How can Women’s Health Physiotherapy help my pelvic floor?
The pelvic floor muscles are something that are easy to take for granted, as while they are working well, you won’t really notice them. When they aren’t doing their job properly though – as is common following pregnancy – they can lead to a range of unpleasant and uncomfortable symptoms. Pelvic floor issues are not something that are a natural result of ageing but can be caused by trauma to the pelvic region, such as childbirth, infection, gynaecological intervention or investigation.
Your pelvic floor is a complex structure comprised of a series of muscles, ligaments and fascia that help to lift and support your pelvic organs such as bladder, uterus, bowel and form both the birth canal and passages for excretion. These muscles affect continence. They contract to keep us continent, but also need to be able to relax effectively to allow for urination and bowel movements, intercourse and childbirth.
If your pelvic floor muscles are too weak they will be less effective at supporting your pelvic organs, which can lead to urinary or bowel incontinence, as well as prolapse. If the muscles are too tight and unable to relax, you may experience increased urgency or frequency to urinate, but may find doing so difficult or even painful. Other symptoms include constipation, lower back pain, pain in your pelvic or genital region, pain during or after intercourse or lack of orgasm.
In some cases, your pelvic floor muscles can also experience symptoms of both too much, and too little, tension, in different areas.
Pelvic floor muscles assessment
An external and internal assessment to determine the condition of your pelvic floor muscles will be undertaken so that a programme can be developed specifically to tackle the symptoms you are experiencing.
Laycock developed the PERFECT Scheme which is a method of examination of the pelvic floor muscles that looks at:
- Power - Modified Oxford Scale) 0-5
- Endurance - How long can they hold a maximal voluntary contraction (up to 10sec)
- Repetitions - How many maximal voluntary contractions they hold with a rest between them, up to 10 reps (eg 10 repetitions of a 10-second hold)
- Fast- The number of 1 second maximal voluntary contractions they can perform in a row (up to 10)
- Every Contraction Timed - a reminder to time every contraction
Internal vaginal examination will as well assess apart from muscle strength: anatomical changes, the symmetry of a contraction, muscle tone as well as any painful areas.
A structured approach can strengthen your pelvic floor muscles
Depending on yours symptoms, the approach might include:
- Exercises to re-train your pelvic floor
- Muscle stimulation to educate and improve your ability to contract or relax your pelvic floor muscles
- Stability training pelvic exercises to improve abdominal muscle strength
- Exploration and treatment of any low back/pelvic pain issues
- Visceral mobilisation
- Internal and external manual therapy
- Breathing techniques
A pelvic floor examination is nothing to worry or be embarrassed about. You will be asked to try and initiate or hold a pelvic floor contraction, which you may find easy or difficult depending on the condition of your muscles.
- If you are not able to contract your pelvic floor, our therapist will work with you to teach you how to correctly engage those muscles.
- If your muscles are too contracted, we will work to relax them through internal manual therapy techniques including trigger point release, myofascial stretches and massage.
After treating any tension we can then address any underlying weaknesses as tight pelvic floor does not mean strong pelvic floor. When your muscles achieve a more normal resting state, their strength can be reassessed and then strengthening exercises, if needed, will be explained. If you are suffering with issues related to your hips and pelvis, we can release the connective tissues of the abdomen, hips and pelvis which support the pelvic floor and finally, there are a series of breathing and relaxation techniques we can explore to help with stress, tension and anxiety.