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Pelvic floor physiotherapy is a form of specialized physical therapy designed to strengthen the pelvic muscles located between the hip bones and the sacrum or release tension in the pelvic floor. Strengthening the pelvic floor helps support organs such as the bladder, colon, and uterus. Easing tension in the pelvic floor can alleviate pelvic pain and chronic constipation. 

When is Pelvic Floor Therapy Recommended? 

People with any pelvic floor dysfunction will benefit from the treatment. Pelvic floor dysfunction means that the pelvic muscles are either too tight or too weak. 

Tight Pelvic Floor Muscles (Hypertonicity) 

Tight pelvic muscles can cause chronic pain in the pelvis, lower back, and abdomen. 

People with tight pelvic muscles tend to experience frequent, urgent, and often painful urination. A tight pelvic floor can lead to nocturia, which causes people to wake up frequently during the night to urinate. Tight pelvic floor muscles can also cause constipation and painful bowel movements. 

Sexual dysfunction is common in people with tight pelvic floors. Women may experience pain during penetration, painful orgasms, or be outright unable to have vaginal intercourse. 

Men with tight pelvic floors may experience erectile dysfunction, painful erections, and premature ejaculation. 

Weak Pelvic Floor Muscles (Hypotonicity) 

People with weak pelvic floor muscles may experience incontinence during or after physical activity. The condition is known as stress incontinence and can lead to involuntary leaking during sports or while coughing or sneezing. 

A weak pelvic floor can also cause pelvic prolapse, where the pelvic organs slide out of position. Pelvic prolapse may cause bulging at the vaginal or rectal opening. 

Weak pelvic muscles are common in women who have recently given birth. Many see weak pelvic floors as a mere fact of giving birth, but the condition is easily remedied with pelvic floor therapy. 

People who have undergone prostate surgery can experience urinary incontinence due to weakened pelvic muscles, known as post-prostatectomy incontinence. 

How Does Pelvic Floor Physiotherapy Work? 

Pelvic floor physiotherapy is tailored to each client’s unique needs. Before pelvic floor therapy, the physiotherapist examines the skin, fascia, and muscles in the lower back, abdomen, and thighs. They will also look at posture, flexibility, and general strength to assess the root of the problem. 

Occasionally, an internal assessment is included, during which a doctor will conduct a digital vaginal or rectal exam. While not necessary, internal examinations can shed light on the nature of a person’s pelvic disorder. 

After the assessment, the physiotherapist will recommend a personalized treatment plan with exercises to help remedy the relevant pelvic disorder. If you have a weak pelvic floor, your physiotherapist may recommend Kegel exercises, which involve tensing and releasing your pelvic muscles to build strength. 

Beyond Kegels, pelvic floor therapy for weak muscles requires strengthening the entire core, which comprises the abdomen, lower back, pelvic floor, and diaphragm. Your physiotherapist may recommend core exercises such as modified planks or arm and leg lifts to help strengthen the pelvic floor and surrounding muscles. 

Patients with tight pelvic muscles will benefit more from relaxation and stretching exercises. If you have a tight pelvic floor, your therapist may recommend diaphragmatic breathing exercises to help relax the pelvic muscles. They will likely recommend yoga stretches such as the happy baby pose or child’s pose to ease tension in the pelvis. 

Most patients notice a difference in pelvic floor function after 5 to 7 physiotherapy sessions.  

Who is a Good Candidate for Pelvic Floor Therapy? 

Some groups are more prone to pelvic floor disorders, but anyone can benefit from pelvic floor physiotherapy.  

Contrary to popular belief, pelvic disorders are not a normal part of aging and can be remedied at any stage of life. 

The following groups may benefit from pelvic floor physiotherapy: 

  • Prenatal and postpartum women. Bodies change significantly during pregnancy. Women often experience pain in the lower back, pelvis, and hips while pregnant. After giving birth, women may experience urinary incontinence due to a weakened pelvic floor. 
  • Post-menopause. Estrogen plays a crucial role in maintaining pelvic function. During menopause, women experience a drop in estrogen production, leading to potential incontinence, pelvic pain, and nocturia. 
  • Post-surgery. Abdominal and pelvic surgeries often lead to pelvic floor issues due to catheterization. Pelvic floor therapy can help minimize pain and increase mobility after surgery. 
  • Men. Men experience pelvic floor dysfunction due to chronic pain, prostatitis, and after prostatectomy surgery. Men may experience slow or weak urination and erectile dysfunction, which can be treated with pelvic floor exercises. 

Pelvic floor therapy may also help relieve the symptoms of endometriosis and vaginismus. 

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