Women’s Health Edition:
Pelvic Floor Physiotherapy
Who is it for? What do we do?
Women are often surprised to learn that physiotherapy interventions can help them with seemingly gynaecological and urological symptoms. Often, they are not sure what to expect as far as assessment and treatment. The approach to pelvic floor physiotherapy remains strongly rooted in the paradigm of an orthopaedic musculoskeletal exam. The primary difference with the pelvic floor exam is that it includes a digital vaginal and rectal exam. Using these techniques, the assessment ensures that all musculo-skeletal systems are addressed:
· Peripheral neurological scan (reflexes, myotomes, dermatomes)
· Articular system (sacro-coccygeal, sacroiliac joints, lumbosacral junction and lumbar spine
· Muscular system (strength, tone, coordination, quality of contraction)
In addition, systemic pathology is screened for pelvic organ prolapse and pelvic pain as well as a complete subjective history including an evaluation of behavioural or lifestyle factors which may be contributing to the problem.
Urinary Incontinence
Women with either stress or urge incontinence can benefit from this conservative approach. A systematic review from the Cochrane Collaboration suggests that “pelvic floor muscle training helps women with all types of incontinence although women with stress incontinence who exercise for three months or more benefit most.”. Specifically, “women who did pelvic floor muscle training were more likely to report they were cured or improved than women who did not. Pelvic floor muscle training women also experienced about one fewer incontinence episodes per day.” Other studies found reduced incontinence severity, increased pelvic floor strength, decreased voiding frequency and increased overall quality of life.
Pelvic Pain
Vulvodynia, provoked vestibulodynia (PVD) (formerly called vulvar vestibulitis syndrome (VVS)), vaginissumus and dyspareunia are complex, multi-factor pathologies that family practitioners struggle with in guiding their patients towards good results. Currently, psychological counselling with pharmacotherapy (tricyclic antidepressants) seem to be the front line treatment of choice.However, evidence is accumulating that including pelvic floor physiotherapy in this combination yields greater results. 80% of members from the International Society for the Study of Vulvovaginal Disease found this combination to be very effective or somewhat effective. In fact, of women with PVD, 51.4% of participants noted a complete or great improvement and 20.0% had a moderate improvement within an average of 7 treatments. This study specifically inquired about pain during intercourse and gynaecological exam, frequency of intercourse and levels of sexual desire and arousal. Other literature suggests an overall decrease in pain and improvement in quality of life.
Coccydynia
Acute pain around the coccyx can be treated medically with the use of a stool softener, adjustable seating and NSAIDs. However, if symptoms persist for longer than 8 weeks, a combination of pelvic floor massage and cortico-steroid injection has been found to be successful once other pathology such as tumour have been ruled out. Interestingly, levator ani (pubovaginalis, puborectalis, pubococcygeus and illiococcygeus) muscle massage and stretch were found to be more effective than joint mobilization and manipulation in persons with a normally mobile coccyx.
The five muscles of the pelvic floor:
- pubovaginalis
- puborectalis
- pubococcygeus
- illiococcygeus
- ischiococcygeus
are often forgotten when patients attend their family practitioner with complaints of gynaecological or urological symptoms.
A body of evidence is accumulating linking the role of the pelvic floor with some of these problems. Practitioners may be able to offer more comprehensive treatment options to their patients complaining of urinary incontinence, pelvic pain and coccydynia.
A referral to a pelvic floor physiotherapist for an assessment is a good first step in determining whether this is a viable treatment option. To find a physio who specializes in women’s health contact us at 250-478-7227. Shannon Bourrassa is our Women's Health Practitioner at Parkway.
References:
Eyjolfsdottir H, Olafsdottir M, Geirsson G . Pelvic floor muscle training with and without functional electrical stimulation as treatment for stress urinary incontinence. Laeknabladid, The Icelandic Medical Journal, 2009 Sep; 95 (9):575-80
Bergeron S, Brown C, Lord M, Oala M, Binik Y, Khalife S. Physiotherapy for vulvar vestibulitis syndrome: A retrospective study. Journal of Sex and Marital Therapy, 2002; 28 (3): 183-192.
Maigne J; Chatellier G; Le Faou M; Archambeau M; The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study, Spine, 2006 Aug 15; 31 (18): E621-7.
