De Mystifying the Pelvic Floor

Stress urinary incontinence, pelvic pain, urge incontinence, prolapse…what do all these terms mean? In this blog, we hope to clarify some questions you may have on this delicate topic. We also hope that if anything, you take home these three main points from this article: 

  1. Pelvic floor issues are not treated as simply as “squeeze and release” 
  1. Pelvic floor disorders are VERY COMMON among men and women, but is not a healthy part of ageing 
  1. Women’s and Men’s Health Physiotherapy offers effective solutions for these issues yet are they are highly underutilised

Anatomy –What is the pelvic floor? 

The pelvic floor is the tissue that physically supports the pelvic organs (bladder, bowels, prostate, uterus) –think of a sling or a floor! It’s an interplay of muscle, fascia and fibrous tissue. The pelvic floor muscles help you control movement of materials (urine and faecal matter) through the urethra and anus. They are also important for sexual function, and they work with your abdominal muscle ‘corset’ to help you stabilise and support your lower back.  

 

Figure 1: Superior view of the pelvic floor. 

Image adapted from: https://www.theinjuryclinic.com.au/the-role-importance-of-the-pelvic-floor/  

What can go wrong with them? 

There are several issues that can arise; it depends on the person and their experiences. For example, a woman that has had a difficult pregnancy and delivery may be susceptible to pelvic pain during intercourse, pelvic organ prolapse or incontinence while a man that has been diagnosed with prostate cancer may develop sexual dysfunction or incontinence. Some risk factors for developing pelvic floor disorders are pregnancy, menopause, obesity, prostatectomy/hysterectomy, and reduced mobility. 

Here is a list of more commonly seen disorders and a brief description: 

    • Stress Urinary Incontinence: leaking with activities such as coughing, sneezing, laughing, running and jumping 
    • Urge Urinary Incontinence: a sudden, compelling urge to urinate. Involuntary contraction of the bladder wall causing this sensation and urine loss 
    • Overactive Bladder: High frequency of urination, common with Urge Urinary Incontinence 
    • Faecal incontinence: Inability to control back passage  
    • Pelvic organ prolapse: Sagging down or protrusion of a pelvic organ such as either bladder, uterus, or rectum.  
  • Post-natal tears
    • Pelvic Pain: Also called vaginismus, an involuntary painful tightening or spasming of the pelvic floor muscles 
  • Constipation  
  • Sexual dysfunction

Understanding the Relationship between Pelvic Floor Strength and Pelvic Floor Disorders

Often times, multiple pelvic issues present simultaneously. For example, a prolapse may put too much pressure on the bladder and also cause stress incontinence or overactive bladder. Understanding the relationship between pelvic floor strength and overall pelvic health can be complicated so let’s use the Boat in the Dock Theory:

 

 

 

 

In the above schematic, 

The boat = Organs (bladder, uterus, prostate, rectum)

The ropes = Ligaments (fascial bands that hold everything in place)

The water = Pelvic Floor Muscles

When you have strong pelvic floor muscles, there is less strain on the ligaments that hold your organs up, thereby supporting your organs in place. However, if your muscles are weak, there is more strain on your ligaments and the organs sag down, placing pressure on unwanted areas.

How big of a problem is it?  

A few quick stats from the Continence Foundation of Australia 

  • Bladder incontinence affects up to 37% of Australian women 
    • 70% of these women don’t seek help  
  • Half of women between the ages of 45-59 are affected!  
  • 13% of Australian men are also affected by Bladder incontinence 
  • Roughly half of all women in nursing homes are there primarily because their incontinence is  unmanageable at home 

In 1998 the World Health Organisation stated,

“Incontinence is a largely preventable and treatable condition…it is certainly not an inevitable consequence of ageing” 

A recent Australian study found that 84% of women with stress urinary incontinence were cured with the help of pelvic floor muscle rehabilitation led by a Women’s Health Physiotherapist. 

The average number of visits required was only 5. 

What does a Women’s or Men’s Health Physiotherapist do? 

A Women’s or Men’s Health Physiotherapist is able to help people through various pelvic issues.  Some of the ways these healthcare practitioners help include: 

  • Pelvic floor retraining for stress urinary incontinence, prolapse, post-natal injuries, pre/post-operative management (prostate or gynaecological surgeries) or post menopause
  • Real-time ultrasound visual feedback for confirmation of pelvic floor musculature engagement
  • Bladder training to normalise urge incontinence
  • Lumbar and pelvic pain management throughout the lifespace –young athletes, during pregnancy, post-natal, return to sport, and menopause
  • Provide evidence based advice and education
  • Aid with sexual dysfunction or pain 
  • Antenatal fitness 
  • Breast mastitis management
  • Abdominal separation (DRAM)
  • Pelvic floor retraining for bowel function (constipation, straining and control of wind) 

Taking Action

We hope this article has addressed some of your questions. More importantly, we hope this has highlighted the importance of seeing a Women’s or Men’s Health Physiotherapist if you have any concerns regarding your pelvic health. There is no need to suffer in silence; we are here to help! 

Ring Agility Physiotherapy and Pilates and ask to see our women’s health physiotherapist Karen. 

PH 07 3862232

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