Pelvic Health

Pelvic Health Treatments in Kingston

Experienced professional assessment & individual physiotherapy treatment plans

Pelvic Floor Dysfunction – What is it?

Most of us take our pelvic floor muscles very much for granted and are usually unaware of how they are constantly working and regulating important bodily functions. These are the muscles that form a strong supportive sling inside the base of the pelvis, helping to support our internal organs. The pelvic floor muscles have several vital roles that help our bodies operate properly. These functions include:

  • Regulation of the storage and release of urine and feces
  • Contributing to sexual arousal, pleasure, and release
  • Contributing to the quality of our breathing and posture
  • Contributing to the support of our bodies during movement as part of our “core” group of muscles

When pelvic floor muscles are functioning well, most people are completely unaware of these muscles, but just as with other muscles in the body, they can sometimes become dysfunctional and cause us problems. Sadly, unlike other muscle problems, many people will suffer in silence when the pelvic floor starts to have issues.

In Canada, urinary incontinence and/or urgency affects 1 in 4 people with vaginas and 1 in 9 people with male anatomy, and of those, only about 1 in 12 seek out treatment. We have come to accept that people will have incontinence after childbirth or a prostatectomy, and while it is not unusual or anything to be ashamed of, it is important to know that it can be treated!

Incontinence and/or urgency of any kind can have a huge impact on quality of life and the ability to get out into the world, particularly in this COVID-19 impacted world where public washrooms can be difficult or impossible to access. The good news is that pelvic floor physiotherapy can help, and there is strong evidence that supports physiotherapy as the first line of treatment for urinary incontinence and/or urgency.

Pelvic health is a sensitive topic that can be awkward to bring up even with family or friends, never mind a healthcare provider. Even so, it is important to be aware of and talking about these issues, because pelvic floor dysfunction affects a surprising number of us. It can result in so many different health concerns, many of which can cause significant limitations:

  • urinary incontinence
  • urinary urgency (overactive bladder)
  • constipation
  • fecal incontinence
  • pain with penetration (intercourse)
  • pelvic organ prolapse
  • other types of pelvic pain, hip pain, low back pain, and sacroiliac joint pain

How does the pelvic floor work together with the bladder?

overactive bladder urinary incontinence

The pelvic floor is made up of several muscles that attach to the bottom of the pelvis and sacrum and form a strong sling to support the pelvic organs (bladder, uterus, and/or rectum). The muscles wrap around the openings of the urethra, vagina, and rectum to help maintain urinary and fecal continence. The wall of the bladder also contains a large muscle, called the detrusor muscle.

The pelvic floor and the detrusor work together to control storage and release of urine. When the pelvic floor is contracted, the detrusor is relaxed, allowing the bladder to fill; when the pelvic floor relaxes, the detrusor contracts to empty the bladder. When the relationship between the pelvic floor muscles and the detrusor gets interrupted by injury, weakness, or surgery, it can result in incontinence and/or sensations of urgency to void.

The most common pelvic floor issues are related to bladder function. Urinary Incontinence is the involuntary loss of urine. It is estimated that 1 in 4 people with vaginas and 1 in 9 people with prostates experience incontinence. Urinary incontinence can be one of three types:

    Stress Urinary Incontinence
  • The loss of urine due to an increase in abdominal pressure such as coughing, sneezing, laughing, lifting, or exercise

  • Urge Urinary incontinence
  • The loss of urine associated with a strong, uncontrollable urge to urinate

  • Mixed Urinary Incontinence
  • A combination of Stress Urinary Incontinence AND Urge Urinary Incontinence

Stress Urinary Incontinence is often the result of weak pelvic floor muscles. When we cough or sneeze it causes a downward pressure on the bladder. Normally, the urethral sphincters – muscles around the tube leading from the bladder to outside the body – squeeze the urethra closed with the help of the pelvic floor muscles; however, if the pelvic floor muscles are too weak to withstand the pressure from the abdomen, it results in the involuntary loss of urine when intraabdominal pressure is increased.

Urinary Urgency can occur with or without incontinence but still have a big impact on quality of life. Urgency can manifest in a couple of ways:

    Overactive Bladder
  • Balance testing

  • Nocturia
  • Waking up more than once per night to urinate – can contribute to an increased risk of falls
    • While some medications or chronic conditions can be the main cause nocturia, pelvic floor dysfunction can contribute, and/or a pelvic health physiotherapist may be able to provide you with some tips on how to minimize the number of times you need to wake up

A complete evaluation could take place over a few visits, depending on the status of the individual and severity of symptoms. If there is a baseline evaluation (often done pre-season with athletes) available, post-injury findings will be compared with the baseline results. If no baseline testing has been done, the healthcare professional will use the post-injury results as a starting point. Individualized management strategies and treatment will be determined based on findings.

Urgency, with or without incontinence, is often the result of an overactive detrusor (bladder) muscle, and pelvic floor muscles that are weak, overactive, or both – that is, unable to fully contract or relax. As the bladder fills with urine from the kidneys, the detrusor muscle begins to stretch. This stretch signals to the muscle that it will need to contract soon to empty the bladder.

Normally, the detrusor muscle will ignore the initial stretch and remain relaxed until the bladder is full. However, with an overactive bladder, the detrusor muscle tends to contract as soon as it feels any stretch, long before the bladder is full. This results in a sudden urge to use the toilet and may cause the involuntary loss of urine if the pelvic floor muscles are also weak.

Pelvic Organ Prolapse can occur when the tissues and muscles of the pelvic floor no longer support the pelvic organs fully. When this happens the bladder, uterus, or rectum can sink down into the vaginal opening. Generally, this is not a cause for concern unless it begins to cause difficulty with urination or defecation. Pelvic organ prolapse symptoms include:

  • a feeling of heaviness around your lower tummy and genitals.
  • a dragging discomfort inside your vagina.
  • feeling like there's something coming down into your vagina – it may feel like sitting on a small ball.
  • feeling or seeing a bulge or lump in or coming out of your vagina.

Who is affected by Pelvic Floor Dysfunction?

Pelvic Floor Dysfunction can affect anyone, from young to old; from athletes to couch potatoes; from people who have had children to those who haven’t; and from women to men to anyone in between. Chances are good that you or someone you know is already dealing with problems in this area.

Risk Factors

  • Pregnancy
  • Vaginal Delivery
  • Childbirth trauma (forceps, suction, tearing)
  • Post-menopausal (hormone changes)
  • Gynecological or urinary surgery
  • Prostatectomy
  • Obesity
  • Chronic illness
  • Smoking
  • Chronic straining (constipation)
  • Chronic cough

Common Misconceptions

  •  Not much can be done about incontinence/urgency
  •  Pelvic organ prolapse can only be managed with surgery
  •  Kegels are the only exercise for the pelvic floor
  •  Getting up to pee at night is just part of getting older

The Truth

  •  Regardless of the cause, incontinence symptoms can frequently be improved
  •  Depending on the grade of pelvic organ prolapse, there are ways to manage prolapse symptoms without surgery
  •  Kegels are not always indicated
  •  Getting up more than once at night to pee is not a normal part of ageing
  •  Pelvic floor physiotherapy is for everyone
  •  Pelvic Floor Physiotherapy can help!

How can Physiotherapy help with Pelvic Floor Dysfunction?

Pelvic floor physiotherapists have additional post-graduate training in the assessment and treatment of pelvic floor dysfunctions. Pelvic floor physiotherapy is 80% effective in treating urinary incontinence and should be the first line of defense, before surgical consultation.

During the initial assessment, the physiotherapist will ask about your bladder and bowel symptoms, past medical history and surgical or gynecological history. This is followed by an external and internal vaginal and/or rectal assessment to determine the tone and strength of the pelvic floor musculature and assess for areas of tension and pain. However, if you choose not to do an internal exam, the physiotherapist can still work with you on ways to resolve your symptoms.

An individualized treatment plan will then be devised to address any assessment findings and your goals. Subsequent appointments will involve some internal and some external treatments, depending on the cause of your symptoms.

Pelvic health physiotherapy generally involves an internal vaginal and/or rectal examination to assess the specific muscles that are contributing to your symptoms.  This is of course, completely dependent on your comfort level and consent.  At your first appointment, a Pelvic Floor Physiotherapist will go review your medical history and symptoms with you.  Based on that, the therapist will do an examination of relevant body parts – perhaps your back or your hips – and then proceed with an internal examination if appropriate.  The therapist will explain the reasons for the exam, what the process is like, and what you can expect from the assessment. The internal assessment can also be completed at your second appointment if you would like a chance to digest the information and come prepared.  If you decide not to go through with an internal assessment, there are still many other ways that you and the therapist can work together to improve your symptoms.

At Best Health Physiotherapy, Kathryn McGuire PT Resident provides Pelvic Floor Physiotherapy assessment and treatment. Currently, Kathryn’s training is geared most specifically to treating symptoms of urinary incontinence and urgency. She is also comfortable working with patients who are struggling with constipation, hemorrhoids, and/or other bowel issues that could benefit from pelvic floor physiotherapy. If you are struggling with any of the above issues, contact us and speak with our staff about setting up an appointment.

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