Some health issues are not making the headlines, but still affect the quality of life of many women, as well as men …

For example:

1. Bladder problems
   • Urine loss (following delivery, after prostate surgery or at any age);
   • Urinate frequently;
   • Urinate with difficulty;
   • Having to run to the restroom.

1. Rectum and anus related problems
   • Stool loss;
   • Defecate with difficulty;
   • Painful defecation;
   • Anal pain.

1. Vulva and vagina problems
   • Difficulty or impossibility to penetrate;
   • Painful sexual intercourse
   • Vulva, clitoris and vestibule pain.

These problems can be treated with a specialized approach in physiotherapy called Perineal and Pelvic Rehabilitation.

The common element of the aforementioned issues: poor pelvic floor muscle functioning. Some of these problems occur when the pelvic floor muscles are weak. In this case, they are not able to tighten enough, or at the right moment to avoid urine loss when coughing, sneezing, practicing sports, or lifting weights (stress urinary incontinence). Or, they are no longer able to support the organs located in the pelvis (bladder, vagina/uterus, intestine).

In other situations, it becomes difficult to control a pressing urge to urinate or defecate (urgency and/or urgent incontinence). These situations affect both men and women, but are more common in women.

Problems may also occur when the pelvic floor is tight.  One can have a hard time to easily tighten and release pelvic floor muscles, or to control their muscles. Thus, it can become difficult to urinate or defecate. This can also be painful during sexual intercourse, and penetration may become difficult.

The pelvic floor can be directly involved as it is the case for vaginismus. It can be associated with other structures within the perineal area to a genital illness (i.e. vulvodynia) or a dermatological problem (i.e. eczema, lichen sclerosis, infections).  In these cases, there could be a lack of elasticity at the vagina’s entrance and very often exaggerated skin sensitivity.

Now, what is the link between these problems and physiotherapy? Physiotherapists treat muscle and joint related problems affected by injuries or illnesses.

Problems related to incontinence, constipation, pelvic pain and discomfort during sexual intercourse often involve pelvic floor muscles.  Physiotherapists trained in perineal and pelvic rehabilitation areprofessionals in this area of treatment.

They have the expertise to assess and treat responsible muscles of the pelvic floor, of the pelvis, hip and lumbar spine. Furthermore, they know the pathology related to urinary, gynaecological, ano-rectal and sexual dysfunctions.

What are the treatments? The objective of perineal and pelvic rehabilitation is to help the person develop adequate functioning of the urinary, anorectal system, and/or a painless perineal area.

Here are the treatments used:

1. Complete evaluation which might necessitate vaginal or anal examination (with fingers);
2. Teach pelvic floor muscle exercise with or without a device such as:
   1. Biofeedback (biological feedback)
   2. Electrical muscle stimulator.
3. Different manual techniques aiming at reinforcing, stimulating, relaxing, tempering or to diminish pain.

As for other physiotherapy approaches, patients have an active role to play to achieve its objectives. They must put into practice the advices received in physiotherapy (exercises or changes in the way of living).

In order to know if perineal and pelvic rehabilitation is what you need, consult your family practitioner or a specialist who will determine the nature of the problem and refer you to physiotherapy.[i]