In this article we’ll cover the basics of the pelvic floor, what a pelvic physiotherapist does, the conditions we can treat, and answer some frequently asked questions about what to expect at an appointment.
What is the pelvic floor?
The pelvic floor is a group of muscles that sits underneath the pelvis. In women there are 3 holes which pass through it:
- Urethra (where you pee from)
- Vagina
- Anus (where you poo from)
When the pelvic floor contracts, it applies pressure to these passages and this is what keeps us continent; that is, prevents us from leaking pee or poo. When the pelvic floor relaxes, it allows the opening of these passages so we can evacuate our bladder and bowels smoothly. The pelvic floor also works with the diaphragm, abdominals and back muscles to provide stability around the torso.
Why the need for pelvic physio?
Did you know that 1 in 3 women will experience incontinence (leaking pee) in their lifetimes? And this is just one of many conditions affecting the pelvic floor. When we look at pregnancy and childbirth, a large proportion of women will experience things like pelvic floor weakness, pelvic pain, incontinence and tissue damage after childbirth. There are also changes associated with menopause that can make these conditions more widespread in women over 40.
Pelvic floor dysfunction is incredibly common, but there if often a lot of embarrassment in talking about it. Many of us simply choose to live with it, but the good news is that you don’t have to! There is so much that can be done for the pelvic floor – number one being pelvic physio.
What is pelvic physiotherapy and what to expect ?
Pelvic physio is a fast-growing field in the realm of rehabilitative health. It’s exactly what its name suggests – physiotherapy for conditions associated with pelvic floor. Much like you’d see a physiotherapist for a muscle tear or sporting injury and go through treatment and rehabilitation, a pelvic physiotherapists uses similar methods to treat the pelvic floor.
Your therapist will have a look at and assess the muscles of the pelvic floor by doing a digital vaginal exam (DVE) and/or a digital rectal exam (DRE), and will then create a treatment/rehab program for you. The assessment is generally a lot more gentle than with a gynaecological exam or pap smear, and most women don’t experience much discomfort. A DVE/DRE is not always done at your first appointment and sometimes not even done at all. You have the final say in what you’re comfortable with. You’ll find a bit more info here on internal examinations.
Your therapist may ask you to complete a bladder/bowel diary to assist in creating a bladder/bowel retraining program for you if you experience any incontinence, urgency or constipation. They may also assess your back, pelvic, abdominal and hip areas to explore anything else that may be contributing to your symptoms.
What conditions can pelvic physio assist with?
Pelvic physiotherapy can make a massive difference for any of the following:
- Stress incontinence (leaking pee with increased abdominal pressure)
- Urge incontinence (a very strong urge to urinate accompanied by leaking)
- Urinary urgency (a very strong urge to urinate which you battle to control)
- Anal incontinence (leaking stool or gas)
- Constipation/obstructed defaecation
- Overactive bladder (increased urinary frequency)
- Pelvic prolapse
- Pelvic pain e.g. vulvodynia, vaginismus, coccydynia, pan during dex, endometriosis, irritable bowel syndrome, bladder pain syndrome etc.
- Pregnancy-related pelvic girdle or back pain
- Abdominal separation (diastasis recti)
- Postpartum spinal, hip, upper limb or lower limb pain
Belly Strong is currently only treating patients with stress incontinence, urge incontinence, urinary urgency/overactive bladder, constipation, anal incontinence, pelvic pain conditions, pregnancy-related pelvic girdle or back pain, diastasis recti and postpartum joint pains.
How do I find a pelvic physio?
You can book an assessment using our Calendar or email info@bellystrong.com for more information.
Frequently Asked Questions
1. Do I have to have an internal vaginal/rectal assessment?
The short answer is no. You get the final say as to what you are comfortable with. However, physically assessing the pelvic floor will provide much more information about what could be causing your symptoms, and enable treatment to be a lot more specific. If you have any reservations, please chat to your therapist.
2. Will it hurt?
As mentioned before, pelvic floor assessments are usually a lot more gentle than a standard gynaecological exam, so most women experience no (or very little) discomfort. You are also free to stop the exam at any time should you feel uncomfortable, without any need to offer an explanation to your therapist.
3. Can I still be examined while on my period?
Yes, you can. Your therapist will still be able to assess your pelvic floor during your period. However, if you are having a particularly heavy flow or are uncomfortable being assessed while menstruating, let your physio know. You should be able to postpone the internal examination, or your therapist might focus on other aspects of your assessment.
4. Can I see a pelvic physio if I’m pregnant?
Yes! There is plenty that a physio can do during pregnancy for things like pelvic girdle pain, back pain and incontinence to name but a few. Internal vaginal exams are usually only done after 20 weeks of pregnancy, and only if you have a low-risk pregnancy and have been cleared by a doctor. Your therapist will still be able to do a visual assessment of your pelvic floor if an internal one is contraindicated. Once you’ve given birth, this may be a good time to proceed with a vaginal exam.
5. How many sessions will I need?
This will vary depending on how responsive your symptoms are to rehab. Some women may need 2-3, while other might require 6-10. Problems typically develop over a period of time. Likewise, recovery also needs to be given the time it needs to take place. At Belly Strong we try to avoid unnecessary appointments and only book you in for what you really need. On average, most women need 4-6 sessions to fully explore assessment and treatment.
6. Can I have a pelvic assessment after I’ve given birth?
Most definitely, but usually we need to wait until your 6-week GP check-up to do any internal vaginal assessments.
7. What happens after a session?
After your therapist has reached a working diagnosis for your symptoms, they will usually give you exercises to do at home. This is the most important part. Problems usually occur over time, and it takes consistent rehab (normally something daily) to work towards a place where you start to recover. In our experience, this makes the most difference. Your therapist can and will do things with you in clinic, but it’s what you do outside of your appointments that results in long-term change and prevents conditions from coming back.
8. Can I have a chaperone?
A chaperone is another person who observes an examination done by a therapist, for both patient and therapist accountability. They are usually trained specifically for the role. Unfortunately Belly Strong does not currently offer chaperones.
9. What kind of appointment should I book?
If this is your first appointment with Belly Strong, you will need to book a 45-min initial consult. Follow-up appointments are generally 30min unless your therapist advises that you need a longer session. If you are an existing client with a NEW issue, or it’s been more than 3 months since your last appointment, you will need to book a 45-min initial consult.
Add Comment