What is the Pelvic Floor?

The pelvic floor is a group of muscles that sit at the very bottom of your pelvis, usually described as sitting in a hammock type fashion. They span from the coccyx and sacrum in the back to the pelvic bones along the sides, and the pubic bone in the front. These muscles have important functions including:

• holding up all the organs directly above against gravity and intra-abdominal pressure
• controlling the openings of the urethra, rectum, and vagina
• sexual sensation
• stability to the low back, hip and sacroiliac joints

What is Pelvic Floor Dysfunction?

Dysfunction of the pelvic floor occurs for different reasons, however, in all cases, the pelvic muscles are not performing as they should. Generally, the muscles can be HYPOTONIC which is when the muscles are long and weak or HYPERTONIC which is when the muscles are short and tight. The dysfunction in the muscles leads to various conditions.

Common conditions treated include

• Stress Urinary Incontinence: peeing when you cough, laugh, sneeze, lift, exercise, and during transitional movements
• Urge Urinary Incontinence: peeing after a strong uncontrollable need to void
• Pelvic Organ Proplase: protrusion of an organ at or near the opening of the vagina
• Dyparenuia or pain with sex
• Bowel dysfunction: fecal incontinence, constipation, hemorrhoids
• Coccydynia: pain over the coccyx or tailbone
• Endometriosis: tissue outside the uterus causing pelvic pain
• Vaginismus: spasm of the muscles with vaginal penetration
• Vulvodynia: generalized pain over the vulvar region
• Interstitial cystitis or Painful Bladder syndrome
• Dysmenorrhea
• Chronic Pelvic Pain Syndrome
• Unexplained low back, hip, and groin pain
• Pregnancy and post-partum related pain and incontinence (see below)

Prenatal and Postnatal Physiotherapy

Pelvic floor physiotherapy during and after pregnancy is being recognized as a necessary part of raising the standard of care for women. Regardless of your pregnancy journey and delivery, there are many implications for the pelvic floor. Some of the common concerns that can be addressed by a pelvic health physiotherapist include:

• Preparation for labour and delivery
• Pelvic Girdle Pain
• Perineal stretching
• Perineal and caesarean scar mobilizations
• Diastasis recti support (AKA “mummy tummy”)
• Pelvic floor muscle and core re-training after birth
• Exercise during pregnancy and returning to exercise after birth

What can you expect during your sessions?

Our Registered Physiotherapist, Marlene Luis, has specialized training in both orthopedic and pelvic health conditions. As such, a thorough orthopedic and pelvic floor history is conducted followed by the assessment and treatment of the pelvic floor. You can expect the following to be evaluated:

• Muscle tone & specific muscle trigger points
• Strength, endurance and coordination of the pelvic floor
• Diastasis recti
• Spinal, hip, abdominal, and pelvic mobility

The preferred method of assessment is an internal pelvic exam since the proper evaluation of the pelvic floor requires internal palpation in the vagina and or rectum. This is a unique and specialized skill that allows the therapist to confirm muscle function directly. A good example of why an internal exam is important is when we consider the performance of Kegels. It is now well known that these pelvic floor muscle contractions, or Kegels, are oftentimes being performed incorrectly and are usually overdone. Having confirmation by a digital exam allows for the best performance feedback.

Your sessions will give you a better understanding of your current pelvic floor function and how it has practical implications in your everyday demands. An individualized and supervised training plan is best when looking to restore your functional strength and mobility.