Pelvic Floor Physiotherapy

In the initial consultation with your Pelvic Floor Physiotherapist, you can expect that your Physiotherapist will take a comprehensive medical and social history from you and may ask specific questions relating to your bladder/bowel/sexual health and obstetric history. They will also ask what lead you to making the appointment, as well as what your goals are for Physiotherapy. This will all help with individualised and holistic treatment planning.

Pelvic floor assessment

A important component of the initial consultation is the examination of your pelvic floor muscles. The ultimate goal with any pelvic floor assessment is to evaluate how well you are able to contract and relax these muscles, to determine how strong these muscles are and their level of coordination and timing. The assessment will assist in improving your awareness of these muscles and give you confidence to perform exercises for these muscles independently and with the correct technique.

There are many ways in which we can assess your muscles, and making sure you are well informed of each assessment technique and the strengths/weaknesses is important. We are committed to ensuring your experience is comfortable and, therefore, we will only use the methods of examination that you are most comfortable with.

The gold standard and most thorough form of assessment for your pelvic floor muscles is via an internal vaginal or rectal examination. This is a gentle and sensitive assessment, where a gloved finger is inserted into the vagina or rectum, to assess the pelvic tissues and pelvic floor muscles. No equipment is needed, so it is very different to having a PAP test for example, and no pain should be experienced.

If you do not feel comfortable with an internal examinationo, or if it's not the best assessment option for you, your Pelvic Floor Physiotherapist may suggest an external examination or ultrasound examination of your muscles instead. An external pelvic floor muscle examination is where your muscles can be assessed externally by feeling the muscles around your pelvis. This is very similar to how other muscles in the body can be assessed.

Ultrasound

Real-time ultrasound imaging is an external examination option. This is where an ultrasound probe is placed over the lower region of your abdomen to visualise where your bladder sits above your pelvic floor muscles. With pelvic floor muscle contraction and relaxation, movement of the bladder may be visible.

The Pelvic Floor

The pelvic floor muscles are a group of muscles arranged like a sling that sit at the floor/base of the pelvis. They attach from the pubic bone at the front of the pelvis, all the way back to the coccyx/tail bone, and to our sit bones either side– almost forming a diamond shaped structure.

Pelvic floor muscles help to:

Support for your pelvic organs and ligaments
Maintain good bladder and bowel control and function
Support increased weight of the baby during pregnancy and stretch to assist with delivery
Enhance sensation during sexual intercourse and optimise sexual function

Your pelvic floor + core + diaphragm muscles

Pelvic floor muscles form the base of our core area, whilst the diaphragm is at the top. These two muscle groups work with low back and abdominal muscles, to support the abdominal contents. If one muscle isn’t working at its optimum function, it may influence how effective the others function to support this region.

Signs of a "dysfunctional" pelvic floor muscle (not necessarily a "weak" pelvic floor muscle)

Leakage of urine, wind or faeces
Urgency to get to the toilet or difficulty holding on
Incomplete bladder emptying
Urinary or faecal frequency
Pelvic organ prolapse
Sexual dysfunction – pain or reduced sensation
Problems with emptying bowels
Constipation or incontinence
Pelvic pain

Pelvic floor muscle function may be affected or influenced by:

Pregnancy and child birth
MenopauseSurgery - both abdominal, vaginal and prostate, and spinal/hip surgery
Gynaecological cancer and subsequent treatments
Lumbar spine/low back/hip injury or muscle dysfunction
Anxiety and stress
Pain – from injuries or conditions such as endometriosis, PCOS and thrush