Pelvic Floor Physiotherapy

Pelvic Floor Physiotherapy in Richmond Hill

Pelvic Floor is a group of muscles, ligaments and connective tissue, fascia and nerves attached to front, back and sides of the bottom of pelvis and sacrum. Pelvic Floor has a very important role in our body. They work like a sling and provide support to the organs such as bladder, uterus and bowel. They also wrap around rectum, urethra and vagina. Pelvic Floor muscles should be able to contract to maintain continence and be able to relax to let bowel movement and urination happen. Pelvic Floor is important for the stability of spine and proper function of bladder and bowel. Any dysfunction of these ligaments and muscles can cause lower back pain, incontinence, prolapse, pelvic pain and sexual dysfunction.

IT IS NOT NORMAL:

– to leak when you laugh cough or sneeze
– to feel pressure in your pelvic region
– to feel pain with intercourse
– to feel pain in the pelvic area

Does Pelvic Floor Physiotherapy work?

In 2010, the Cochrane Collaboration published a review, Pelvic Floor Muscle Training vs. No Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women, which analyzed the effectiveness of pelvic floor strengthening in stress and urge incontinence.
The Cochrane Collaboration concluded that there is Level I/ Grade A evidence (the strongest level of evidence available) for pelvic floor strengthening for urge and stress incontinence. The Cochrane Collaboration recommended that pelvic floor strengthening should be taught by a physiotherapist using internal assessment and treatment techniques, and this treatment should be the first line of defense for urge and stress incontinence. This means that the research says pelvic floor physiotherapy should happen with all patients who leak before surgery is considered.

What conditions can be treated with Pelvic Floor Physiotherapy?

Pelvic Floor Muscle dysfunction is more common than you think. It is not normal to leak when you laugh or sneeze.
Pelvic floor physiotherapy can help anyone who suffers from any of the following symptoms;

    Diastesis Recti: Diastesis Recti is a separation in abdominal muscles (rectus abdominus) which often happens during pregnancy. You might notice a bulge down the centre of your abdominals when you move or that you can sink your fingers into the space between your abdominal muscles across the middle of your tummy.  Pelvic Health Physiotherapist can teach these clients proper exercises, what to do and what not to do. We use ultrasound to determine a treatment program helping to flatten your tummy.

    Urinary incontinence is not being able to control or involuntary loss of urine. Approximately 25% of adults have urinary incontinence. Women are affected twice as often as men. It is not normal to have incontinence after child birth or with aging.

There are 2 common types of urinary incontinence.

Stress incontinence happens to many people when they cough, sneeze, walk, run or exert themselves. These actions increase the pressure within the abdom. The increased pressure squeezes the bladder. Urine leaks out when the pressure squeezing the bladder is greater the the closure pressure of the sphincters sealing the urethra. Pelvic floor muscle (Kegel) exercises can help stop this leakage. Three quarters of women are doing these exercises incorrectly.

Urge incontinence occurs when there is a sudden need to empty the bladder. This urge is caused by an overactive contraction of the bladder muscle. the problem is compounded with weak pelvic floor muscles.Some things that can cause your bladder to become overactive are: small bladder capacity, nerve damage, caffeine and anxiety. Medications can help the bladder be less active.

We use real time ultrasound to help you learn to contract and strengthen your pelvic floor. we also assist you learn behavioral changes to help you regain control of your bladder.

    Bowel  Incontinence is the involuntary loss of stool or gas. It is not a disease but a sympton of a physical or neurological problem that can be helped with pelvic floor physiotherapy.

    Coccydynia or Tailbone pain is persistent pain at the bottom of spine or tail bone pain. It can be caused by trauma to the coccyx by falling on it, vaginal child birth or prolonged sitting on a hard surface. It can make it difficult to sit, lie flat or go from sitting to standing. We can fully assess and treat both the joint and surrounding muscles and tissue.

    Constipation: Damage of Pelvic Floor muscles and ligaments can cause chronic constipation. Pelvic Health physiotherapy can help by providing education about proper diet, proper toilet habits, positioning and exercises.

    Painful Intercourse is also known as vulvar vestibulodynia.  Vaginal pain is not in your head. It is a common and often misunderstood condition that many women suffer from. the pain can be caused from intercourse, tampon use, riding a bike or even sitting or wearing tight pants.

A study published in the Journal of the American Medical Women’s Association [2003] demonstrated that 16% of the female population experienced vaginal pain at some point in their life. Many women chose not to seek treatment, of those that did, 60% saw 3 or more doctors, many of whom could not diagnose the condition.

It is often misdiagnosed as a yeast infection and the actual cause of the condition is unknown.

Treatment options available include physical therapy, medications, dietary modifications, stress and pain management, counselling and exercise.

    Pelvic Organ Prolapse: normally the pelvic organs are supported and held in place by pelvic Floor muscles. When these muscles are weakened, the pelvic organs- bladder, uterus, rectum and vagina- can drop down. It can cause pain, incontinence, constipation and painful intercourse.Types of Prolapses are Cystocoele which is the most common form of prolapse when bladder protrudes in to vagina. Rectocel is when rectum bulge in to the back of vagina. Uterine prolapse is when uterus bulges in to vagina and Urethrocele which is prolapse of Urethra.

    Pregnancy pre-post partum: Pelvic Health Physiotherapy can help women to prepare for delivery; also it can help to strengthen pelvic floor muscles after delivery.

    Persistent pelvic pain or chronic pelvic pain: Pelvic health physiotherapy can help these patients by providing pain education and help them to understand the neurophysiology of pain. Also, teaching relaxation techniques, providing education about proper sleep and positive thinking.

    Vaginismus or inability to vaginal penetration which is considered as connective tissue dysfunction.

    Vulvodynia is a pain condition can be felt anywhere in the vulva, perineum and vagina. Pain is usually constant and made worse with contact.

Physical therapy treatment has many aspects, ranging from learning how to control both the contraction and relaxation of the muscles surrounding the vagina, desensitizing the painful areas to touch, the use of vaginal inserts and information regarding dietary modifications.

Your first visit

Pelvic Floor physiotherapy is offered at our clinic in Richmond Hill. On the first visit your Pelvic Health physiotherapist Mary Kazem will review your medical history and a list of your current symptoms. Also, she will do external assessment to check spine, sacroiliac joints, hips and pelvis mobility, muscles of lower back, abdominal and gluteals. She will also do an internal examination to assess the function of pelvic floor muscles, possible muscle tightness and adhesion.
After the examination Mary will discussed her findings and treatment plan with you. Treatment may include soft tissue release, strengthening exercises, hands on mobilization, pelvic hygiene education and exercises. In some cases your physiotherapist might use a muscle stimulator to train pelvic floor muscles.
At Premier Care physiotherapy clinic pelvic Floor physiotherapy offered by a highly trained registered pelvic health physiotherapist (Mary Kazem) and it is covered by most of extended health plans.

Mary Kazem PT, MSc, BScPT

Mary has been practicing physiotherapy since 1990. She holds a Bachelor and Master Degree in Physiotherapy.  She has extensive experience in different physiotherapy settings including private practice, hospitals and working with seniors. She has an extensive range of expertise; working in several areas, including; Orthopaedics, Neurology, Rheumatology, Geriatrics and Pelvic Health Physiotherapy. Mary strongly believes that treatment should be evidence based and patient centered. Her treatments consist of manual therapy, exercise prescription and patient education.

Mary is a very dedicated physiotherapist and very passionate toward her work. Mary has special interest in pelvic health physiotherapy and Orthopaedic physiotherapy cases.

Mary enjoys treating common pelvic floor conditions including pelvic organ prolapse, pelvic organs pain, and urinary incontinence. Mary has also experience working with women both pre-natal and post partum to ensure a healthy pelvic floor both before and after giving birth.