Physiotherapy is often associated with the treatment of athletes. Although this statement is true, the scope of physiotherapy is much broader and many specializations remain unrecognized. This article aims to highlight one of these lesser-known approaches being perineal, or otherwise known as, pelvic floor rehabilitation.
Perineal rehabilitation focuses on problems such as urinary incontinence, uncomfortable sensations associated with organ descent, pelvic pain and more. Urinary incontinence is defined as the involuntary loss of any amount of urine and organ descent is commonly referred to as a prolapse. Statistics show that 3.3 million Canadians experience urinary incontinence.
That's 1 in 3 women and 1 in 9 men, and that only 1 in 12 is known to health care professionals. Perineal rehabilitation consists of strengthening or lengthening the pelvic floor muscles. Strong perineal muscles improve the pelvic health, prevent leakage of urine and decrease potential problems. It also aims to increase the elasticity of the tissues and the ability to contract and relax the pelvic floor muscles.
What is the Pelvic Floor?
It's a series of muscles at the bottom of our trunk, supporting our bladder and our internal organs. It is in the shape of a hammock, or kite. Lengthwise, it spans from the pubic bone to the tailbone, and width-wise between the sits bones.
The function of the pelvic floor:
Ensures the continence of urine and stool
Supports our pelvic organs (bladder, uterus and rectum)
Helps with sexual function (clitoral orgasm and erection)
Participates in improving the lumbar support, in conjunction with the abdominals
it is a misconception to think that it is normal to have urinary leakage after childbirth
it is a misconception to think that it is normal to have urinary leakage as you age
it is a misconception to think that there is nothing you can do about urinary leakage
Causes of urinary incontinence (UI):
Pelvic floor damage or nerve damage during pregnancy and labour
Surgical procedure such as a hysterectomy
Overweight / High body-mass
* A variety of other factors also appear to play a role, such as diabetes and smoking.
Pregnancy and childbirth are the primary causes of impairment of the pelvic floor muscles and resulting in urine or gas leakage, organ descent, decreased sexual satisfaction and Low back pain. Stress urinary incontinence (loss of urine to cough, sneezing or physical exertion) is a condition that can affect up to 77% of women in the postnatal period. Studies show that nine out of ten women with stress urinary incontinence three months after childbirth will still suffer five years later. However, on the upside, the same study shows that pelvic floor muscle retraining is the first line of treatment for urinary incontinence. As a matter of fact, in Britain, women undergo pelvic floor muscle retraining before any surgical procedure is considered .
Who would benefit from Pelvic Floor Physiotherapy?
Women and men suffering from any of the following symptoms :
Stress Incontinence – being unable to control the loss of urine with coughing, sneezing, laughing or exercise
Urge incontinence – experiencing loss of urine associate with a strong, uncontrollable need to void (ex. leaking while running to bathroom)
Frequency – having to urinate so frequently that your everyday routine is disrupted
Diastasis recti – a gap between your abdominal muscles, commonly occurs after birth
Pain – during or after intercourse
What to expect in your Pelvic Assessment?
Prior to your initial assessment, you will complete a detailed questionnaire regarding your pelvic health online. Your physiotherapist will then review this form with you on the day of your evaluation and proceed with a subjective evaluation which will involve your medical history and a list of your current complaints. Moving forward, the assessment will include an external and internal evaluation in order to assess the strength, function and integrity of your pelvic floor muscles. This complete assessment will help your physiotherapist come up with the best plan of action which she will discuss with you before continuing to the treatments. A consent will be taken at all time to ensure your comfort and safety.
If you are among the 11 out of 12 people with incontinence who do not seek help, please consult our registered physiotherapist and pelvic floor specialist Svetlana Marianer. She will be able to assess the strength, function and integrity of your pelvic floor and abdominal muscles and provide the appropriate treatment and education to restore them. Moreover, she will prescribe you a customized and personalized exercise program which will focus on your specific needs.
Svetlana Marianer, MSc. Pht