What is the Pelvic Floor?

The pelvic floor is a group of muscles in your pelvic area and lower abdomen. These muscles work together with deep back and abdominal muscles to stabilize and support the spine, and also work to keep abdominal organs in the right place. During exercise, these muscles help control pressure inside the abdomen, especially during lifting and straining. Pelvic floor pain can result from pelvic muscles that are too tight and cannot relax. Pelvic floor dysfunction often is caused by pregnancy or childbirth. Common symptoms of pelvic floor dysfunction include: bladder leakage, constipation, pelvic pain or painful sex.

Pelvic Organ Prolapse

Pelvic organ prolapse is a condition experienced by half of women who have given birth, and one third of all women. Organ prolapse is defined as when organs fall down or droop out of place. There are two types of pelvic organ prolapse: cystocele and rectocele. Cystocele occurs when the bladder prolapses into the vagina. Rectocele occurs when the rectal wall falls into the vagina.

Possible Causes:
– Giving Birth
– Getting a hysterectomy
– Menopause

Common Symptoms:
– Pressure in the pelvic region
– Painful intercourse
– Recurrent UTIs
– A mass at the opening of the vagina

Postpartum

Diastasis Recti is known as a gap between the two sides of the rectus abdominis muscle. These are the muscles that make up the bulk of the stomach. In pregnant or postpartum women this can be caused by stretching of the stomach muscles due to the growing fetus. Those more susceptible to diastasis recti are women over the age of 35, high birth weight of the child and multiple pregnancies. Physical Therapists are trained to prescribe exercises that can help improve the function of the abdominal muscles and even close the gap between the abdominal muscles.

Urinary Incontinence & Constipation

10% of Canadian men and women experience urinary incontinence when laughing, coughing, or sneezing. There are three main types of urinary incontinence: urge incontinence (leakage when you cannot make it to the bathroom in time), stress incontinence (leakage during exercise), or a combination of the two. Women are most likely to experience urinary incontinence due to the changing of their pelvic region during pregnancy, childbirth, or menopause, though men may also experience incontinence (especially thoe who have had prostate surgery). A physiotherapist can help with education and exercises.

Tight pelvic floor muscles can prevent bowel movements from happening normally. 15% of Canadian adults struggle with constipation, but you don’t have to. Seeing a doctor or physiotherapist may help.

Endometriosis

Endometriosis affects 1 in 10 women across the world. It occurs when the lining of the uterus, the endometrium, is misplaced outside of the uterus. During the menstral cycle the blood from this endometrium has no way to drain from the body, resulting in cysts, inflammation, and irritation of the surrounding tissue leading to pain and fertility problems.

Common Symptoms Include:
– Painful periods
– Painful intercourse
– Pain with bowel movements or urination
– Excessive bleeding
– Infertility
– Fatigue
– Diarrhea
– Constipation
– Bloating
– Back pain

Endometriosis can create inflammation, scar tissue, and adhesions in the pelvic and abdominal cavity. In turn, this can encourage the formation of regions of very tight muscles in the pelvic floor, abdomen, hip, and back muscles. In response to this tension, the muscles also spasm and thicken. This can lead to dysfunction and pain that can even cause pain in different parts of your body. A physical therapist can help by providing a full assessment of pain and dysfunction, improve patient awareness and ability to control pelvic muscles, and help retrain overactive muscles that may be causing pain.

How Physiotherapy Can Help

• Pelvic Prolapse: Physiotherapists can help strengthen pelvic floor muscles and help to restore proper function
• Postpartum: Physiotherapists can prescribe specific exercises to help strengthen pelvic floor muscles that have been weakened or stretched during the birthing process
• Constipation: Physiotherapy can perform an internal exam of the pelvic floor muscles, and use hands-on manual therapies and abdominal massage to increase transit
• Urinary Incontinence (after prostatectomy): Physiotherapy can prescribe exercises before and after surgery to help strengthen pelvic floor muscles, and can use electrical stimulation to strengthen these muscles to reduce recovery time and improve outcomes
• Endometriosis: Physiotherapy helps to reduce low back pain, fatigue, painful intercoursem and can help with ease of bowel movements
• Pain with Exercise or Sex: Physiotherapists can prescribe exercises to help strengthen pelvic floor muscles and can provide instruction on how to control these muscles to decrease pain

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Students from the School of Physiotherapy created posters on this topic in partnership with the Saskatchewan Physiotherapy Association. Click on the following links to view the posters.

Pelvic Organ Prolapse 1, Pelvic Organ Prolapse 2, Postpartum 1, Postpartum 2, Diastasis Recti, Urinary Incontinence 1 (Men), Urinary Incontinence 2, Pelvic Floor Pain, Constipation, Endometriosis, Dyspareunia