Physiotherapy is often associated with the treatment of athletes. Although this statement is true, the scope of physiotherapy is much broader and there are many areas of specialization which remain unrecognized. This article aims to highlight one of these lesser-known approaches being perineal, or otherwise known as, pelvic floor rehabilitation. We will specifically talk about how perineal rehabilitation helps relieve stress incontinence, organ descent, pelvic pain and more.

Who Benefits from Perineal Rehabilitation?

Women and men suffering from any of the following symptoms can benefit from perineal rehabiliations:

  • Stress Incontinence– inability to control the loss of urine with coughing, sneezing, laughing or exercise
  • Urge incontinence–loss of urine associated with a strong, uncontrollable need to void (i.e. leaking while running to bathroom )
  • Frequency– needing to urinate so often that your everyday routine is disrupted
  • Diastasis recti – a gap between your abdominal muscles, commonly occurs after child birth
  • Pain – during or after intercourse

What is Perineal Rehabilitation ?

Perineal rehabilitation focuses on pelvic pain and problems such as urinary incontinence.  It helps with the discomfort associated with organ descent and more. Research shows that pelvic floor muscle retraining is the first line of treatment for urinary incontinence.

Perineal rehabilitation may consist of strengthening the muscles of the pelvic floor (perineum) as strong perineal muscles can improve the pelvic health, prevent leakage of urine and decrease potential problems. However it is important to recognize that these problems are not always about improving strength.  Pelvic distress can be a result of too much muscle tension.

When muscles are tight and/or painful you may need to increase the elasticity of the fibers before strengthening them.  In this case doing the oft prescribed Kegel exercises can cause more weakness and/or pain.  Perineal treatment and specific exercises aim to increase the elasticity of the tissues and your ability to contract as well as relax the pelvic floor muscles.

Kegels are not for everyone!

Stress Incontinence

Statistics show that  3.3 million Canadians experience urinary incontinence. That’s 1 in 3 women and 1 in 9 men, and that only 1 in 12 discuss this with their health care professionals.

Stress urinary incontinence can affect up to 77% of women in the postnatal period. Studies show that nine out of ten women with stress urinary incontinence three months after childbirth WILL continue to suffer five years later.

However, on the upside, the same study shows that  pelvic floor muscle retraining is the first line of treatment for urinary incontinence. As a matter of fact, in Britain, it is standard for women to undergo pelvic floor muscle retraining before any perineal surgical procedure  is considered.

Common Misconceptions:  

Often these problems are accepted as there are many common misconceptions around urinary incontinence.

–> it is a misconception to think that it is normal to have urinary leakage after childbirth

–> it is a misconception to think that it is normal to have urinary leakage as you age

–> it is a misconception to think that there is nothing you can do about urinary leakage

Causes of Urinary Incontinence (UI):

  • Pelvic floor damage or nerve damage during pregnancy and labour
  • Surgical procedure such as a hysterectomy
  • Overweight / High body-mass
  • Muscle weakness
  • * A variety of other factors also appear to play a role, such as diabetes and smoking.

Pregnancy and childbirth are the primary causes of impairment of the pelvic floor muscles and resulting in urine or gas leakage, organ descent, decreased sexual satisfaction and low back pain.

Function of the Pelvic Floor:

  • Ensures the continence of urine and stool
  • Supports our pelvic organs (bladder, uterus and rectum)
  • Helps with sexual function (clitoral orgasm and erection)
  • Participates in improving the lumbar support, in conjunction with the abdominals

What to Expect in Your Pelvic Assessment?

Prior to you initial assessment, you will complete a detailed questionnaire regarding your pelvic health. Your physiotherapist will review this form with you during your evaluation.  Further information will be asked regarding your medical history and any information that will help her better understand the reason for your visit.

The physical assessment will include both an external and internal evaluation to assess the strength, function and integrity of your pelvic floor muscles. This complete assessment will help your physiotherapist determine the best plan of action prior to initiating treatment. A full discussion of the examination procedures and treatments will occur prior to proceeding at each step  to ensure your comfort and safety. Once the assessment is complete your program may consistent of direct treatment and/or home exercises to address your specific symptoms, goals and concerns.

If you are among the 11 out of 12 people with incontinence who do not seek help and would like to improve these or other pelvic floor problems please consult our registered physiotherapist Svetlana Marianer at smarianer@orthophysio.com or call 416-925-4687 to book an assessment.