Urinary Incontinence, leakage when you laugh or cough, can’t make it to bathroom in time, bladder retention…if you’re experiencing these symptoms, pelvic floor physiotherapy can help!
Pelvic floor physiotherapy is a specialized branch in physiotherapy which assesses and identifies weakness and dysfunction of pelvic floor muscles and utilizes evidence-based and safe techniques to treat those muscles.
To assess the pelvic floor muscle function, the approach can be external and/or internal. Getting an internal examination can be quite daunting, however it is not always necessary depending on your condition. Here at the Orthopaedic Therapy Clinic, you will have the option to have an external examination first, and then we will discuss performing an internal examination if it is indicated based on your presentation.
In an external examination, we assess tension and function of the muscles around the pelvis and low back to help you get on the journey of reconditioning your pelvic floor muscles.
What is the “pelvic floor”?
Before we get into explaining the incontinence symptoms, let’s talk about the pelvic floor muscles. Pelvic floor muscles are a group of muscles found between the hip bones and sacrum, and they are part of the “core” muscle group.
Their main function is to:
- Support your organs
- Control the openings of urethra, vagina, and rectum maintaining urinary and fecal continence (sphincter)
- Aid orgasm and blood flow during sex
- Provide a venous and lymphatic pump for the pelvic area to move blood and lymphatic fluid through the body
- Provide stability and assist in unloading the spine
As you can see, they’re really a hard-working group of muscles however they usually get overlooked because we take them for granted until problems emerge.
How do pelvic floor muscles contribute to leakage?
The issue contributing to urinary leakage and retention is usually associated with pelvic floor muscles’ sphincter function. During the day, when you take in fluids, your kidneys filter the fluids and send the urine to your bladder. Your bladder stays relaxed until it becomes fuller, to around 200-450 ml (1-2 cups). The bladder wall muscles relax to expand the bladder while your sphincters contract to hold the urine. When you get to the toilet, the bladder wall muscles then contract to force out the urine and your sphincters relax to allow you to go.
When pelvic floor muscles are dysfunctional, this reflex system between your bladder and pelvic floor can be compromised. This lack of coordination is what causes the leakage to happen. At best it can be frustrating, and at it’s worst it can lead to fear of going out in public or participating in social activities.
Is weakness always the issue?
When it comes to incontinence, the issue is not always “weak muscles”. Overactive and underactive muscles can both lead to incontinence and it’s important for your therapy to know which problem you are having.
Understanding begins with knowing which type of incontinence you have. The two most common types of incontinence are stress or urge.
- In stress incontinence, urine leaks when you cough, sneeze, or during any physical activities.
- In urge incontinence, leakage happens when you have a strong urge to go to the bathroom but cannot make it there in time.
Typically, if you experience stress incontinence, the problem is usually associated with underactive pelvic floor muscles, which means they’re too weak to keep the sphincters contracted when intraabdominal pressure increases when coughing, sneezing or during other physical activities. This often guides us to consider exercises to increase strength in theses muscles, i.e. Kegel’s.
If you experience urge incontinence, it usually means that your pelvic floor muscles are too tight (overactive). The bladder wall muscles contract unexpectedly or spasm, causing the leakage before you reach the bathroom. This guides us to consider exercises that relax or stretch the muscles, i.e., inner thigh muscle stretches.
What to expect from an external examination?
When you come to the clinic for an examination, we first start by taking a thorough history of your current symptoms. This is very important in directing our treatment techniques. If we don’t differentiate the muscle activity, and use the wrong treatment techniques, your symptoms could get worse.
During the physical examination, we focus on assessing:
- Posture
- Breathing
- Tension in muscles around your low back and pelvis
- Core strength
Your posture determines how much pressure you put on your pelvic floor muscles and the breathing technique you utilize determines how you coordinate your intraabdominal pressure change.
Also, the tension in surrounding muscles can impact how freely your pelvic floor muscles can move, thus affecting your pelvic function. Finally, being part of the “core” muscle group, connecting and conditioning the core muscles can help restore pelvic floor muscle function.
Once we have identified the source of the problem, we use manual therapy and modalities to treat the targeted muscles. An individualized exercise program will be designed for you to keep working on independently.
When should you have an internal examination?
Many people can improve without an internal examination however there are specific indications that tell us you may benefit from this next step in the process, such as:
- if you have difficulties connecting to the pelvic floor muscles or coordinating movements.
- pelvic pain is also an indication that an internal examination may be helpful.
What can you do to help yourself?
Before you start an assessment in clinic, here are two things you can do to get started on your own.
- Keeping track of your urinary function
It’s important to document the frequency of your leakage. Does it happen every time you need to use the bathroom, or only occasionally? Document how many times a day you need to pee. Five to eight times a day is considered typical. Bring this record in to your appointment as it helps us to understand the pattern of your symptoms.
- Diaphragmatic breathing
Make sure you know how to breath properly. When you take a deep breath in, the diaphragm should rise, and your pelvic floor muscles should relax (as if you’re letting go the flow of urine). And the opposite happens when you exhale. Focusing on this technique will help you work on the timing and coordination of your pelvic muscle recruitment.
Practice this technique in multiple positions. Make sure you can breathe properly lying down, sitting and standing. Start with lying down. It’s easier to do it on your back as it’s the most supported position for your body and your diaphragm is not working against gravity.
Other pelvic floor issues
Other than urinary incontinence, pelvic floor dysfunction can also contribute to the following issues:
- Pelvic organ prolapse
- Erectile dysfunction
- Painful sex
- Constipation
- Nocturia
Pelvic floor physiotherapy can help improve each of these conditions.
What to do if you have pelvic floor issues
If you are experiencing pelvic floor symptoms, or are unsure about the “where do I start”, please contact Tiffany Shi, Registered Physiotherapist at tshi@orthophysio.com, or call The Orthopaedic Therapy Clinic at 416-925-4687 to book an assessment.
