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Pelvic Floor physiotherapy involves the assessment and treatment of the muscles and structures that attach to the front, back and sides of the pelvic ring, including the sacrum. The musculature in this region of the body are like a hammock or sling. They are very important as they support the bladder, rectum, uterus (in women), and prostate (in men). The muscles of the pelvic floor also include those muscles that wrap around the urethra and rectum-which is important for functional bowel and bladder health, as well as muscles around the vagina-which is important for sexual health in women.
Pelvic floor dysfunction can occur for a number of reasons. Common causes can include pelvic pain from conditions such as Vaginismus, Pudendal Neuralgia, and Chronic Prostatitis, as well as changes created as a result of Pregnancy or Menopause. Dysfunction itself can present in two different ways: 1. Hypotonicity, which is weakness and low resting tension in the Pelvic floor musculature, and 2. Hypertonicity, which is tightness or increased resting tension in the Pelvic Floor musculature. In other words, dysfunction does not only occur when musculature is weak. Increased resting tension can interfere with bladder function and create unwanted pain.
Your physiotherapist has taken specialized training and certification to treat those with pelvic floor dysfunction. The physiotherapist will complete a thorough assessment, including a history and physical examination to determine an appropriate treatment plan for each individual client. The physical examination includes observation of pelvic floor muscle activation and relaxation, and both internal and external manual techniques to evaluate the function of the pelvic floor muscles. The lower back, hips and sacro-iliac joints will also be assessed as these joints can stress your pelvic floor musculature.
Treatment is completed based on the assessment findings. If clients are found to be hypertonic, they will often present with troubles such as pelvic pain, urgency incontinence, painful sex (including orgasm, or any sexual stimulation), and constipation. Often this group benefits from treatment techniques that help to relax the pelvic floor musculature including myofascial release techniques, breathing exercises, and education on self guided techniques.
Hypotonic or weak pelvic floor clients will often present with troubles such as stress incontinence and organ prolapse (bladder, uterine, rectal). These clients often benefit from education on bladder habits, strengthening exercises with or without biofeedback, and if appropriate referral on to other professionals for possible surgical intervention or device fittings such as pessaries.
Dumoulin C, Hay-Smith J, Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women (Review), The Cochrane Library, 2010 http://pelvichealthsolutions.ca/for-the-patient/what-is-pelvic-floor-physiotherapy/ Herman & Wallace Pelvic Rehabilitation Institute- Pelvic Floor Level 1 Certification Manual
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