From urinary incontinence to prolapse, pelvic pain to constipation, there is growing evidence that physiotherapy can alleviate, and in many cases, cure these conditions.

Urinary incontinence is an involuntary loss of urine, occurring in roughly 6 out of 10 women. While some experience it during coughing, sneezing, laughing, and exercise, others report it as an “urgency,” or even, incomplete urination.

The “pelvic floor” muscles support the pelvic organs and form the birth canal, as well as form passages for urine and stools. These muscles need to contract effectively to hold the urine, but they must also relax to allow for urination, bowel movements, childbirth and sexual intercourse.

Urinary incontinence develops when the pelvic floor muscles become too weak to support the pelvic organs. It could be triggered by: trauma, surgery, childbirth, aging and overactive detrusor. If neglected, weak pelvic floor muscles lead to pelvic organ prolapse.

Physiotherapy can reverse the symptoms of urinary incontinence. The treatment includes:

• Pelvic floor re-training and exercises.

• Provision of pelvic floor educators/muscle stimulators to improve your activation and power of your pelvic floor contraction.

• Core stability training.

• Assessment and treatment of any low back/pelvic pain issues, which can lead to weakness of the pelvic floor muscles.

Pelvic Pain

• “Hypertonia” is a condition in which there is too much muscle tone, such that arms or legs, for example, are stiff and difficult to move.

• When the pelvic floor muscles are hypertonic, they can cause pelvic pain, urinary frequency, urgency, incomplete emptying and painful urination, as the muscles are unable to fully relax to allow urine to flow freely. One may also experience pelvic pain as constipation or an unexplained pain in the lower back, pelvic region or genital area during/after intercourse.

Following an assessment, treatment for the symptoms of an hypertonic pelvic floor may include:

• Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myofascial stretches

Myo-fascial release of the connective tissue of the abdomen, hips and pelvis, which support the pelvic floor:

• Relaxation and breathing techniques

• Advice on toileting and positional modifications

• Provision of vaginal dilators, pelvic floor educators to assist in the release and relaxation of pelvic muscles

• Assessment and treatment of any unresolved low back, hip or pelvic pain Physiotherapy During Pregnancy

During pregnancy, whilst 1 in 3 women experience low back pain, 1 in 5 experience pelvic girdle pain. These symptoms often occur due to hormonal changes and the ever-increasing weight of your baby and uterus.

A Women’s Health Physiotherapist ensures that you are doing the correct exercises to maintain a strong lower back and pelvic floor, throughout your pregnancy and beyond. Treatments include:

• Mobility exercises for spine

• Connective tissue release of the abdomen, back, hips and pelvis

• Pelvic stability exercises

• Advice on sleeping positions, exercise and movement modification

The immediate weeks after the birth of your baby is an important time for your body, as it would have undergone many changes during pregnancy and continues to change postnatally. It is important to address any issues that occur at this time, so as to prevent problems later in life.

Childbirth can lead to pelvic floor trauma, perineal tears and pudendal nerve injury (the nerve carrying sensation to your bladder and pelvic floor). Consequently, the pelvic floor can become dysfunctional and you may experience urinary or bowel urgency, incontinence, urinary frequency, incomplete emptying and pain during sexual intercourse.

A pelvic floor assessment is important to establish the cause of these symptoms. A Women’s Health Physiotherapist can conduct the assessment after your 6-week Post Natal check up. Treatment may include:

• Pelvic floor re-training and exercises.

• Provision of pelvic floor educators/muscle stimulators to improve your activation and power of your pelvic floor contraction.

• Internal manual therapy techniques to relax the pelvic floor muscles, including trigger point release, myo-fascial stretches, scar massage, neural mobilisations.

• Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor.

• Relaxation and breathing techniques.

• Provision of pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles.

• Provision of vaginal dilators, pelvic floor educators or muscle stimulators to assist in the release and relaxation of pelvic muscles.

• Assessment and treatment of any unresolved low back, hip or pelvic pain.

Diastasis Recti and Exercise After Pregnancy

• A Women’s Health Physiotherapist can advise on exercise after pregnancy and the healing of separated abdominal muscles, known as “Diastasis Recti”.

• Diastasis recti is the partial or complete separation of the rectus abdominis muscle, or the “six-pack” muscles, which meet at the midline of your stomach. When these muscles are overstretched during pregnancy, they often separate, making it harder for you to regain your flat tummy.

• Therefore, it is advisable for a new mother to be assessed, and if necessary, treated for diastasis recti, before she starts her regular abdominal workouts. This assessment can be carried out after 6 weeks of vaginal delivery or 8 weeks after the C-section.