Bladder & Bowel Dysfunction
Rehabilitation of pelvic floor muscles involves retraining. The reflexes of the bladder and bowel need to re-learn correct voiding techniques. This requires learning when to tighten and when to release.
Physiotherapy for Bladder and Bowel
Bladder dysfunction has many different forms. These include:
- Stress incontinence. When an increase in abdominal pressure such as with a cough or running overcomes the closure pressure in the urethra and a leak occurs.
- Urge incontinence. When a strong urge to go to the toilet precedes the leak and there isn’t enough time to get there.
- Urgency. When there are frequent strong urges to go to the toilet and they are difficult to control.
- Frequency. When there is a need to go to the toilet more than 8 times in a 24 hour period.
Bowel dysfunction includes:
- Urgency. The bowel has to be emptied immediately once the urge/sensation is experienced and is difficult to control.
- Faecal incontinence. When there is leak of stool.
- Anal incontinence. When there is leak of gas or mucus.
- Difficulty cleaning. When there is poor control at the time of emptying.
- Defecation dysfunction. Where it is difficult to pass a motion often due to imbalance of the pelvic floor muscles.
- Rectal pain. When there may be contributing pelvic floor muscle tension.
Physiotherapy can be used in the rehabilitation of the pelvic floor muscles through either release or strengthening, retraining of the reflexes of the bladder and bowel and learning correct voiding and defecation techniques.
Chronic Pelvic Pain
Rehabilitation to reduce pain and control the tone in the pelvic floor muscles through specific exercises to restore normal balance and function.
Physiotherapy for Chronic Pelvic Pain
Pelvic pain is frequently misunderstood. It is often associated with an overactive pelvic floor and may include the presence of trigger points and increased muscle tension. The pain can be diffuse or localised.
The onset of pelvic pain can be secondary to any of the following:
- Injury to the sacrum or coccyx
- Trauma to the pelvic floor during childbirth.
- Disorders associated with overactivity of the pelvic floor muscles.
- Chronic constipation.
- Adhesions, for example post surgery.
- Direct trauma to the pelvic floor.
- Unknown cause.
Disorders that we at Premier Physiotherapy can address:
- Pelvic floor / perineal pain.
- Urethral / vaginal / rectal pain.
- Lower abdominal pain.
- Interstitial cystitis.
- Pudendal neuralgia.
Treatment includes assessment of the pelvis, the perineum, the pelvic floor, the abdomen and often the muscles and fascia of the thighs. Techniques used are:
- Trigger Point Therapy.
- Tissue mobilisation / release / manipulation.
- Dry Needling
- Manual Therapy.
- Postural rehabilitation.
Treatment also requires a re-learning how to reduce and control the muscle tone in the pelvic floor musculature. Ultimately the aim is to restore normal balance and function of the muscles and relieve pain.
Pelvic Girdle Pain in Pregnancy
Physiotherapy can also be utilised to treat Pelvic Girdle Pain (PGP) or Symphysis Pubis Dysfunction (SPD). This is a painful disorder that can occur with pregnancy.
Physiotherapy for Pelvic Girdle Pain
Pelvic dysfunction is common in pregnancy. The pelvis can become very hypermobile (too much mobility) due to the hormonal changes that occur with pregnancy. This can affect the pelvis and lower spine.
Muscles that attach to the bones of the pelvis, the sacrum, the coccyx, the hips and the lumbar spine may be overloaded as they attempt to compensate for an increase in movement and lack of stability. They can also develop increased tone, leading to the development of trigger points.
Studies have shown that asymmetry between the two sides of the pelvis (often with hypermobility on one side and hypomobility on the other) is a major cause of pain. The following are all relatively common:
- Pelvic dysfunction where the pelvis is held in poorly aligned posture due to abnormal muscle contraction.
- Pubis symphysis separation, where there is instability and loss of alignment.
- Sacral torsion, where the sacrum rotates or bends from its central position.
- Lumbosacral dysfunction where the lumbar vertebrae become involved.
- Pelvic rotations where the pelvic bone rotates forwards or backwards in relation to the other side.
Physiotherapy treatment involves the restoration of correct pelvic movement and positioning. This is vital to maintain efficient movement between the pelvis and spine. Manual therapy techniques help the pelvis and lumbar spine move while motor re-education allows normal movement patterns. Core exercises provide the pelvis with the stability it requires when dysfunction has occurred.
Correct rehabilitation of the pelvic floor is also central to treatment of Pelvic Girdle Pain.
Prolapse is caused by lack of support from the ligaments and fascial structures attached to the organs.
Treatment is through targeted muscle rehabilitation, a home exercise program, lifestyle changes and postural changes. The aim is to improve pelvic organ position and reduce awareness of discomfort.
Physiotherapy for Prolapse
Prolapse can mean descent of the:
- Front wall of the vagina and the bladder (cystocele).
- Urethra (urethrocele).
- Back wall of the vagina and the rectum (rectocele).
- Upper vaginal support to bowel (enterocele).
- Rectum (rectal prolapse).
Prolapse can be as a result of childbirth or sometimes happens with chronic constipation. A smaller number of people can even have descent with no reason at all.
Physiotherapy can be effective in strengthening/stabilising the pelvic floor muscles. These muscles act as a hammock or shelf for the organs to rest on.
The aim of treatment is to maximize the action of the muscles, to achieve a better level of comfort and reduce awareness of the prolapse. This is achieved through targeted muscle rehabilitation, a home exercise program, lifestyle and postural changes as well as general advice to optimise improvement.