pelvic floor rehabilitation

Don’t wait but get help to treat your problem or prevent future problems!

Physio for All is one of the first clinics in London to have specialised in Pelvic Floor Rehabilitation. We can answer your questions with discretion and get you on the right path to a well-functioning pelvic floor.

Pelvic health physiotherapists are specially trained to assess and treat a wide range of pelvic floor problems in women, men and children such as incontinence, organ prolapse, painful sexual intercourse, bedwetting and pelvic pain.

Pelvic floor rehabilitation or re-education is not only about pelvic floor exercises. After a thorough assessment, a treatment plan will target your current problem and underlying causes. Treatment modalities vary according to your needs and may include relaxation and strengthening pelvic floor exercises, manual therapy, biofeedback, electrotherapy, education and advice.

When can Pelvic Floor therapy help you ?

Pelvic floor muscles become weak, too tight or painful for many reasons. This is not all due to ageing. Pelvic floor problems often start with pregnancy and childbirth and they are also common in young athletes. Men, women and children of all ages need a healthy pelvic floor. Pelvic health or Womens health physiotherapy has proven to be effective in treating and preventing many conditions.

  • To strengthen or relax pelvic floor muscles
  • Bladder and bowel symptoms
  • Prolapses
  • Sexual satisfaction
  • Childbirth preparation and recovery post birth
  • Rehabilitation before and after surgery
  • Core stability and back problems

We recommend all women

to have their Pelvic Floor assessed: not only after your 6 weeks postnatal check but at any time during a women’s life.
Read more about our MOT Pelvic Floor Check 

Common problems with Pelvic Floor Muscles

Like any other muscles in our body, the pelvic floor muscles can become too weak or too tight. They can also be overstretched or torn with injury or traumatism.

  • Weak pelvic floor muscles

Low-tone Pelvic floor muscles can lead to stress incontinence and pelvic organ prolapse.

USI or Urinary Stress Incontinence is when you leak when coughing, sneezing, running or laughing.

Organ prolapse happens when the too loose pelvic floor muscles and their surrounding fascia do not hold sufficiently the pelvic organs leading to a descent of the bladder, uterus or rectum.

Pelvic floor rehabilitation

The good news is that the training and strengthening of pelvic floor muscles have shown to be effective in many conditions. Your physiotherapist will prepare a specific exercise programme to train and strengthen pelvic floor muscles. Other approaches may be used such as manual therapy, biofeedback and electrotherapy technique.

  • Tight or overactive pelvic floor muscles

Muscles are not only about strength. Their ability to relax and lengthen is as important. A stiff neck can bring neck pain or headaches. Short, tight or hypertonic pelvic floor muscles can bring many problems which are often misdiagnosed such as:

  • Urinary frequency and urges or the inability to empty completely your bladder or bowels.
  • Sexual pain during or after intercourse. When muscles are too tight, intercourse can be very difficult.
  • Pelvic pain such as pain in the genitals area (vulva, vestibule or penis) or around the rectum and the coccyx. Tight pelvic floor muscles can lead to unexplained chronic back or hip pain.
  • Constipation and pain with straining when emptying bowels.

Tight does not mean strong muscles!

When pelvic floor muscles are in spasm or unable to relax, strengthening exercises may just exacerbate the symptoms. Pilate core type exercises which focus on tightening the pelvic floor muscles would not be appropriate. We must first treat the tension and then only the weakness.  It is difficult to initiate or activate hypertonic pelvic floor muscles if they are not able to relax towards the basic resting tone.

Physiotherapy treatment for hypertonic pelvic floor muscles usually includes “hands on” manual therapy, diaphragm breathing, awareness exercises, biofeedback and down-training approaches to relax and lengthen the pelvic floor.

  • Lack of awareness, coordination and control

Pelvic floor muscles are not easy to work out simply because women and men are often not aware of the pelvic area and simply due to the difficulty of seeing them!

  • Scar tissues and adherences

Scar tissues, adherences and nerve damages can cause pelvic floor tension and pain. Childbirth, perineal tears, surgery, endometriosis or radiation can affect abdominal and pelvic function.

  • Lack or excessive local sensitivity

Sensitivity issues may lead to difficulty in feeling and controlling the muscles, lack of sexual sensation or pelvic and sexual pain.

Pelvic Floor Rehabilitation

The goals of Pelvic Floor Re-education are to help you regain a functional pelvic floor.

After a full, detailed evaluation and a physical assessment which might include manual vaginal or rectal examination, a programme of treatment is agreed, based on the findings, individual needs, goals and progress desired.

Pelvic Floor Rehabilitation may include pelvic floor retraining, manual therapy, bladder or bowel training, biofeedback, electrotherapy, education and advice.

  • Pelvic floor muscle retraining

The most important part of pelvic floor reeducation. We will first provide you with awareness techniques to make sure you are doing the right pelvic floor exercise. We will then tailor a personalized exercise programme towards a healthy pelvic floor.

We will teach :

  • How to identify and activate the right muscles
  • How to relax tight and overactive muscles
  • How to control and do the right exercise at the right time
  • How to coordinate the pelvic floor muscles with the diaphragm, the deep abdominals and the other core muscles
  • How to adapt Pilates exercise to your problem
  • How to control abdominal pressure and avoid damaging the pelvic area with high impact activities, wrong abdominals exercises or coughing
  • How to Integrate functional exercises according to your daily activities and sports

The pelvic floor muscles are skeletal muscles which means that you can voluntary control them and that they can be trained, retrained, strengthened just like you may do for your quadriceps by repeating the same exercise overtime.

  • Manual “hands on” therapies

Manual therapy in pelvic floor problems aim to relax, lengthen, mobilise and alleviate pain. This may include internal vaginal or rectal techniques and/or external techniques to treat your muscles, ligaments, fascias, tendons, nerves and joints.

We use many manual techniques according to your needs such as soft tissue mobilisation, myofascial release, deep tissue massage, urogenital mobilisations, joint mobilisations, muscle energy techniques, nerve mobilisation, trigger point pressure, connective tissue manipulation and visceral mobilisation.

  • Bladder and Bowel retraining
  • How the bladder or bowel function
  • Techniques to control your bladder or bowels
  • Advice on diet and fluid intakes as well as general advice
  • How to use a bladder or bowel diary
pelvic floor rehabilitation for men and women
  • Biofeedback

Biofeedback is very useful tool to help you connect with your pelvic floor muscles and for retraining weak or over-active muscles. It makes it easier to control the muscle activation during functional and sports’ activities. It also assists in creating strategies to confront or reduce pain.

Biofeedback provides information on a screen about when and how strong you contract or relax a group of muscles. External electrodes or a vaginal or rectal probe connected to the biofeedback machine measure the strength of the muscles and the resting tone. The readings are useful for outcome measures and to show your progression.

  • Electrotherapy

Muscle electrostimulation can be used to enhance awareness and to remind very weak pelvic floor muscles how to work and to assist in strengthening the muscles.

Other electrotherapy modalities are used for overactive bladder and for pain relief as TNS (Trancutaneous electrical stimulation) and Ultrasound.

  • Home Exercise Programme

You will be taught a progressive exercises programme, self-manual techniques and advice. For best outcomes and to achieve your goals, we encourage to play an active role in your rehabilitation and to put in practice the advice we give and Home Exercise Programme.

  • Patient education

We will teach you about your condition and give you tips and advice on specific lifestyle changes, advice on irritants and dietary/fluid modification advice and other behavioural modifications techniques.

  • Acupuncture & Dry Needling

Acupuncture and dry needling can be used to help with pelvic pain conditions

  • Postural re-education
  • Breathing, Relaxation
  • Vaginal dilators
  • Treatment of back pain

What are the roles of the pelvic floor muscles ?

The pelvic Floor is made up of thick layers of muscles, ligaments and fascia supporting the pelvic organs (bladder, rectum, small intestine, uterus and vagina). They are stretched like a hammock between the pubic bone in the front, the coccyx at the back, the sitting bones and the deep hip muscles. It is remarkable how many roles those muscles which are often forgotten have:

  • Help support the pelvic organs

The pelvic floor muscles and surrounding ligaments and fascia support the pelvic organs and prevent them prolapsing out.

  • Bladder and bowel control

The pelvic floor muscles control the passage of urine and faeces through the urethra and anus. Sphincters are wrapped around the urethra and anus. When the pelvic floor muscle contracts, the sphincters tighten at the openings preventing leakage of urine, faeces and winds. When the pelvic foor muscles relax, the sphincters open allowing urine and faeces to be evacuated.

  • Core stability

The pelvic floor muscles are part of the deep muscles of the abdominal canister. Together with the deep abdominals (Transvers abdominus) and back muscles, they stabilise your spine and pelvis.

  • Sexual satisfaction

Pelvic floor muscles are important for both men and women to enhance sexual arousal and satisfaction.

Are you doing successful pelvic floor muscles exercises ?

One of the difficulties with exercising the pelvic floor is to know if you are doing it right, as you cannot see it working.  One study showed that after being taught, 31% could not correctly contract their pelvic floor muscles (Bo et al. 1988). Another study (Bump et al. 1991) showed that after instruction 25% of women were “pushing” instead of contracting the pelvic floor.

Our women’s health physiotherapists can help you do the right and successful exercises.

Need expert HELP with your Pelvic Health?

Do not hesitate to call us if you would like to speak confidentially to one of our Pelvic Health Physiotherapists, regarding specific queries or for information on our services.

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