Pelvic Health – for ANYONE!

The public is becoming more aware of the benefits of pelvic floor physiotherapy (PFPT). When we first opened in Warman in 2014, about 20-25% of people had even heard of PFPT! Now there appears to be an assumption that leakage or pelvic floor pain issues ONLY happen to people that have had kids. That it can’t happen for those who have never been pregnant or given birth before – but that is not the case!

Pelvic Floor Dysfunction

There are people of all backgrounds and ages of any gender, who suffer from pelvic floor problems. There are many different reasons for why this may be the case. First, here are some issues that are common symptoms:

  • low back or hip pain
  • leaking of urine (or stool)
  • pain (with intercourse or otherwise)
  • night wetting (or waking to void)
  • constipation
  • hemorrhoids
  • pressure/heaviness (feeling like things will fall down/out)
  • tailbone pain
  • pelvic girdle pain (SIJ, hips, pubic symphysis)

 

Some of the reasons for pelvic floor dysfunction include post op complications or side effects from surgeries performed in the abdominal or pelvic region, radiation therapy to the pelvis due to pelvic cancers, prostate issues, and menopause. Stress, anxiety, and overall pressure system problems can also be an underlying cause.

Weigh the Risk

There are some risk factors that may contribute to leakage of the bladder including:

  • chronic strain to the pelvic floor from a persistent cough (ie smoking or asthma/COPD)
  • chronic constipation
  • highly athletic populations (especially with a vagina)
  • individuals that have obstetric injuries
  • someone that has had trauma to the pelvis
  • anyone that has received abdominal surgery

Our athletes in particular may have some leakage issues or heaviness/prolapse symptoms. This may be associated with heavy lifting or running/jumping sports due to the strain that can be placed on the pelvic floor with these activities. The exercise itself is unlikely to be the culprit, but the strategies being used may be contributing.

 

The Pelvic Floor and What you Consume

There are some behavioral components that may impact urinary leakage as well including:

  • consuming or drinking caffeine(!!) and carbonated beverages
  • spicy foods
  • citrus foods
  • alcohol (red wine in particular!)

 

Our Pelvic Floor Helps us Compensate

Sometimes anxiety can have a role as well if we have a tendency to hold too much tension in the pelvic floor muscles. This in turn can contribute to pelvic pain or incontinence issues – or even constipation!

People with chronic pain conditions such as:

  • endometriosis
  • irritable bowel syndrome
  • inflammatory bowel diseases
  • interstitial cystitis

…for example may have tightness in their pelvic floor muscles which may be contributing to some of their pain presentation. Sometimes back or hip pain can actually be originating from the pelvic floor. When someone has had “problems forever” and they haven’t seen a PFPT – this is often a good place to start.

 

How does PFPT Help?

A PFPT can be helpful as part of the medical care team in addressing pain that may be contributed to by the pelvic floor muscles. PFPT utilize various techniques, either with internal manual therapy techniques or external techniques. If the client is comfortable with internal, this via a vaginal or rectal exam. Some people are not comfortable and we can proceed with education and exercises for relaxation/stretching of these muscles.

 

If there is urinary leakage then there can be behavioural techniques that a pelvic floor physiotherapist can teach to help address these issues. This is especially true if there is leakage preceded by a strong urge to pee. Should there be weakness of the muscles then this can contribute to leakage of the bladder or bowel as well. Although this weakness is not a common finding, it can happen post operatively in the pelvis or abdomen. Regardless of the reason, a PFPT can be helpful in teaching specific exercises to address the issues.

 

If you are having problems with any of these issues seeing a pelvic floor physiotherapist may be beneficial:

  • leaking with laughing/coughing/sneezing
  • leaking due to urgency of the bladder
  • chronic constipation
  • pain with intercourse
  • pelvic pain/low back or hip pain (especially if addressing the back and hip tissues with prior rehab does not appear to be resolving the issue)

If you are finding yourself worried about what to expect as an adult coming for a first appointment, check out this blog!

 

Ready to take control? Book your assessment today in Warman HERE and in Saskatoon HERE

 

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Physio for your… Behind?! Anorectal Disorders Explained!

Pelvic floor physiotherapists are physios who have had additional training to perform external and internal pelvic exams in order to treat a variety of pelvic floor disorders. Among those disorders include some that pertain to the dysfunction of the bowel – your behind. These anorectal disorders may include

  • Leaking of stool from the rectum (fecal incontinence)
  • Inability to control flatulence (being unable to hold back a fart)
  • Chronic constipation
  • OASIS (obstetric anal sphincter injuries) which include 3rd or 4th degree perineal tears sustained during labour and delivery, rectocele, rectal prolapse, and pain disorders of the anus
There is something we can do to help!

Fecal incontinence refers to the uncontrolled passage of fecal material (aka poop) in individuals who are 4 years old or older. There can be various reasons why fecal incontinence may be present. There may be damage to the internal or external anal sphincters during OASIS. Radiation therapy for certain pelvic cancers may have reduced the ability of the rectum to stretch contributing to incontinence, stool consistency may be too liquid making it difficult for the sphincters to stop the feces from exiting the anus (possibly due to partial bowel resection surgery due to various medical conditions. Food intolerances/poor diet may also cause stool consistency to be too loose. There may be some weakness in the external anal sphincter muscle or the puborectalis portion of the levator ani muscle (the main pelvic floor muscle group) contributing to leakage of stool.

Some leakage can be due to nerve disorders (example multiple sclerosis). Sometimes even chronic constipation can be a source of loose stools leading to fecal incontinence!

 

What does it mean to have a 3rd or 4th degree tear during labour and delivery?

A 3rd degree tear is a tear into the external anal sphincter and a 4th degree tear includes tearing into the internal anal sphincter. These two sphincters are what control the exit of the stool and gas out at the anus from the rectum. When there is a tear in the sphincters, the scar tissue that forms from the injury may cause problems. Common issues to these injuries include having pain during bowel movements and it can contribute to constipation. There can also be low tone of the IAS or EAS (internal or external sphincters) or weakness of the external anal sphincter that may cause fecal incontinence or difficulty with controlling an unwanted fart. Fecal urgency can also be a symptom following 3rd or 4th degree vaginal tears.

Even if there is no bowel dysfunction in the post partum period following labour and delivery with a 3rd or 4th degree tear, having a pelvic floor physiotherapist examine the pelvic floor and provide an individualized home exercise program to optimize the scar tissue mobility, pelvic floor mobility and strength, and provide education on optimization of defecation strategies. This can be very helpful as sometimes occult injuries (meaning those without obvious injury to the anal sphincters) are present. They could result in symptoms like fecal urgency and loss of control of farting or fecal incontinence later in life (post menopausal).

Proactive treatment can be beneficial in these cases!

Chronic constipation is often characterized by:

  • having a bowel movement less than 3 days/week
  • and/or a stool consistency on the Bristol Stool Chart of Type 1 or Type 2
  • history of very large bowel movements (plugging the toilet for instance)

A pelvic floor physiotherapist can be helpful in providing various strategies to assist with the evacuation of the bowels. Some basic recommendations may include:

  • general advice on fibre and fluid intake recommendations for optimal stool consistency
  • activity recommendations
  • manual therapy techniques to assist with motility of the stool through the rectum
  • education on various physical evacuation strategies
  • breathing techniques to assist with optimal bowel evacuation
  • minimization/elimination of straining

 

 

 

For those suffering from prolapse, a physiotherapist can help by teaching optimal defecation techniques to reduce strain to the area, thereby reducing strain to the tissues. There may also be too much tension in the pelvic floor muscles or there may be scar tissue present from obstetrical or other surgical injuries which can lead to pain in the pelvic floor or anus with or without having a poop.

Struggling? Book online with a physiotherapist today in Warman at Warman Physiotherapy & Wellness or Saskatoon, at Warman Physio Saskatoon. Don’t see a spot that works? Add yourself to the waitlist! You can even select if you have a therapist, location, and day/time preferences!

 

 

This post was created by Maja Stroh MPT and pelvic health physiotherapist at Warman Physiotherapy & Wellness

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