Pelviperineal physiotherapy is a therapeutic discipline that makes it possible to assess and treat pelvic floor and sexual dysfunctions, supporting women through pregnancy, birth, the postpartum period and the menopause, and men mainly after prostate surgery.
But not only them: preventive or rehabilitative treatment can also be needed by women who have not given birth and are not perimenopausal, as well as by men who have never had a prostatectomy.
Even children can have pelvic floor problems if, for example, they are still wetting the bed beyond the age of seven (enuresis, or night-time urinary incontinence), and so can women who do high-impact sport (running, tennis, athletics, weightlifting).
These are some of the pelvic floor dysfunctions that pelviperineal physiotherapy can help with:
- Urinary incontinence
- Urinary urgency
- Frequent urination
- Faecal incontinence or leakage of wind
- Descent of the organs (prolapse)
- Perineal pain
- Obstructed defecation
- During pregnancy, as prevention
- In the postpartum period, as rehabilitation
- Sexual dysfunction (dyspareunia, vaginismus, erectile dysfunction)
These muscles can be affected in anyone, but it is most common in women who have had one or more births.
For various reasons, talking about this is still not very common, and patients see their quality of life reduced out of embarrassment or because they do not know that highly effective and accessible forms of treatment exist, physiotherapy among them.
What symptoms does pelvic floor dysfunction cause?
The most frequent symptoms of the dysfunctions the pelvic floor can suffer are:
- Lower back and pelvic pain, both acute and chronic.
- Urinary or faecal incontinence, or leakage of wind.
- Prolapse of the pelvic organs.
- Sexual dysfunction.
All of these can be treated with physiotherapy techniques and physical exercise. These therapies should be prescribed by a professional, who will take a clinical history and carry out a thorough physical examination in order to tailor the treatment and achieve the greatest possible benefit.
What happens in a first pelvic floor physiotherapy session?
- First, we ask a series of questions covering urogynaecological and obstetric history as well as habits, emotional impact and current physical condition.
- Next, the hypothesis formed in the first part of the session is confirmed through assessment and physical examination.
- Finally, we design a treatment plan intended to achieve the patient’s goals, with the physiotherapist’s guidance and supervision.
What physiotherapy techniques are used to treat the pelvic floor?
Treatment is approached differently depending on the person and the symptoms they present. Some of the techniques used are:
- Anatomical awareness of the area.
- Muscle training through guided exercises.
- Massage, myofascial therapy, stretching and treatment of muscle contractures or related areas.
- Behavioural training of bladder habits.
- Electrostimulation.
- Abdominal and hypopressive exercises.
Conclusions and benefits of pelvic floor physiotherapy
In conclusion, pelvic floor physiotherapy is a highly effective and beneficial tool, one that can put an end to problems such as incontinence and pain, as well as reducing and controlling the symptoms of prolapse in this area. It also improves the physical wellbeing of women hoping to become pregnant, and the treatment is very positive both during pregnancy and afterwards. Giving the subject visibility and offering a good service can therefore go a long way towards supporting the comfort, health and self-esteem of many people, and improving patients’ quality of life in general.
Why physical preparation matters during pregnancy
Over the 40 weeks of pregnancy, a woman’s body goes through a metamorphosis in every sense, one that can push the body to its limit at certain moments.
At a musculoskeletal level, as the end of pregnancy approaches the centre of gravity shifts, forcing the lower back to increase its physiological lordosis. That ends up producing a hyperlordosis, so the lumbar facet joints press together and the muscles tighten, causing lower back pain. At the same time the sacroiliac joints of the pelvis are forced to move more, which causes inflammation in those structures (sacroiliitis). All the weight the mother gains is carried by the feet and knees, which usually end up swelling because of poor circulation in the area, caused by the pressure the bump places on the inguinal lymph nodes.
At a systemic level, all the internal organs are affected, because the baby takes up the space they normally occupy. Their mobility is reduced and their function is somewhat altered.
Because of this, the mother may experience urine leakage and urinary infections, poor digestion and reflux, constipation and wind, gestational diabetes, high blood pressure, liver congestion, fatigue and so on.
All of the above may sound like an exaggeration, but it is genuinely what happens. Some women suffer it more than others depending on their physical and general health before pregnancy, but above all depending on whether they stay as active and as fit as possible during it.
Exercise and a healthy life (diet, rest and so on) are the only tools that can make all these symptoms as manageable as possible. Doing cardiovascular exercise during pregnancy, for example, helps keep the circulation working well and so avoids swollen legs and pain in the feet, knees and hips, and even constipation. In the same way, strength work helps you feel more agile, cope better with the extra weight and have less back pain.
And do not forget that at the end of pregnancy comes the birth!
Birth is not something to fear, but you do need to be aware that it is an endurance event, and that in first-time mothers it is considered normal for it to last 12 hours or more.
So the fitter we are, the better we will cope both with the muscular fatigue of dilation and delivery and with the cardiovascular fatigue of the effort the whole process demands.
It is also worth bearing in mind that the better our physical condition during pregnancy and birth, the faster the recovery will be afterwards and through the postpartum period.
And remember that after all of it we still have to look after the baby, which takes a great deal of energy and effort. The baby gains weight day by day and we have to carry them, for most things and for at least the first year: feeding, nappy changes, getting them to sleep, settling them and so on.