Endometriosis is a condition where tissues which is similar to the inner lining of the uterus grows outside the uterus which can affect nearby organs including the bowel and bladder. The tissue thickens
and does shed with the monthly cycle. At times when tissues get trapped and does not exit the body it can progress to form cyst called endometriomas. At last, it results in irritation to surrounding tissues and organs forming scar tissue and adhesions.
What are the symptoms?
Symptoms includes,
Firstly, Pelvic pain.
Secondly, Heavy periods.
Infertility.
Abdominal bloating.
Urinary and bowel concerns.
lastly, Fatigue.
However, endometriosis can be mistaken for other conditions such as Irritable bowel syndrome, Inflammatory pelvic disease. Therefore, early diagnosis will help in managing the symptoms.
Treatment options available:
There is no cure for endometriosis currently. Although, treatments to manage the symptoms includes,
1. Hormone therapies.
2. Over the counter medication.
3. Pelvic physiotherapy.
4. Surgery.
Pelvic health physiotherapy in Endometriosis
Pelvic health physiotherapy can help to reduce the symptoms, improve the function, improve the flexibility and improve the strength of the pelvic floor muscles. The techniques help to relax the muscles which ultimately help to ease the symptoms. How does pelvic floor physiotherapy help in endometriosis,
Relieve endometrial pain: Approaches to down train the pelvic floor muscles and introducing bio-psychosocial approach to help in relaxing the pelvic floor muscles.
Reduce painful sex: Helping with stretches and breathing techniques, dilators, and hands on techniques to reduce the tension and resistance in the pelvic floor area.
Reduce abdominal bloating or endo belly by helping in assisting venous and lymphatic drainage
in our body.
Painful urination: by educating on proper water intake, and voiding techniques and by
maintaining a bladder diary to reduce the effects pressure causing pain when bladder fills up.
Painful bowel movements: Education and advices on diet and positions on easy bowel movements along exercises to manage the situation.
Also, pelvic floor therapy post endometriosis surgery would help to retrain pelvic floor muscles to relax and to coordinate contractions. This helps to reduce spasms during menstruation.
Lastly, Bio psychosocial component of pelvic floor physiotherapy helps in identifying and addressing the psycho social aspects and its influence on normal function of your body. Relaxation techniques and hands on techniques to calm down the senses that could be the trigger to pain can be managed to a great extent.
Take away message – If you are suffering from endometriosis and are finding difficulty to manage its symptoms, our team of qualified Pelvic PT will help you assess and guide through the whole treatment. Book your appointment today!
The Pelvic Floor. Perhaps you have heard this referenced
before but did not have a definitive idea of what it was. Is it just a region
in the body? A single muscle? Let us explore this very important topic.
The Pelvic floor
is a group of extremely important muscles located on the inside of the pelvis
with a hammock like orientation. They attach to the tailbone (coccyx) at the
back, the pubic bone in the front and span side to side.
Functions:
These muscles are involved in several complex functions but
are often overlooked in their contribution due to their “out of sight, out of
mind” presence. These functions include:
1. Bowel and Bladder Function and Support
Assists in control of the bladder and bowel (helping to prevent incontinence) in males and females. In females, the pelvic floor supports the uterus and other organs located in the pelvic cavity. This helps to prevent prolapse. Prolapse is the lowering down of a pelvic organ from its normal position.
Contribution to our Core Muscles?
The pelvic floor acts as the base of our core together with the deep back muscles and diaphragm. Core muscles help to provide strength and stability of the spine.
Involvement in Sexual Function
The pelvic floor plays a role in sensation during sexual intercourse. As a result, dysfunction of these muscles may lead to painful intercourse. In addition, it can lead to decreased sensation, and reduced erectile function amongst other symptoms.
Involvement in pregnancy and delivery
The strength of the pelvic floor muscles is very important during pregnancy. They help to support the extra weight of pregnancy. This can reduce certain symptoms of discomfort. They can also help to decrease the incidence of incontinence (bladder leakage), and prolapse. Additionally, they play a large role during delivery in guiding the baby’s head down the birth canal.
Symptoms of Dysfunction?
When the pelvic floor is working in harmony, it plays a big role in a variety of our functions. What happens when something is not quite balanced in the pelvic floor? Symptoms may arise. For example, they can be as a result of one of two scenarios: weakness in the pelvic floor or increased tension in the pelvic floor.
What about Kegels?
It is common to assume that any pelvic floor concerns are automatically as a result of weakness. Many people think that kegels should immediately be practiced. However, kegels are NOT always the answer! If the primary problem in the pelvic floor is tension, kegels can in fact do more harm than good. The Mysterious Pelvic Floor issues can be solved with a little Pelvic Physiotherapy!
So, what are some of the symptoms associated with pelvic floor dysfunction?
Urinary issues, such as the urge to urinate, incontinence (bladder leakage), urinary frequency and painful urination.
Bowel concerns such as constipation and incontinence
Lower back pain
Pain in the pelvic region, genitals, or rectum.
Discomfort during sexual intercourse for women.
Pressure in the pelvic region or rectum.
Muscle spasms in the pelvis.
What are some of the Risk Factors for issues with The Mysterious Pelvic Floor ?
A history of back pain
Previous trauma to the pelvic region such as a fall or pelvic radiotherapy
Ongoing constipation (i.e. for example, regularly straining to empty your bowels)
A chronic cough or sneeze (e.g. due to asthma, smoking or hayfever)
Being overweight, or having a body mass index above 25, and
Heavy lifting on a regular basis – either at work or at the gym most commonly
During pregnancy and post-partum, some factors may arise
Women who are going through, or have been through, menopause
Women who have had gynaecological surgery (e.g. hysterectomy)
Men who have had prostate surgery
Elite athletes such as gymnasts, runners or trampolinists.
What is a Pelvic Physiotherapist and How Can We Help?
What is a Pelvic Physiotherapist and How Can We Help?
A Pelvic Physiotherapist has advanced training . They assess and treat the pelvic floor through a combination of external and internal examinations. This treatment is for both males and females. Internal examination allows the Physiotherapist, to evaluate the pelvic floor directly. As a result, this will help to identify contributing factors to your concern.
Typically, tension or weakness are underlying imbalances in the pelvic floor. The Mysterious Pelvic Floor issues are usually treatable!
Although this is an area less known for its muscle contribution, the parallel of a shoulder injury should be drawn here, for example. In order to help treat a shoulder problem, a Physiotherapist would still have to evaluate all the muscles around it. We would check to see where the problem lies. Once found, these same muscles would be treated directly.
This is the same principle to keep in mind when trying to understand pelvic floor problems and treatment.
Treatment of The Mysterious Pelvic Floor?
Once a full examination has been completed, the Pelvic Physiotherapist discusses the results with you. Together, they will develop a treatment plan with you. Pelvic Physiotherapy treatments vary, however, some of the methods often used can include:
Postural training
Release and mobilizations , (often the low back, hips, etc. are involved).
Connective tissue release. Connective tissue is the thin layer found above our muscles. Sometimes, it can cause tension pulls and compression in areas. As a result, this causes pain and poor function.
Dilator work
Internal techniques to release areas of tension. We teach contraction exercises AND relaxation techniques. These are often overlooked
Exercises: These are positional to alleviate pain and pressure. They strengthen, stretch, and activate muscles. As a result, they help to build endurance, and improve coordination.
Breathing techniques
In cases where internal assessment or treatment may be painful, external treatment can be started first. This can often reduce the tension causing the internal discomfort. Improvements can be made to achieve your ultimate goals.
It is also important to note that Physiotherapists are primary health care providers. Therefore, you can see a Physiotherapist without a doctor’s referral. However, if your Physiotherapist feels that you may benefit from further testing, we will reach out to your doctor of choice.
Summary of The Mysterious Pelvic Floor
The Mysterious Pelvic Floor doesn’t need to be so mysterious!
Two of the most common phrases that I hear patient’s mention during or after a pelvic physiotherapy assessment are:
“I didn’t even know that this type of Physiotherapy existed” and
“I wish I knew about this sooner”
These phrases are often derived from patients who have a pelvic concern. In most cases, it has significantly affected their function. It has resulted from the belief that nothing could be done, besides “living with it.”
My hope is that Pelvic Physiotherapy becomes well known! My hope is that you seek treatment as often as our rotator cuff friends. Afterall, they both involve muscles that can be easily treated. Take care of your pelvic floor, it is literally of foundational importance!
If you or someone you know suffers from Pelvic Floor issues, PhysioNow can help! We have specially trained Pelvic Floor Physiotherapists available at all of our clinics to help. Call today to get started on your treatment!
PELVIC FLOOR: POSTURE is a very important area if you have issues with urinary incontinence, pelvic pain, etc. The muscles of the pelvic floor support the abdominal and pelvic viscera. These muscles are active in standing and sitting. Furthermore, because the abdomen is a fluid-filled cavity, intra-abdominal pressure is distributed in all directions. The Pelvic Floor muscles, which form the floor of the abdominal cavity, contribute to its muscle control.
As a result of this contribution to control of intra-abdominal pressure, the muscles of the pelvic floor are likely to contribute to control of the spine and pelvis. The slouched posture places a lot of pressure on our internal organs and pelvic floor. This can cause a worsening of:
urinary incontinence,
pelvic pain,
symptoms related to prolapse,
and rectus diastasis.
Pelvic Floor: Posture, sitting slumped
Research has shown that when we sit in a slumped posture, our pelvic floor muscle activity is much less than when we are sitting tall.
Pelvic Floor: Posture IS VERY IMPORTANT!
slouched sitting postures decrease the activity of your transverse abdominal muscles.
A Proper breathing pattern encourages the pelvic floor to move more dynamically.
Dysfunctional breathing patterns inhibit this dynamic movement of the pelvic floor.
Pelvic Floor: Posture,
An assessment by a Pelvic Health Physiotherapist includes a thorough postural examination.
Your Pelvic Health Physiotherapist will be able to identify your unique postural compensations
They can help guide you on the road to improved body posture awareness.
At PhysioNow, we have fully trained Pelvic Health Physiotherapists that can help to assess and treat pelvic issues like the following conditions:
Constipation
Dyspareunia
Endometriosis
leakage of urine
pain with intercourse
pelvic organ prolapse
pelvic pain
urinary incontinence
vaginismus
erectile dysfunction
If you or someone you know suffers from one of these conditions, give us a call today. We would be happy to help!
Sapsford, RR. et al (2006) Sitting posture affects pelvic floor muscle activity in parous women: an observation study. Aust L Physiother. 52(3):219-22
Reeve, A., Dilley, A., (2009) Effects of posture on the thickness of Transverse Abdominal Muscle and Pelvic Floor Muscle Exercises for Stress Urinary Incontinence: A Randomized controlled Trial. J Phys Ther Sci. 26(8): 1161-1163.
Vaginismus is a painful feeling of discomfort or inability when inserting a tampon, finger, penis or during a doctor’s internal pelvic exam. It occurs when there are involuntary contractions of the muscles in the outer third of the vagina.
Primary Vaginismus: when a woman has never been able to have pain free intercourse due to pelvic floor muscle spasm.
Secondary Vaginismus: pain that develops sometimes later in life after a traumatic event such as childbirth, surgery, or a medical condition.
With Vaginismus, there is usually significant Connective Tissue Dysfunction that needs to be addressed first before any internal work. It is suggested that you follow up the self-help treatment for connective tissue dysfunction before embarking on the stretching exercises with the dilators.
Pelvic floor exercises and Desensitisation techniques
A physiotherapist may be able to teach you pelvic floor exercises, such as squeezing and releasing your pelvic floor muscles, that can help you gain control over the muscles causing the vagina to close involuntarily. Occasionally, a technique called biofeedback may be useful. A small probe is inserted into your vagina. This monitors how well you are doing the exercises by giving you feedback as you do them.
Biofeedback can help with the following:
• Teach you strategies that may help to relax the muscles that are contracting involuntarily
• Teach you appropriate timing of the contraction and relaxation of the pelvic floor muscles.
• Educate you about your condition and why it might be occurring.
• Teach you various strategies for getting the muscles to relax
• help you to Use manual therapy to release the muscles either externally and/or internally that are causing the contractions.
More information about Vaginismus can be found here.
Some general tips about pelvic floor muscle exercises:
• Choose a convenient time and place where you can exercise regularly.
• Put a reminder about pelvic muscle exercises somewhere obvious to you (or set an alarm on your watch or mobile phone).
• Avoid quick pelvic floor muscle exercises where you don’t hold the contraction. This tends to cause an increase in pelvic floor muscle resting tone.
• Be aware that it will take 6 to 8 weeks of regular exercise before you can expect to see improvement. It will take approximately 3 months for the pelvic muscles to strengthen.
• You could try inserting one finger into the vagina to check the strength of your squeeze as you pull in the pelvic muscles. Alternatively, you may be able to feel a pelvic floor contraction if you place the tip of your index finger on the perineal body (on the outside, between the vagina and back passage).
Other tips to reduce Vaginismus:
• If you are overweight, try reducing your weight.
• Try not to become constipated, as a full bowel will put pressure on the bladder. Straining to empty your bowel will weaken the pelvic muscles.
• If your job involves lifting, think of your pelvic muscles as well as your back. Pull up your pelvic muscles when lifting a heavy weight.
• If you smoke, consider quitting. Frequent coughing puts a strain on the pelvic muscles.
If you or someone you know suffers from Vaginismus, please call PhysioNow today! Our specially trained Physiotherapist can start your treatment Now!
Dyspareunia and Physiotherapy
Dyspareunia is genital pain experienced by women just before, during or after sexual intercourse. Some women have always experienced pain with intercourse from their very first attempt. Other women begin to feel pain with intercourse or cyclically with menstruation. They can also have pain after an injury or infection . Sometimes the pain increases over time. When pain occurs, the woman may be distracted from feeling pleasure and excitement.
Causes
• vaginal dryness from menopause, childbirth, breastfeeding, medications
• skin disorders that cause ulcers, cracks, itching, or burning
• infections, such as yeast or urinary tract infections
• spontaneous tightening of the muscles of the vaginal wall
• endometriosis
• pelvic inflammatory disease
• uterine fibroids
• irritable bowel syndrome
• radiation and chemotherapy
Other factors that affect a woman’s ability to become aroused can also cause dyspareunia.
These factors include:
• stress, which can result in tightened muscles of the pelvic floor
• fear, guilt, or shame related to sex
• self-image or body issues
• medications such as birth control pills
• relationship problems
• cancer, arthritis, diabetes, and thyroid disease
• history of sexual abuse
Symptoms of Dyspareunia
• Pain while inserting a tampon or during penis penetration
• Pain with certain sexual partners
• Deep pain during thrusting
• Burning pain or aching pain
• Throbbing pain, lasting hours after intercourse
To help describe how the pelvic floor muscles can cause pain. Education can also provide techniques that can be used at home.
Manual Physiotherapy: to mobilise muscle and soft tissue, normalize overactive muscles, improve circulation and desensitize painful areas.
Desensitization therapy: learning vaginal relaxation techniques, such as Kegel exercises, that can decrease pain.
Sex therapy: learning how to re-establish intimacy and improve communication with your partner.
Water-based lubricants rather than petroleum jelly or other oil-based lubricants are preferable. Oil-based lubricants tend to dry the vagina.
Psychologic therapies: Cognitive-behavioral therapy and mindfulness-based cognitive therapy can be helpful.
Pelvic muscle relaxation exercises: used with biofeedback, this can help women with tight pelvic muscles learn to consciously relax tight muscles.
If you or someone you know suffers from dyspareunia, please call today to get started on Physiotherapy treatment! We can help at PhysioNow. Often only a few visits with our specially trained Phyiotherapist can help to get you on the road to recovery.
Prostatodynia or Chronic Pelvic Pain Syndrome (CPPS) is a pelvic pain condition in men. This means ‘inflammation of the prostate’. There are two basic types of prostatitis, acute and chronic.
Acute Bacterial Prostatitis
Acute Bacterial Prostatitis is an infection of the prostate. This type of Prostatitis causes chills and fever. In this case, you need your Doctor’s attention promptly!
Nonbacterial or Chronic Prostatitis
The other is Nonbacterial or Chronic Prostatitis. This can be treated with alternative treatments such as Pelvic physiotherapy, exercises, lifestyle modifications etc. Investigations in this case show that bacteria and yeast are negative. The physical examination does not usually show anything unusual. However, the prostate may be swollen. What can make the problem even more confusing is that often young, otherwise healthy men develop this condition. Antibiotics, pain-killers, and medications prescribed are often not effective. Many men have been told that they must learn to live with the symptoms because a cure is not available.
Symptoms may include a few or all of the following:
• Pain in the testicles, or tip, shaft or base of the penis
• Pain at the perineum (the area between the testicles and penis)
• Urination Causes Pain
• Increased pain in sitting
• Pain or discomfort with sexual arousal, or during or after ejaculation
• You May notice Pain or discomfort above the pubic bone
• Urinary frequency
• Urinary urgency
• Pain before, during or after a bowel movement
• Decreased interest in sex
Treatment
The Pelvic Health Physiotherapist creates an individualized treatment program. Treatment is based on pelvic floor dysfunction, symptoms, and response to the treatments.
The following treatment programs and techniques may be involved in Pelvic Physiotherapy for Prostatitis:
Trigger point release therapy
Trigger point release therapy is also known as myofascial trigger point release. Trigger point release therapy is an alternative treatment for chronic prostatitis. It is often helpful for treating CP/CPPS symptoms that are associated with stress and tension of the pelvic floor muscles.
Trigger point release therapy is often combined with paradoxical relaxation therapy. This exercise method involves autonomic self-regulation. This decreases pelvic floor muscle tension. It teaches you how to release this tension. Paradoxical relaxation involves a specific breathing technique to help relieve anxiety.
Total body
Total body (exercise, chronic stress management, lifestyle) changes help relieve pain. It is important to know which foods make the symptoms worse. Try to avoid those foods. The most common foods that have been found to trigger symptoms include:
Pelvic floor muscles form the ‘bowl’ or ‘hammock’ that supports our lower back and pelvic organs (bladder, uterus/prostate and rectum).
Pelvic health physiotherapists have taken courses allowing them to perform an internal evaluation in order to assess the tension and strength of these muscles. Often there is too much tone of the pelvic floor leading to weakness.
What are common symptoms of pelvic health dysfunction?
• Leakage of urine with coughing, sneezing, laughing and exercise
• Urgent need to urinate or leaking before you get to the washroom
• Constipation/straining with bowel movements
• Heavy feeling or bulge in the vagina
• Pain in the pelvic or low back or genital area
• Pain with intercourse
Check out this link for more information.
Some benefits of Pelvic Floor Physiotherapy
• Leave your house without worrying about your bladder
• Exercise without worrying
• Sleep through the night
• Learn to control urgency
What can I expect on my first Visit for Pelvic Health physiotherapy?
A medical history will be taken with a discussion of your concerns. Questions will be asked to further understand your symptoms. Your posture, muscles of your hip, low back and abdominal will be assessed for contributing factors such as weakness or tightness. In addition to the external exam, an internal exam of your pelvic floor (vaginally and rectally) may be included to assess imbalances and dysfunction of the muscles and soft tissues.
Based on the assessment findings and your goals, the physiotherapist will put together a treatment plan.
What can I expect for treatment with Pelvic health physiotherapy?
Pelvic Health Physiotherapy Treatments Typically include,
• Correcting postural dysfunction
• Manual therapy
• Connective tissue release
• Pelvic floor muscle facilitation with breathing techniques
• Exercises for other core muscles
• Training for healthy bladder and bowel habits
• Education such as behavioural therapy/stress management
We have fully trained Pelvic Health Physiotherapists at each of our clinics ready to help you. If you have any questions, or would like to book an appointment, please contact the clinic .
Post-prostatectomy-incontinence is a common problem after radical prostatectomy. Patients report that this is the symptom which most disrupts their quality of life. Up to 75 percent of men experience a short period of mild incontinence. This is particularly after removal of the catheter that was placed during surgery. Most patients regain total urinary control after radical prostatectomy. However, this can take up to a year to achieve. Apparently, a small percentage (2% to 4%) experience permanent incontinence. Following radical prostatectomy, men who experience post-prostatectomy-incontinence may express concerns about visible wetness, urine odor, and the type of clothing that can be comfortably worn.
Types of Urinary Incontinence
The two types of post-protatectomy incontinence following prostate surgery are:
• Stress incontinence – Stress incontinence is the involuntary loss of urine that can occur during physical activity, like lifting a heavy object, or when you laugh or sneeze. These . activities put increased “stress” or pressure on the bladder.
• Urge incontinence – Urge incontinence is the sudden need to urinate due to bladder spasms or contractions.
What Can Be Done to Treat post-prostatectomy-incontinence after Prostate Cancer Treatment
• Pelvic floor exercises: Kegel exercises strengthen the muscles when you squeeze them
• Stop urinating mid-stream. These exercises can be combined with biofeedback programs that help you train these muscles even better.
• Supportive care. This treatment includes behavioral modification. This includes drinking fewer fluids, avoiding caffeine, alcohol, or spicy foods, and not drinking before bedtime.
People are encouraged to urinate regularly and not wait until the last moment possible before doing so. In some people, losing weight may result in improved urinary control. Supportive care also involves changing any medications that interfere with incontinence.
• Neuromuscular electrical stimulation.
This treatment is used to retrain and strengthen weak urinary muscles and improve bladder control. With this treatment, a probe is inserted into the anus and a gentle current is passed through the probe at a level below the pain threshold.This causes a contraction. The patient squeezes the muscles when the current is on. After the contraction, the current is switched off.
As you can see, there are many things that can be done to treat post-prostatectomy-incontinence. PhysioNow has trained pelvic Health Physiotherapists in Etobicoke ready to help you get started on regaining your life. It is hard to talk about these symptoms, and harder yet to find somebody who can help. Our therapists are sensitive and discreet. You will be treated in a quiet private room and your privacy will be fully respected. Get started today! Call today and ask for a pelvic health physiotherapy consultation at PhysioNow.
Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra. Bacteria then begin to multiply in the bladder. The most common UTIs occur mainly in women and affect the bladder and urethra.
• Infection of the bladder (cystitis).
• Infection of the urethra (urethritis)
Symptoms
• A strong, persistent urge to urinate
• A burning sensation when urinating
• Passing frequent, small amounts of urine
• Urine that appears cloudy
• Urine that appears red, bright pink or cola-colored — a sign of blood in the urine
• Strong-smelling urine
• Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone
Urinary tract infections can be painful. You can take steps to ease your discomfort until antibiotics treat the infection. Follow these tips:
• Drink plenty of water. Water helps to dilute your urine and flush out bacteria.
• Avoid drinks that may irritate your bladder. Avoid coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate your
bladder. These drinks tend to aggravate your frequent or urgent need to urinate.
• Use a heating pad. Apply a warm, but not hot, heating pad to your abdomen to minimize bladder pressure or discomfort.
• Wear cotton underwear on a daily basis. Cotton underwear allows more air movement to occur. This keeps the urethra dry.
• Do NOT wear thongs. They track bacteria from your anus forward to your vagina (to the underwear section).
Physiotherapy Treatment
Physiotherapists that are trained in pelvic floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes training pelvic floor musculature, manipulative techniques and local heat. It also includes breathing and relaxation techniques. Lastly, treatment includes postural education, muscle coordination reeducation, and behavioral therapy.
• Reverse Kegel Down training
• Dynamic ROM program including dynamic stretching and core exercises
• Pain education
• Internal pelvic muscle work including trigger point release techniques
• Connective tissue mobilization
If you suffer from urinary tract infections, consider getting a consultation from one of our pelvic health physiotherapists today. They can help! Please call Physionow to book an appointment and get back to living a comfortable life!
Endometriosis is a condition where tissues which is similar to the inner lining of the uterus grows outside the uterus which can affect nearby organs including the bowel and bladder. The tissue thickens
