For decades, pregnant women have been instructed to do Kegel exercises during and after pregnancy. Kegels have been taught as the primary method of improving function of the pelvic floor muscles after childbirth.
Believe it or not, there’s a lot more involved with pelvic health than simply doing Kegels. In fact, for many women with pelvic pain, these exercises may be doing more harm than good. Before getting into the ins and outs of pelvic health physiotherapy, Pulse Physiotherapy wants you to meet the newest member of their team…
The staff at Pulse Physiotherapy would like to officially welcome Jenn Donovan to their growing team of health professionals. She is a registered physiotherapist with three years of experience working in orthopaedic clinics in and around Peterborough.
Jenn grew up in Brockville, Ontario and graduated from the University of Toronto with a Master’s in Physiotherapy in 2013. She’s taken several post-graduate courses in the areas of manual therapy, acupuncture and pelvic health. With the addition of Jenn to the team, Pulse is very excited to be able to offer pelvic health physiotherapy to our community.
SO WHAT IN THE WORLD IS PELVIC HEALTH PHYSIOTHERAPHY?
This is a question that many patients have when they learn about Jenn’s field of study because most people know little about it. Pelvic health physiotherapy is a growing branch within the scope of physiotherapy practice that offers treatment options for people with pelvic pain and/or dysfunction.
In fact, a 2010 collaborative research study determined that physiotherapy is the most effective first-line defense for the treatment of stress, urge and mixed incontinence.
“I PEE A LITTLE WHEN I EXCERCISE… THAT'S NORMAL, RIGHT?"
Believe it or not, 50 percent of women and one in nine men will experience urinary incontinence at some point in life. Many people believe it’s normal and expected after pregnancy or with age.
While it’s true that incontinence is common in women post-pregnancy and in older men and women, it shouldn’t be considered normal! Pelvic pain and incontinence are common issues in men and women for various reasons and there are treatment options available to people living with these issues.
Think about a distance runner with knee pain for a minute: Just because knee pain is common in runners, doesn’t mean a runner would think it’s normal to have knee pain while running, right? They would likely seek some form of treatment in hopes of fixing the issue to get them back to pain-free running.
Physiotherapists would assess the runner’s gait pattern, muscle strength, and flexibility to determine a root cause of their pain and dysfunction. They would then prescribe a combination of exercise and pain treatment modality to get them back to running without pain. Pelvic health physiotherapy takes the same approach. Finding the root cause of the issue allows the physiotherapist to treat the problem, decrease pain and eliminate dysfunction.
WHAT'S A PELVIC FLOOR?
Before delving into pelvic floor dysfunction, you need to know what a pelvic floor actually is. The pelvic floor is a group of muscles in the lower part of your pelvis that support the pelvic organs (bladder, bowel and uterus). They attach to the pubic bone at the front and to the spine (via the tailbone) at the back.
When functioning properly, the pelvic floor works to stabilize the pelvis. It also acts as a sphincter to provide tone for the vaginal and rectal canals, which is important for maintaining continence and proper sexual function.
WHAT TYPES OF PELVIC FLOOR ISSUES EXIST?
There are many issues that can cause pain and dysfunction in the pelvic floor region. Here are a few of the more common issues that pelvic health physiotherapists can help improve...
-> Urinary incontinence is the involuntary loss of urine. It can happen as the pressure within the abdomen increases quickly like when we laugh, cough, jump or run. An involuntary loss of urine can also happen when you feel a sudden strong urge to void and are unable to hold it long enough to make it to the bathroom. Incontinence occurs in women most commonly after pregnancy or in men with prostate enlargement or post-prostatectomy. Pelvic floor muscles act as a sphincter, contracting to maintain continence and relaxing to allow urination or a bowel movement. If these muscles are too tight, it can lead to urinary urgency and frequent urination; if they’re not strong enough, it can lead to incontinence and/or pelvic organ prolapse. Since incontinence is a sensitive issue, many people go on for years living with this issue, never seeking treatment.
PELVIC ORGAN PROLAPSE
-> Pelvic organ prolapse is a disorder described as a bulge or a feeling of pressure at the vaginal opening. This bulge or pressure often feels worse when standing and better when lying down. Pelvic organ prolapse often happens after having one or more children or post-surgery due to weakness of the pelvic floor muscles.
LOW BACK PAIN
-> There is a strong association between pelvic floor dysfunction and lower back pain. Pelvic floor muscles work in a coordinated effort with your inner abdominals, lower back muscles and diaphragm to support your lower back and prevent pain and dysfunction. The term core strengthening refers to the inner unit or the “core four” muscles. The core four includes your pelvic floor, abdominals, lower back muscles and diaphragm. Therefore, improving pelvic floor function is an integral part of any core strengthening program to decrease low back pain.
-> When your pelvic floor muscles are tight, they often cause pelvic pain. Like other areas in the body, tight pelvic floor muscles can also refer pain to other regions. Common areas include your low back, buttock and hips. Many cases of lower back pain actually stem from dysfunction in the pelvic floor. Tight muscles in the pelvic floor can also lead to pain during or after intercourse.
-> Diastasis rectus is the vertical separation of your “six-pack” abdominal muscles, which occurs most often during pregnancy. Many studies have found that the majority of women will have at least some level of abdominal separation during or after pregnancy. The degree of severity will determine the level of dysfunction associated with this issue.
“OKAY, THAT SOUNDS LIKE WHAT I HAVE... SO NOW WHAT?"
Physiotherapy treatment for pelvic health dysfunction is really not that different than physiotherapy for the runner with knee pain mentioned earlier. An assessment is required to get a comprehensive history of your pelvic health and determine the factors leading to the symptoms you’re experiencing.
Due to the fact that the pelvic floor muscles are hidden within the pelvis, an internal exam may be conducted to assess strength and muscle tone. This will help the physiotherapist determine if muscle weakness or tightness is the root cause of your dysfunction. Your physiotherapist will make a diagnosis based on the results of the information you provide and the assessment that has been completed.
A comprehensive treatment plan will be outlined for you at your initial appointment. Treatment often involves a specific home exercise program to either relax tight muscles or strengthen weak muscles. A physiotherapist will then follow you through your recovery to assess progress and update your home exercise program. The goal for each of client is to decrease your pain and improve your function to allow you to get back to the activities you love!
CONTACT YOUR LOCAL PELVIC HEALTH PHYSIO
For more information about Pelvic Health Physiotherapy and the other services they offer, visit Pulse Physio's website. If you have any questions about Pelvic Health Physiotherapy, feel free to call Pulse Physio at 705.874.0222 or email Jenn Donovan directly here. To book your initial assessment, call or email them to set up an appointment with Jenn at your earliest convenience.
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