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FAQ's

Frequently Asked Questions about Pelvic Floor Disorders- please see answers below

 

Q1.What is the pelvic floor?

Q2. Are pelvic floor problems always linked to weakness?

Q3. Who has pelvic floor problems?

Q4. What are pelvic floor disorders?

Q5. What are pelvic floor symptoms?

Q6. Are pelvic floor disorders a normal part of aging?

Q7. What causes pelvic floor disorders?

Q8. Who treats pelvic floor disorders?

Q9. When should I seek help for pelvic floor disorders?

Q10. What role do pelvic floor muscles play in bowel problems?

Q11. What is pelvic floor dysfunction, and what are the symptoms?

Q12. How is pelvic floor dysfunction treated?

Q13. How can Women’s Health Physiotherapy help my pelvic floor?

Q14. How can Women’s Health Physiotherapy help me postnataly?

Q15. What can I expect at my first Women’s Health Physiotherapy appointment?

Q16. Why do we do an internal examination?

 

Q1. What is the pelvic floor?

A. In women, the pelvic floor is the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum and help these pelvic organs function.

In men, the pelvic floor includes the muscles, tissues and nerves that support the bladder, rectum and other pelvic organs.

The pelvic floor is a complex structure made up of a group of muscles that support the pelvic organs and form the the birth canal and passages for urine and stool. The pelvic floor muscles are often described as a hammock lifting and supporting the pelvic organs above. These muscles need to be able to contract to keep us continent, but also they must relax to allow for urination, bowel movements, child birth and sexual intercourse. Problems with the pelvic floor can occur when these muscles are too weak (hypotonic) or too tight (hypertonic). It is also possible for these muscles to combine a pattern of too much tension in some areas while too relaxed in others!

Q2. Are pelvic floor problems always linked to weakness?

A. no

When the pelvic floor muscles are high-tone (Hypertonic) they can cause urinary frequency, urgency, hesitancy or incomplete emptying and painful urination as the muscles are unable to relax fully to allow the passage of urine down the urethra. You may also experience constipation or pain with bowel movements, unexplained pain in your low back, pelvic region or genital area, pain during or after intercourse, orgasm, or sexual stimulation due to the tension in these muscles.

Hypertonic pelvic floor muscles can also contribute to Interstitial Cystitis, Vulvodynia and Pudendal nerve Neuralgia. There are again many reasons for these changes to occur in the pelvic floor muscles but hypertonicity may follow trauma to the pelvic floor/pelvic organs (for example in childbirth), following gynaecological intervention or investigation, unresolved low back or hip pain or following an infection.

When the pelvic floor muscles are already in a state of increased tone you may find it difficult to initiate or hold a pelvic floor contraction and increase the tone any further. In this case it is important to relax the pelvic floor muscles fully and treat the tension before any underlying weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed.

Q3. Who has pelvic floor problems

A. For many people, particularly women, the pelvic floor does not work as well as it should. Almost one-quarter of women face pelvic floor disorders, according to a study funded by the National Institutes of Health. The study found that pelvic floor disorders affect about 10 percent of women ages 20 to 39, 27 percent of women ages 40 to 59, 37 percent of women ages 60 to 79 and nearly half of women age 80 or older.

Q4. What are pelvic floor disorders?

A. Pelvic floor disorders occur when the muscles and ligaments that support the pelvic organs become weak or damaged. The three main types of pelvic floor disorders are:

  • Urinary incontinence, or lack of bladder control
  • Faecal incontinence, or lack of bowel control
  • Pelvic organ prolapse, a condition in which the uterus, bladder and bowel may "drop" onto the vagina and cause a bulge through the vaginal canal

Q5. What are pelvic floor symptoms?

A. People with pelvic floor disorders may experience:

  • Urinary problems, such as an urgent need to urinate, painful urination or incomplete emptying of their bladder
  • Constipation, straining or pain during bowel movements
  • Pain or pressure in the vagina or rectum
  • A heavy feeling in the pelvis or a bulge in the vagina or rectum
  • Painful sex
  • Muscle spasms in the pelvis

Q6. Are pelvic floor disorders a normal part of aging?

A. While pelvic floor disorders become more common as women get older, they are not a normal or acceptable part of aging. These problems can have a significant impact on a person’s quality of life. Fortunately, these disorders may often can be improved with conservative treatments such as physiotherapy.

Q7. What causes pelvic floor disorders?

A. There are a number of factors linked to pelvic floor disorders

Childbirth is linked and a woman’s risk tends to increase the more times she has given birth.

Women who are overweight or obese also have a greater risk for pelvic floor disorders.

Having pelvic surgery or radiation treatments also can cause these disorders. For example, these treatments can damage nerves and other tissues in the pelvic floor.

Other factors that can increase the risk include repeated heavy lifting or prolonged standing, the menopause and our inherited genetic makeup.

Q8. Who treats pelvic floor disorders?

A. A variety of experts can treat these problems, and often, a combination of experts provides the best outcome for patients.

  • Urogynaecologists, who are obstetrician/gynaecologists who specialize in the care of women with pelvic floor disorders
  • Urologists, who specialize in the treatment of urinary disorders in women and men
  • Colorectal surgeons, who provide surgical treatment of the digestive system
  • Gastroenterologists, who treat the digestive system
  • Plastic and reconstructive surgeons, who use advanced reconstructive techniques to rebuild damaged tissues in the pelvis
  • Specialist Physiotherapists, who can help women and men with bespoke lifestyle advice and exercises to improve their symptoms
  • Radiologists, who perform advanced studies to determine the cause of pelvic floor disorders
  • Nurses, who are specialist in continence

Q9. When should I seek help for pelvic floor disorders?

A. Many people don’t feel comfortable talking about personal symptoms liked with pelvic floor disorders such as incontinence. But these are actually very common medical problems that can be treated successfully. Millions of people have the same issues, but many don’t seek treatment and compromise their quality of life.

If you have a pelvic health issue, don’t hesitate to discuss it with your doctor to learn more about your treatment options.

Q10. What role do pelvic floor muscles play in bowel problems?

A. The pelvic floor muscles play an important role in the process of having a bowel movement. The muscles of the pelvis must relax and contract in a coordinated way to eliminate stool.

However, some people cannot control these muscle movements and need to strain or assume different positions to achieve a bowel movement.

Q11. What is pelvic floor dysfunction, and what are the symptoms?

A.  Pelvic floor dysfunction is when you are unable to control the pelvic floor muscles in a coordinated way and may affect women and men. The symptoms include:

  • Constipation, straining and pain with bowel movements
  • Unexplained pain in the lower back, pelvis, genitals or rectum
  • Pelvic muscle spasms
  • A frequent need to urinate
  • Painful intercourse for women

Experts do not know for sure what causes pelvic floor dysfunction. However, people who have it tend to contract their pelvic floor muscles rather than relax them

Q12. How is pelvic floor dysfunction treated?

A. Treatment can have a dramatic effect on pelvic floor dysfunction. For most people, this usually involves:

  • Behavior changes, such as avoiding pushing or straining when urinating and having a bowel movement. This also might include learning how to relax the muscles in the pelvic floor area. For example, warm baths and yoga can help relax these muscles.
  • Medicines, such as low doses of muscle relaxants like diazepam
  • Physiotherapy and biofeedback, which can help you learn how to relax and coordinate the movement of your pelvic floor muscles

Q13. How can Women’s Health Physiotherapy help my pelvic floor?

A. A structured exercise program to rehabilitate the pelvic floor muscles is effective in reversing the symptoms in 80% of women.

Following an assessment treatments for the symptoms of weak pelvic floor muscles include:

  • Pelvic floor re-training and exercises
  • Provision of pelvic floor educators/muscle stimulators to improve your activation and power of your pelvic floor contraction
  • Pilates based pelvic stability exercises to strengthen the abdominal muscles which play a supporting role in the strength of the pelvic floor

Following an assessment treatment for the symptoms of hypertonic pelvic floor may include:

  • Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myofascial stretches, scar massage,
  • neural mobilisations
  • Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor
  • Relaxation and breathing techniques
  • Advice on toileting and positional modifications
  • Provision of pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles
  • As and when suitable pelvic floor muscle strengthening can begin

Q14. How can Women’s Health Physiotherapy help me postnatally?

A. The immediate weeks after the birth of your baby is an important time for your body. Your body undergoes many changes during pregnancy and continues to change post-natally. It is important to address any issues that occur at this time so as to prevent problems later in life. Childbirth can lead to pelvic floor trauma, perineal tears and pudendal nerve injury (the nerve which supplies your bladder and pelvic floor). Consequently the pelvic floor can become dysfunctional and you may experience urinary or bowel urgency and/or incontinence, urinary frequency, incomplete emptying, pain on urination/defeacation and pain or discomfort with sexual intercourse.

A pelvic floor assessment is important to establish the cause of these symptoms.

A Women’s Health Physiotherapist can assess you from 6-8 weeks post-natally.

Following your assessment appropriate treatment can be provided which may include:

  • Pelvic floor re-training and exercises
  • Provision of pelvic floor educators/muscle stimulators to improve your activation and power of your pelvic floor contraction
  • Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myo-fascial stretches, scar massage, neural mobilisations.
  • Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor
  • Relaxation and breathing techniques
  • Advice on toileting and positional modifications
  • Provision of pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles
  • Provision of vaginal dilators, pelvic floor educators or muscle stimulators to assist in the release and relaxation of pelvic muscles
  • Assessment and treatment of any unresolved low back, hip or pelvic pain

A Women’s Health Physiotherapist can also help with advice on return to exercise and healing of separated abdominal muscles (Diastasis Recti). Diastasis Recti often occurs in the third trimester of pregnancy when the abdominal muscles are at their greatest stretch. The linea alba normally joins the left and right hand rectus abdominal muscles. When the linea alba is overstretched a separation can occur between the left and right sides. Diastasis recti may make it harder for you to regain your tummy tone and return to your normal exercise routine. It is important to have an assessment to determine if your muscles are stretched; “Divarification Recti” or separated “Diastasis Recti” as this will determine which exercises are suitable for you. An assessment can be carried out from 6 weeks if you had a vaginal delivery or 8 weeks if you had a C-section.

Q15. What can I expect at my first Women’s Health Physiotherapy appointment?

A. Your assessment and treatment will depend upon your presenting condition. We will start with taking a confidential and detailed history. Whilst these sensitive issues are often difficult to discuss, understanding the onset of your symptoms and how your daily life is affected is vital in directing your treatment. Following this assessment you may be offered an internal examination. This is an important part of your examination and necessary in identifying the tone, strength and control of your pelvic floor muscles. Using finger palpation the pelvic floor muscles and connective tissue will be assessed for injury or scarring, signs of pelvic organ prolapse, muscle tone, tenderness, sensation and neural sensitivity. Following this the pelvic floor muscle will be tested for strength and endurance. It is important to determine if the left and right, superficial and deep pelvic floor muscles are working together, and if not why not. Once we establish your baseline of pelvic floor muscle control we can then develop a specific and individualised exercise programme. The assessment findings will be discussed with you and treatment will depend upon findings and your symptoms.

Q 16.Why Do We Do an Internal Examination?

A. Our pelvic floor muscles do their job silently, assisting bowel function, bladder function, and sexual function.  They also contribute significantly to our core strength which allows our low back to function without difficulty.  However this important muscle group is often neglected.

The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bones and sacrum.  They are like a hammock or sling, and they support the bladder, uterus, prostate and rectum.  They also wrap around your urethra, rectum, and in women the muscles wrap around the vagina.

In the 1940’s a gynaecologist, Dr. Arnold Kegel, first described how to strengthen pelvic floor muscles.  As the pelvic floor muscles are internal, we cannot see them because they are hidden inside the pelvis. Therefore to assess them properly, an internal examination is essential.

Assessing the pelvic floor without doing an internal examination is like doing a knee examination through a duvet.

In Europe, internal examination of the pelvic floor has been the gold standard by which treatment of the pelvic floor has been carried out for more than 30 years.  When the pelvic floor muscles are assessed this way, the research has shown that the treatments carried out by a specialist physiotherapist for pelvic floor problems are very successful and should be the first line treatment for both pelvic pain and incontinence.  (Refer to research section)

The physiotherapist who carries out this work is a highly trained, sensitive professional who will discuss your issues with you thoroughly before carrying out any assessment or treatment interventions.  Internal palpation is an integral part of treating the pelvic floor and is the gold standard.  

Before a doctor or any other health professional examines or treats you, they need your consent. If you later change your mind, you’re entitled to withdraw consent-even after a signed consent.

 

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