Pelvic Floor Rehab / Physiotherapy

* Note that the perineal physiotherapy service for men is only available at the Montreal clinic.

Perineal Physiotherapy Or Pelvic-perineal Rehabilitation:

PHYSIOTHERAPY SERVICES

In addition to a second cycle university diploma (master’s) to become a physiotherapist, the physiotherapist specializing in perineal rehabilitation has advanced post-graduate training in the field.

What is perineal rehabilitation?

Perineal rehabilitation, also called pelvic-perineal rehabilitation, treats health problems related to the pelvic floor.

The pelvic floor is the name given to the group of muscles and other structures that form the base of the pelvis. Its role is primarily to support the bladder, urethra, rectum and uterus. These same muscles are used to retain and then evacuate urine, stool and gas at the appropriate times. The pelvic floor also has a sexual function since it is involved in the adequate perception of sensations during sex and during orgasm.

Like other muscles in the body, pelvic floor muscles can become dysfunctional as a result of various conditions.

The role of the physiotherapist specializing in perineal rehabilitation is first of all to make a detailed assessment in order to find the precise source of this problem. Once the dysfunction has been identified, the physiotherapist can establish an appropriate treatment plan with you.

The objective of this treatment plan is to restore control, level of strength and endurance of the pelvic muscles or to relax them in order to help the person regain adequate functioning of the urinary, anorectal and / or vulvovaginal systems. . This regained control will often eliminate or improve the abnormal symptoms affecting your urinary system, perineal or anorectal area.

What kinds of problems can be treated in perineal rehabilitation?

In men and women:

– Pelvic, perineal, anorectal and coccygeal pain

– Urinary incontinence: involuntary loss of urine

– Overactive bladder: urgent and frequent urges to urinate

– Anal incontinence: involuntary loss of stool or gas

– Difficulty / pain in passing stool: constipation problem, anal assynchronism

– Prolapse: descent of the uterus, bladder, rectum or small intestine

– Perinatal

– Diastasis: separation of the abdominals following pregnancy

What does the perineal rehabilitation treatment consist

The role of the physiotherapist specializing in perineal rehabilitation is first to make a detailed assessment in order to find the precise source of your problem. Once the dysfunction has been identified, the physiotherapist can establish an appropriate treatment plan with you. The exact nature of the treatment depends on the type of problem for which you are seeing. As a general rule, perineal rehabilitation treatments consist of:

– manual therapy (internal and external techniques);

– rehabilitation of muscle control of the pelvic floor and other muscles of the pelvis;

– exercises and advice.

You should plan on average between 3 to 10 visits, depending on your problem.

Female Specific Pelvic Perineal Pain

The terms dyspareunia , vulvodynia , vaginismus , vestibulitis and vestibulodynia are frequently used to make a diagnosis when there is a problem with pain in the perineal region in women.

Dyspareunia

Dyspareunia is defined as pain on vaginal penetration. It is therefore a general diagnosis that encompasses other conditions such as vestibulodynia, vaginismus, vulvodynia and pain caused by vaginal atrophy. It is estimated that about one in five women report having pain during sex. This problem is therefore quite common. Unfortunately, few healthcare professionals are trained to recognize and diagnose these conditions. You may therefore be referred to several people before getting the correct diagnosis. In addition, patients with painful intercourse are frequently mistakenly treated for vaginal infections. If your pain persists despite taking medication or cream to treat vaginitis,

Another diagnosis frequently made in patients reporting pain in sexual relations is that of a problem of a psychological nature (anxiety, aversion to sexuality, etc.) The patient’s symptoms are then often minimized or even a simple referral to the psychologist. or sex therapist is made. While there may indeed be a psychological component, this usually explains only one part of the problem. It may therefore be necessary to consult a physiotherapist in parallel with the treatments with the psychologist / sexologist to identify all the components of the problem.

Vestibulodynia / Vestibulitis

Vestibulodynia (formerly called vestibulitis) is characterized by pain when entering the vagina often described as a burning and / or tearing. There are two types of vestibulodynia. Induced vestibulodynia manifests itself only at the time of penetration (intercourse, insertion of a tampon or pelvic exam), while unprovoked vestibulodynia manifests with or without penetration. In both cases, this problem is often caused by an increase in muscle tension in the pelvic floor. Vestibulodynia frequently occurs following episodes of recurrent urinary and / or vaginal infection or following other trauma in the pelvic region.

Vulvodynia

Vulvodynia is characterized by pain in the vulva. This can occur during sexual relations or spontaneously. It can be very localized or generalized over the entire vulvar region.

Vulvodynia is frequently reported by patients with other pathologies affecting the urinary or digestive system, such as interstitial cystitis, irritable bowel syndrome or Crohn’s disease. In these patients, part of the pain can also be explained by a contraction of the pelvic floor in reaction to the pathology. Although physiotherapy cannot by itself cure these conditions, it can help reduce the pain associated with them.

Vaginismus

Vaginismus is similar to vestibulodynia in the location and type of pain reported by patients. While vestibulodynia makes penetration painful, penetration is usually downright impossible with vaginismus. This condition is related to involuntary spasms of the pelvic floor and usually manifests itself during the first sexual intercourse or gynecological examinations.

Postpartum And Postoperative Pain

Pelvic-perineal pain frequently occurs following childbirth or surgery, since these situations create lesions which subsequently form adhesions and scars. Stiff scars decrease the flexibility of the tissues of the vagina which can make penetration painful. In addition, the trauma of childbirth or surgery can cause a contraction of the pelvic floor which can also be the source of pain.

Vaginal Atrophy Following Menopause Or Radiation Therapy

The hormonal changes that accompany menopause can create vaginal atrophy, which is characterized by a decrease in the flexibility of the walls of the vagina. It therefore becomes narrower. The same phenomenon can occur following radiation therapy or brachytherapy in the pelvic area. This atrophy can cause pain in intercourse. Physiotherapy can help reduce this pain by promoting better elasticity of the tissues of the vagina.

Perineal rehabilitation in pregnant women (perinatal)

Consulting a physiotherapist specializing in perineal rehabilitation during pregnancy and after childbirth promotes optimal recovery of the pelvic floor muscles. In addition, your physiotherapist can help you treat several musculoskeletal problems that manifest themselves throughout pregnancy, such as pain in the lumbar region, the back region, the pubic symphysis. Physiotherapist can also help with urinary incontinence. Even in the absence of symptoms, a consultation in perineal rehabilitation is recommended in pregnant women to allow the adequate teaching of exercises for strengthening and softening the pelvic floor, as well as pushing techniques that will be very useful to you. ‘delivery.

Abdominal diastasis

Abdominal diastasis is characterized by a separation of the abdominals which typically occurs following pregnancy. This can be associated with lower back pain and exarcerate problems of urinary incontinence and descent of organs already present. Your perineal rehabilitation physiotherapist can help you reduce your diastasis by teaching exercises and advice specific to your condition.

Male-specific pelvic-perineal pain (prostatitis)

Pelvic pain is the main cause of men’s visits to the urologist. These pains can be localized in the penis, rectum, testicles and lower abdomen. They typically occur during erection and ejaculation, but can also be experienced in other circumstances such as when sitting for a long time. Pelvic pain can be associated with other symptoms such as erectile dysfunction, numbness in the perineal area, trouble with bowel movements, and frequent urination. When a patient consults for this type of pain, the diagnosis of prostatitis is frequently made. The term prostatodynia is also sometimes used. While it was once taken for granted that this type of pain was related to inflammation or infection of the prostate, current scientific evidence shows that 90% of prostatitis is actually related to pelvic floor dysfunction. called chronic pelvic pain syndrome. It may therefore be relevant to consult a physiotherapist in perineal rehabilitation if:

1 – You suffer from pelvic pain (penis, testicles, glans, pubis, anorectal, coccyx)

2 – Your doctor has not identified objective signs of infection or specific medical conditions that could explain your pain (urine culture, analysis of prostate fluid and inconclusive blood test)

3 – Your symptoms have not improved after taking antibiotics or alpha blockers prescribed by your doctor.

Pelvic pain can frequently be caused by spasms of the pelvic floor muscles. These spasms can be the result of a fall, pelvic surgery such as a vasectomy, repetitive lifting, prolonged sitting (e.g. cycling), sexual abuse or a chest problem. or lumbar. When the problem is muscular in nature, your perineal rehabilitation physiotherapist can help you reduce your pain.

Post-prostatectomy urinary incontinence

A high proportion of men who have had prostate surgery report suffering from urinary leakage. This problem is explained by the fact that some structures of the urinary tract, as well as the mechanisms of the bladder, may have been altered by the surgery. Leakage can also be accompanied by an urgent and frequent urge to urinate, as well as erectile problems. Urinary incontinence usually resolves within 6 to 9 months after surgery, but may persist in some cases. The goal of physiotherapy before and / or after surgery is to speed up the return to full continence. Treatments usually consist of teaching exercises to strengthen the muscles of the pelvic floor, as well as in several relevant tips that can improve your situation (nutrition, hydration habits, constipation etc.). In general, you can plan an average of 3 to 5 treatments for this condition.

Pain in the perineum area which may be present in both women and men

Anorectal pain

Fleeting proctalgia (proctalgia fugax) is a condition that is characterized by very intense and spontaneous pain in the rectum. This can last from a few seconds up to 20 minutes. It is often the result of a cramp in the muscles of the pelvic floor which can, among other things, be triggered by orgasm or during sleep. It can affect both men and women. Your physiotherapist specializing in perineal rehabilitation can help you manage this pain.

Coccygeal pain

Tailbone pain often occurs after a fall or any other trauma to the pelvis, such as childbirth. The tailbone is one of the attachment points of the pelvic floor, and dysfunction of this musculature can therefore contribute to pain in this region. Although coccygeal pain can frequently be treated with various external techniques, it may sometimes be necessary to use internal techniques (anal) to permanently treat the problem. Your physiotherapist specializing in perineal rehabilitation has the necessary training to perform such techniques and thus relieve your pain.

Pudendal Nerve Neuralgia Or Pudendal Nerve Syndrome

Pudendal nerve syndrome is characterized by burning and / or numbness in the rectal area and genitals, which may radiate to the thighs. It affects both men and women. The pain can be constant or intermittent and tends to increase with prolonged sitting. This syndrome can be accompanied by urinary, faecal and sexual problems. It can occur after a fracture, surgery or trauma in the pelvic area. It can also be caused by prolonged activity while sitting. Irritation or compression of the pudendal nerve (by the bones, muscles or pelvic ligaments) is the cause of this problem.

It should be noted that although the pudendal nerve syndrome is the best known, other pelvic nerves (ilio-inguinal, ilio-hypogastric, genitofemoral) can also be irritated or compressed and thus be the cause of your symptoms. pains.

Urinary Incontinence

Urinary incontinence is any involuntary loss of urine regardless of the amount or the context. There are different types of urinary incontinence. It is therefore important to determine precisely with your physiotherapist through a complete evaluation, the precise factors that contribute to your leaks and thus be able to determine a treatment plan specific to your condition.

Stress Urinary Incontinence

Urinary stress incontinence is the most common form. It is most commonly seen by laughing, coughing, sneezing, changing position, jumping, lifting a load, or exercising. This problem usually occurs when the pelvic floor muscles are weakened and can no longer contract enough or at the right time to prevent urine loss. For this reason, urinary incontinence is often associated with pregnancy and childbirth even several years after it. Stress incontinence can also occur when the pelvic floor is too tight, preventing normal and optimal muscle contraction. It is therefore common that women of all ages who have never had children report having urine leakage.

Urge Urinary Incontinence

Urge urinary incontinence is characterized by involuntary loss of urine accompanying or preceding an urgent need to urinate. People with urge urinary incontinence also tend to have more frequent urges to urinate. Involuntary bladder contractions sometimes associated with weak pelvic floor muscles can cause these problems. These can be exacerbated by inadequate urination and hydration habits, as well as the presence of certain irritants in the diet.

Mixed urinary incontinence

Mixed urinary incontinence is defined by urinary leakage which occurs both during exertion and in emergency. The treatments for urinary incontinence in physiotherapy generally consist of teaching exercises to strengthen (or sometimes relax) the muscles of the pelvic floor, as well as several relevant tips that can improve your situation (nutrition, hydration habits, constipation etc.) Usually 5 to 8 treatments are planned for the treatment of these conditions.

Anal Incontinence (Fecal Incontinence And / Or Gas Incontinence)

Anal incontinence is characterized by the involuntary loss of elements of the rectum whether it is stool or gas. There are various factors that can cause anal incontinence. These can be muscular (weakness of the pelvic floor or change in sensitivity of the rectum), neurological (damage to the pelvic nerves) or pathological (disease of the digestive system such as irritable bowel syndrome or Crohn’s disease).

Physiotherapy can help solve your problem with anal incontinence when it has a muscle component. The treatments consist of teaching pelvic floor exercises, rehabilitation techniques for normal rectal sensitivity and relevant advice that can improve your situation (nutrition, hydration habits, evacuation habits etc. typically 5 to 8 treatments for the treatment of this condition.

Difficulty Passing Stools (Constipation And / Or Pain)

Complete and painless bowel movements require adequate relaxation of the pelvic floor muscles to allow the anal sphincters to open. In some people, this muscle relaxation is incomplete or even absent (anal assynchronism), making it difficult and painful to pass stool. Rehabilitation of pelvic floor muscle control can help correct this problem. In addition, other factors such as toilet positioning, diet, hydration and level of physical activity can influence your evacuation problems and will therefore be addressed by your physiotherapist.

Pelvic Prolapse (Organ Descent)

A pelvic prolapse is characterized by the descent of one or more organs of the pelvic cavity whether it is the bladder (cystocele), the uterus (hysterocele), the rectum (rectocele), the small intestine (enterocele) or the urethra (urethrocele). Organ descents are usually the result of a lack of support normally provided by the pelvic floor muscles and pelvic ligaments. This problem is common in women who have had children, but also in those with chronic constipation disorders or respiratory problems causing frequent coughing. Physiotherapy treatments consist of teaching breathing exercises, strengthening the muscles of the pelvis and teaching any relevant advice that could improve your situation (nutrition, posture, hydration habits, evacuation habit, constipation, training techniques etc.). In some cases, the prescription of a pessary (a vaginal prosthesis providing organ support) may be relevant. Your physiotherapist can ensure the proper fit and follow-up for wearing the pessary. You should plan an average of 5 to 8 visits for the treatment of pelvic prolapse.

Scientific Evidence Supporting The Use Of Perineal Physiotherapy

Urinary incontinence

– The pelvic floor training in an important way during and after childbirth prevents urinary incontinence in women

(Siv Mørkved et al. 2013. Pelvic floor muscle training during pregnancy to prevent urinary incontinence: a single-blind randomized controlled trial. Obstetrics & Gynecology, Volume 101, Issue 2, February 2003, Pages 313-319.)

– The use of electrical stimulation coupled with physiotherapy for pelvic floor rehabilitation in cases of urinary incontinence reports a significant improvement in pelvic floor strength, as well as a marked reduction in urinary leakage.

(Amaro J, Oliveira Gameiro M, Padovani C. Treatment of urinary stress incontinence by intravaginal electrical stimulation and pelvic floor physiotherapy. Int Urogynecol J. 2003; 14 (3): 204-8.)

Pain in the vaginal and perineal area

– 51.4% of women with vestibulodynia treated in physiotherapy using pelvic-perineal rehabilitation, including biofeedback, report a significant improvement in the intensity of pain during sexual relations.

(Bergeron et al. 2002. Physical therapy for vulvar vestibulitis syndrome: A retrospective study. Journal of Sex and Marital Therapy, 28, 183-192.)

– 83% of women with induced vestibulodynia who received physiotherapy treatment with biofeedbak reported having a significant reduction in their pain and 83% of them regained an active sex life following treatment.

(McKay et al. 2001. Treating vulvar vestibulitis with electromyographic biofeedback of pelvic floor musculature. J Reprod Med, 46, 337-342.)

– After 8 physiotherapy treatments, 10 out of 13 women with induced vestibulodynia reported having a significant decrease in the intensity of pain during sexual intercourse.

(Goldfinger et al. 2009. A Prospective Study of Pelvic Floor Physical Therapy: Pain and Psychosexual Outcomes in Provoked Vestibulodynia. J Sex Med, 6: 1955-1958.) 1968.