Pelvic Health Physiotherapy - Nelly Faghani Physiotherapist www.pelvichealthsolutions.ca
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Pelvic Health Physiotherapy
Canadian Federation of University Women
January 26, 2021
Nelly Faghani
Physiotherapist
www.pelvichealthsolutions.ca
Objectives • What is pelvic health (floor) physiotherapy? • Become familiar with conditions and evidence that a pelvic health physiotherapist can treat • Learn the components of a pelvic health physiotherapy assessment and treatment • Know when and how to find a pelvic health physiotherapist
Pelvic Floor Function
• Healthy muscles silently do their 1) Sphincter
job allowing us to function
without interruption
2) Support
• Most do not even know these
muscles exist
• Many people do absolutely 3) Sexual
nothing to ensure its good
health 4) Stability
1- Incontinence • Stress • Urge • Functional • Mixed
Social Consequences
• Decreased self esteem
• Impaired emotional status
• Depression/Isolation
• Impedes social activity
• Impedes physical activity
• Institutionalization
• Heavy economic burden on patients,
families and society
Urinary Incontinence
• Urinary Incontinence • Pelvic floor training is the first-line
• 1 in 3 women treatment for stress and mixed
urinary incontinence in women
(Level 1, Grade A evidence)
• HUGE impact on quality of life
• Only 1 in 12 known to health
care workers because:
• People may feel embarrassed
• Many thinks it’s normal
• Don’t want surgery
Overactive Bladder (OAB)
• Behavioral Training Level of Evidence
1b, Grade B
• Overall prevalence in Canadian
population estimated to be
13.9%- 18.1% Herschorn et al 2008, Corcos • Lifestyle change
et al 2004
• Address Constipation Level of Evidence
• OAB symptoms more common 3a, Grade B
with increasing age Herschorn et al 2008
• Tibial Nerve Stimulation(PTNS)
Level of Evidence 1b, Grade B
2 - Pelvic Organ Prolapse • Subjective disorder described as an annoying protrusion at or near the vaginal opening • May or may not be accompanied by perineal pressure • Aggravated by standing • Relieved by lying down
Pelvic Organ Prolapse
• 41.1% prevalence in • Pelvic floor training is effective &
postmenopausal women older cost-effective in reducing
than 60 years who have not had prolapse symptoms & should be
a hysterectomy recommended as first-line
management for prolapse (Hagen,
2011)
• High level of bothersome
• Huge impact on quality of life3 – Sexual • Orgasm, blood flow • Provide tone for the vaginal and rectal canals
Dyspareunia (Pain with Intercourse)
• 2 out of 3 women at some point in
their lives (2015 National Women’s • Physical therapy modalities such as
Health Resource Center) education, biofeedback, dilators,
electrical stimulation, multimodal
• 25-40% of postmenopausal women physical therapy and multidisciplinary
find sex painful approaches were effective for
decreasing pain during intercourse
and improving sexual function
• Causes (tight pelvic floor muscles, Morin et al 2017
poor accommodation, fear, poor
lubrication)4 - Stability • Assists in SIJ, pubic symphysis, sacrococcygeal, lumbo-pelvic and hip joints (Lee, Lee 2004, Hodges 2007) • Assists in unloading the spine (Sapsford 2001, Hodges 2007)
What is Pelvic Physiotherapy?
PT
• Evidenced based treatment of pelvic floor dysfunction (incontinence,
prolapse, overactive bladder, pre-post surgical, pelvic pain, bowel
dysfunction)
• Digital vaginal and/or rectal evaluation of the pelvic floor muscles by
specially trained physiotherapistsSubjective
Bladder
Listen to Bowel Outcome Self
Hope
their story Sexual Measures Efficacy
PainObjective Assessment
Global
Contributors
Breathing Posture
Central Pelvic
Connective
Nervous Floor Tissue
System FunctionHistory of Kegels • Dr. Kegel in 1940’s decided that women needed to exercise their pelvic floors • Used Perineometer • Used palpation (one finger) • Where are we now: • Verbal • Stop-sign, kitchen counter • Stop midstream urine
Current Practice • Simple verbal or written instruction does not constitute adequate training for a Kegel exercise program (Bump et al 1991) • Guidelines on the conservative management of urinary incontinence, the Society of Obstetricians and Gynecologists of Canada recommends that “proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback”
Kegels are Not “One Size Fits All”
Underactive/Hypotonicity Overactive/Hypertonicity
Incontinence Pelvic Pain
Pelvic Organ Prolapse UI/urgency/frequency
Kegels OK to do Dyspareunia
Constipation
Kegels NOT ok to doThe Psychology of the
Pelvic Floor
• Overactivity of the pelvic floor is not simply an
isolated dysfunction, but a physical manifestation
of the patient’s emotion state
• In cases of actual or imminent physical or mental
pain or anxiety the pelvic floor muscles will
involuntarily and often unconsciously, contract
• Learn how to lengthen (relax) your pelvic floor to
improve symptomsChronic Pelvic Pain • Physiotherapists are an important part of the health team in relation to chronic pelvic pain due to myofascial dysfunction Consensus Guidelines for the Management of CPP SOGC 2005
Pain Education • Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual and potential tissue damage Pain Definition by IASP 2020 • Thoughts are nerve impulses, and negative thinking alone can drive the pain Moseley 2008 • There is compelling evidence that pain education reduces pain, disability, catastrophization and improves physical performance Louw et al, 2012
Vulvar Care • Wash with water, avoid soaps • Wipe front to back after urination • Use organic or fragrance-free detergent • Use cotton disposable feminine hygiene products • Different pads for urinary incontinence • Always pads = NEVER • Use cotton underwear or sleep without underwear • Remove wet clothes immediately • Stay well hydrated
Bladder Irritants to Avoid • Caffeine • Alcohol • Spicy food • Citrus/acidic fruits and juices • Carbonated beverages • Artificial sweeteners
Bladder and Bowel Function
Virtual Physiotherapy
Benefits Limitations
• Easy and convenient • Don’t have required technology
• Prevents interruption of care • Technical issues
• Covered by many extended health • Not capable of performing hands-on
care providers physical assessment or treatmentWhat You Can Expect from a
Pelvic Floor Physiotherapist
• 1-1 assessment and treatment from a physiotherapist that has post-
graduate training in pelvic health that takes a biopsychosocial approach
• Education (vulvar care, diet modification, bowel and bladder retraining,
pain education, sleep education, meditation, CBT, mindfulness)
• Improved bowel and bladder routine
• Improved proprioception of the pelvic floor
• Individualized exercise program
• Manual therapy to treat pelvic floor over-activity & muscle imbalances
• Hope and self efficacyConditions We Treat
• Incontinence (stress, urge and • Vaginismus
mixed) • Vulvodynia (Provoked
• Urinary frequency/urgency Vestibulodynia)
• Prolapse • Endometriosis
• Constipation • Interstitial Cystitis/Painful Bladder
• Pregnancy & post-partum Syndrome
• Dyspareunia (pain with • Chronic Pelvic Pain Syndrome
intercourse) • Pudendal Neuralgia
• Coccydynia (tailbone pain)
• Pre/post surgical
•PREVENTION ☺How to Find a Pelvic Health Physiotherapist
www.pelvichealthsolutions.ca
www.opa.on.caFull Disclosure
Part Owner
• Aurora Prime Physiotherapy
• Aurora (905) 726-2252
• Complete Physiotherapy
• Richmond Hill (905) 883-8146
• The Physiotherapy Professionals
• Vaughan (905) 760-7767
• Advanced Pelvic Physiotherapy Centre
• Toronto (416) 977-3456You can also read
