Understanding the Importance of Pelvic Floor Physiotherapy (PFP)

By Keziah Loewen

What It Is and How It Can Help

It is a specialised area of physiotherapy that focuses on assessing and treating the muscles, ligaments and connective tissues of the pelvic floor (PF).

It plays an important role in several everyday functions, including:

• Bladder control
• Bowel control
• Sexual function
• (PF) and core stability
• Supporting the organs
• Recovery following pregnancy and childbirth

Despite its importance, PF dysfunction is often overlooked or considered something people simply have to live with. However, many pelvic floor problems can be assessed and managed with appropriate physiotherapy.

Understanding:

It is a group of muscles and connective tissues that form a supportive, hammock-like structure at the base of the pelvis.

These muscles support organs such as the bladder, bowel and uterus. They also help control the openings of the urethra and anus and, in women, the vagina.

To work effectively, the muscles need an appropriate combination of strength, relaxation, endurance and coordination.

Problems can occur when the PF muscles become weak, overactive, poorly coordinated or unable to relax appropriately.

Common Problems

PFP may help people experiencing a range of symptoms and conditions.

Urinary Incontinence

Urinary incontinence involves the involuntary leakage of urine.

For example, leakage may occur during:

• Coughing
• Sneezing
• Laughing
• Running
• Jumping
• Lifting
• Exercise

Physiotherapy can help assess the factors contributing to urinary leakage and develop an individualised treatment program.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when one or more organs, such as the bladder, uterus or rectum, move downward and create pressure or bulging within the vaginal canal.

Symptoms may include:

• A feeling of heaviness or pressure in the pelvis
• A dragging sensation
• A vaginal bulge
• Difficulty with bladder or bowel function
• Discomfort during physical activity

Appropriate exercise modification may form part of the management of pelvic organ prolapse.

 Pain

Pain can sometimes be associated with increased PF muscle tension, poor muscle coordination or sensitive tissues within the pelvic region.

Persistent pain can affect exercise, work, sleep, relationships and overall quality of life.

Importantly, treatment is not always about strengthening. For some people, treatment may instead focus on helping tight or overactive PF muscles relax and function more effectively.

Sexual Dysfunction and Pain

PF dysfunction may contribute to symptoms such as:

• Pain during intercourse
• Pelvic muscle tension
• Difficulty relaxing the PF
• Reduced comfort with sexual activity

A physiotherapist with appropriate pelvic health training can assess whether PF muscle function may be contributing to these symptoms.

Pregnancy and Postpartum Recovery

Pregnancy and childbirth can place significant stress on the PF.

Postpartum PFP may assist with recovery following:

• Vaginal delivery
• Caesarean section
• Perineal tears
• Episiotomy
• Pelvic floor weakness
• Urinary leakage
• heaviness or prolapse symptoms
• Abdominal and core weakness

Physiotherapy can also help women gradually and safely return to exercise following childbirth.

What to Expect During Physiotherapy Appointment

During your first PFP assessment, your physiotherapist will discuss your symptoms, medical history, lifestyle and treatment goals.

The assessment may include looking at:

• PF muscle strength
• Muscle coordination
• Ability to relax the PF
• Breathing patterns
• Abdominal and core function
• Hip and pelvic movement
• Bladder and bowel habits
• Exercise and activity levels

Depending on your symptoms and with your consent, a more specific examination may also be discussed.

Your physiotherapist should explain each part of the assessment beforehand, and you can ask questions or decline any part of the examination.

Treatment

Treatment will depend on your individual symptoms and assessment findings.

A  treatment plan may include:

•  strengthening exercises
• relaxation techniques
• Breathing exercises
• Core strengthening
• Bladder retraining
• Bowel management strategies
• Posture and movement advice
• Exercise modification
• Education about pelvic floor function
• Gradual return to exercise or sport

The aim is not simply to make the PF stronger. Instead, treatment focuses on helping the muscles work appropriately for the activities and demands of everyday life.

Can Exercises Help?

Exercises can be very effective when they are performed correctly and are appropriate for the individual’s condition.

However, not everyone with PF symptoms needs more strengthening.

For example, a person with an overactive or very tight PF may benefit more from learning how to relax and coordinate these muscles before beginning strengthening exercises.

This is why an individual assessment can be valuable before starting an exercise program.

When Should You See a Physiotherapist?

Consider seeking experience if:

• Urinary leakage
• Urinary urgency or frequency
• Pelvic heaviness or pressure
• Symptoms of pelvic organ prolapse
• pain
• Pain during intercourse
• Difficulty controlling bowel movements
• Changes following pregnancy or childbirth
• Difficulty returning to exercise after giving birth
• Ongoing PF Symptoms that affect daily activities

These symptoms are common, but they should not necessarily be considered a normal or unavoidable part of ageing, pregnancy or childbirth.

Supporting Better Pelvic Health

The PF plays an important role in bladder and bowel control, sexual function, pelvic stability and everyday movement.

When these muscles are not functioning effectively, PFP can help identify the underlying problem and provide an individualised approach to treatment.

Whether you are experiencing urinary incontinence, pelvic pain, prolapse symptoms or difficulties following childbirth, an assessment with a qualified physiotherapist can help determine the most appropriate next steps.

To learn more, book a physiotherapy assessment online.