic floor exercises that strengthen the muscles.
- Pelvic prolapse surgery.
- Pelvic floor biofeedback therapy.
- Medications, such as estrogen, might be appropriate for some women with a prolapse.
- Pessaries are silicone support devices that are placed in the vagina to hold the pelvic organs in place.
Pelvic Floor Pain
The third pelvic floor syndrome symptom is pelvic floor pain. The pelvic floor pain can be brought on by a pelvic prolapse or a weakening of the pelvic floor. Women can experience pelvic pain or discomfort during intercourse. Further, prolapse can lead to constipation or painful bowel movements since the support from the vaginal wall has been impacted by a prolapse. Pelvic floor pain can be addressed through pelvic floor physiotherapy.
Pelvic Floor Therapy: What to Expect
When it comes to getting help for incontinence or a prolapse there are many things that you can do before you consider surgery.
- Pelvic floor training that includes education and strategies designed for pelvic floor muscle rehabilitation, to keep your pelvic floor healthy and to help you get it back to a healthier state.
- Pelvic floor physical therapy exercises for strengthening your pelvic floor.
- Use estrogen vaginally.
- Use a vaginal pessary to support your pelvic organs and pelvic floor.
- Work with a skilled, experienced and trained pelvic floor physiotherapy clinician.
Pelvic Health Physiotherapy
The Physiotherapists at MelioGuide Physiotherapy have extensive pelvic floor training to assist you with incontinence and prolapse.
We start the pelvic floor physiotherapy process by sending you a patient intake form that allows you to provide us with information we need to assist you. This includes obtaining information about your gynaecological history and medical history that includes any past medical procedures. We want to know what symptoms you are dealing with as well as your digestive and bowel function so that we can best help you.
In the privacy of our individual treatment rooms and with your full consent we will, in the same manner as a gynaecologist, provide you with an outer pelvic floor assessment as well as a vaginal assessment. This is an important step. It gives us information on the health of your perineal area, the muscle tone of your pelvic floor, and the strength of your pelvic floor muscles.
We can also assess whether or not you have a prolapse and at what stage it appears to be at the time of the examination.
Pelvic Health Therapy
Our goal through your pelvic floor physiotherapy treatment is to provide you with strategies to get your pelvic floor back on track and help reduce your pelvic floor syndrome symptoms.
Pelvic floor muscles can sometimes hold onto stresses either physical, emotional or psychological. If your pelvic floor muscles have tension or discomfort then we will help them to relax and release the tension before we proceed to strengthening,
If needed, we will instruct you on pelvic floor physical therapy exercises to strengthen your pelvic floor. We will make sure you understand your pelvic floor exercises and are able to do them well without our continued instruction.
With your permission, we will work with your physician to ensure appropriate follow up is needed such a prescription for vaginal estrogen cream or a referral to a gynaecologist, if this is indicated, for a pessary.
Pelvic Floor Physiotherapy Ottawa • Schedule an Appointment
We also have had two children vaginally, three c-sections, one hysterectomy (abdominal incision), two episiotomies, a fifteen hour labour, a forcep delivery, and one of us has been fitted for (and appreciates the utility of) a pessary.
We have learnt the hard way to keep our own pelvic floors strong to support us until we each reach 100 years old. We would like to help you do the same.
Start your pelvic health muscle rehabilitation by scheduling an initial assessment with us.
(1) Obstetrics & Gynecology, Prevalence and Trends of Symtomatic Pelvic Floor Disorders in U.S. Women, pp. 141 – 148, January, 2014
Pelvic floor physiotherapy is one of our Services.