Incontinence, prolapse, pelvic pain and constipation – topics women fear yet rarely discuss.
Medical experts are discovering more and more evidence that physiotherapy can alleviate, and in many cases, cure these symptoms. Yet, most women don’t know that help is available.
It can be an embarrassing topic but it should not be ignored.
Some information below is hopefully helpful either in answering questions or helping you to understand how and whether women’s health physiotherapy can help you.
The Pelvic Floor – what exactly is it?
The pelvic floor is made up of a group of muscles that attach from the symphesis pubis at the front of the pelvis to the coccyx at the base of the spine. They form a sling or hammock of muscle creating the ‘floor’ of the pelvis. This is important for lifting and supporting the pelvic organs above. It also forms the birth canal and passages for urine and stool, which is why childbirth (and age) affects these areas.
These muscles have dual purpose – they need to be able to contract to help us maintain bladder and bowel control, but also they must relax to allow for urination, bowel movements, childbirth and sexual intercourse. Problems with the pelvic floor can occur when the muscles are too weak (hypotonic) or too tight (hypertonic), or damaged as can happen following childbirth.
A weak pelvic floor is less effective at supporting the pelvic organs and can lead to symptoms such as urinary or bowel incontinence and pelvic organ prolapse. This can be the result of many factors but it is important to realise that they are NOT an inevitable part of ageing and can often be treated conservatively, without medical intervention.
A structured exercise program to strengthen the pelvic floor muscles is effective in alleviating the symptoms in 80% of symptomatic women. When the pelvic floor muscles are too tight, they can cause a range of symptoms which may include urinary frequency, urgency or difficulty fully emptying the bladder or bowel, or painful urination as the muscles are unable to relax fully to allow voiding. You may also experience constipation or pain with bowel movements, or suffer with vaginal pain, pain during or after intercourse, orgasm, or sexual stimulation due to the tension in these muscles. Hypertonic pelvic floor muscles may also be associated with Interstitial Cystitis, Vulvodynia and Pudendal nerve Neuralgia.
Tension in the pelvic floor can be due to a variety of factors, some of which we have no control over, such as traumatic childbirth or gynaecological intervention or investigation, infection, or some of which we can change by altering our diet or exercise.
When the pelvic floor muscles are already tight, it makes it difficult to contract the pelvic floor further. Unexpectedly, the pelvic floor may actually be weak even though it is constantly being help in a state of tension. If this is the case the muscles need to learn to fully relax before they can be reassessed and muscle weakness be treated.
An assessment will be made and treatment often includes internal as well as external work. An internal examination may not be possible until connective tissue in the surrounding area is released.
Depending on the assessment findings treatment may include:
- Pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles
- Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myo-fascial (muscle and connective tissue) stretches as well as external release of abdominal and pelvic connective tissue
- Scar tissue massage
- Relaxation and breathing techniques
- Advice on toileting
- Provision of vaginal dilators, pelvic floor educators or muscle stimulators to assist in the release or strengthening of pelvic muscles
- Education about persistent pain is an important part of treating pelvic floor dysfunction since the pelvic area often affected by stress.