-Pelvic floor disorders is a topic that is often misunderstood and not discussed openly due to the consequences that can occur to the individual that could compromise their quality of life.
-The pelvic floor musculature are often termed the “forgotten muscles” however they are very important in supporting the bladder, vagina, rectum and the inner organs of the abdomen.
-The reason these muscles are termed forgotten is because they lie invisible in the bottom center of the pelvis and lie between the sits bone, tailbone and pubic bone- this is referred to as the urogenital triangle.
– Just like any other muscle in the body, these muscles can be retrained to improve the overall vitality of the pelvic floor which will result in an increase in patient self esteem and self control .
-Not many people know that physiotherapy is an option available for both women, men and children wanting to gain sensory awareness and strength of the pelvic floor musculature.
Pelvic floor physiotherapy is particularly useful in helping patients with the following conditions:
-Pregnancy – pre-natal and post partum (c-section, vaginal births -Urinary Incontinence (Stress,Urge, Mixed) Prolapse (sensation of feeling pressure or a bulging sensation at the vaginal opening), Diastasis Recti- weakening of the abdominal connective tissue that gives the “tenting or bulging affect")
-Pelvic pain conditions – dyspareunia (pain with intercourse) ,vaginissmus (specific type of pain with intercourse which is a reflexive muscle tightening), vestibulodynia, symphysis pubic pain dysfunction associated with pregnancy, and interstitial cystitis
-Fecal incontinence or seepage
-Those who are suffering from post surgical pain of the pelvis (fracture, and hip region (labral tears)
-Female patients who have had a failed surgery in the urogenital region ( mesh or taping procedures)
-In Males : Post protectectomy (results in urinary incontinence and erectile dysfunction) , prostatitis – which can cause increase frequency and disturbed sleep throughout the night due to urgency ) and post TURP procedure (Transuretheral resection of the Prostate) which removes a section of the prostate that blocks the flow of urine. Risks of this surgery are urinary incontinence and erectile dysfunction.
-Children: Encopresis (fecal incontinence or soiling secondary to constipation or emotional issues), Nocturnal enuresis (bedwetting) , and stress incontinence, and increase urgency and frequency
Statistics prenatally and post partum
-1 in 4 women have urinary incontinence
-1 in 7 women will have a prolapse
Prenatally and Post-Partum consult a physiotherapist after delivery if you have:
-Scarring from c-section, tearing or episiotomy (surgical cut made in the perineum between the vagina and anus to enlarge the vaginal opening prior to delivery)
-Vaginal births with assistance of forceps or vacuum
-Leaking of urine, gas or stool when you laugh, cough, sneeze, walk, run, jump
-Problems emptying your bladder or bowel completely or frequently
-Pressure, heaviness, or bulging in you vagina (cystoceole, uterus) or rectum (rectoceole) otherwise known as a prolapse
-Ongoing pain in the vagina, rectum, pelvis, hip, pubic bone, coccyx (tailbone), abdomen or lower back
-Bulging or a tenting of your abdomen when you lift your head off a pillow (abdominal diastasis)
-Derived from the greek meaning of separation and is defined as the separation of the right and left rectus abdominus muscle from the midline connective tissue called the linea alba
-The cause of the diastasis is from the continuous stretching of the connective tissue (linea alba) that joins the outer most abdominal muscle which results in weakness and thinning of the tissue. Therefore this “ seran wrap” like connective tissue has an ineffective role in supporting the belly button, low back and organs.
-The goal is to increase tension in the connection tissue by concentrating on strengthening the core muscles. Reducing the diastasis is about healing the connective tissue and reducing intra abdominal pressure. Every individual will have a different rate of healing. Its only in serious cases that surgical intervention is required and it is not recommended and is a very last resort.
Some exercises to avoid when you have a diastasis recti are the following :
-Front loading abdominal crunches and planks
-Overhead medicine ball throws
-Quadruped (on all 4’s)
-Yoga poses to avoid – Cow pose, updog, triangle pose, and any backbend positions
-Avoid any movements that combine the movements of roll up and twist at the same time ( ie. getting out of bed) – use the log roll method and use your arms to push yourself up.
If you would like to inquire more information about pelvic floor physiotherapy and would like an assessment, contact our clinic.
Female pelvic floor diagram referenced from @BruceBlaus.
Male pelvic floordiagram to the right from the Mayo foundation.