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Physiotherapy for Problematic Pelvic Floor

I recently attended a further education course which focussed on the pelvic floor area of the body. It was an exciting and comprehensive course, with lots of focus on current evidence, exercise and patient education.

The course was taught by chartered physiotherapist Michelle Lyons, who specialises in integrative women's health. Her clinical toolbox includes over two decades in pelvic health physiotherapy, yoga, Pilates, nutrition, health coaching and mindfulness as a therapeutic intervention. She teaches nationally, internationally and online and is on the faculty of Herman & Wallace, the Pelvic Rehab Institute.

LADIESThe pelvic floor comprises of a complex arrangement of muscles, ligaments and connective tissue, which act as a sling within the pelvis. It supports our bladder, intestines and uterus (in women). It also provides stability to the low back and pelvic joints. It performs many essential jobs which we take for granted when the pelvic floor is working correctly.

The commons problems which arise when the pelvic floor not working correctly are:

  • Incontinence
  • Bowel dysfunction
  • Pelvic organ prolapse

Did you know that roughly 1 in 3 women will suffer from pelvic floor problems at some stage of their lives?

Incontinence

Incontinence in women is common and can be urge, stress or mixed type. Urge incontinence is a sudden and strong sensation to urinate. The bladder then contracts too early, usually when it is not full, resulting in many extra trips to the bathroom. Stress incontinence is a small leaking of urine when carrying out activities that increase the pressure within our abdomen, which pushes down on our pelvis. Stress incontinence can occur with exercising, jumping, coughing, lifting and laughing. Mixed involves a combination of the two urge and stress incontinence.

A recent study showed that almost 50% of women between the ages of 18-83 experienced stress urinary incontinence while exercising. This can massively impact women's participation in sport and exercise, as well as affecting their social life. While it is not an uncommon issue, it should by no means be considered normal.

Pelvic organ prolapse

Pelvic organ prolapse is a movement down and out of the pelvic organs, when the muscles and tissues of the pelvic floor become weakened and don't provide as much support as they should. This allows one or more of the pelvic organs such as the uterus, bladder, or rectum to drop or press into or out of the vagina

Bowel dysfunction

Bowel function plays an essential role in a healthy pelvic floor. Constipation is a common type of bowel dysfunction can also be a considerable driver of further pelvic floor dysfunction, as such the two problems may co-exist.

Treatment

While it is essential to contract our pelvic floor muscles correctly, it is also sometimes necessary to train them down, i.e. teach them to relax. Stress and anxiety feed into our pelvic floor. Many of us go around holding tension without knowing and without being able to let go or relax fully. This excess tension can cause problems and maybe corrected with specific breathing and muscle control exercises.

There is strong evidence to support the role of physiotherapy when it comes to pelvic floor dysfunction. Learning the correct cues and co-ordination with your breath can help you get your pelvic floor muscle working effectively. The muscles need to work well when needed but not over-work, the key is balance. Once you learn the basics, it's then crucial to progress on more integrated movement-based exercises and to focus on daily function.

Problems relating to the pelvic floor can, with careful and specific assessment and treatment by a trained chartered physiotherapist be very well managed.

If I can be of assistance to you, please call the clinic on 01 -2834303 to book an appointment.

By Katie Farrell BSc Physio, MISCP
Chartered Physiotherapist

References:

Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross-sectional study. Dufour et al, 2018

Stress urinary incontinence is highly prevalent in recreationally active women attending gyms or exercise classes. McKenzie et al, 2016

Pelvic floor muscle motor unit recruitment: Kegels vs specialized movement. Crawford, 2016

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