I’ve been in several situations where I’ve seen people’s eyes grow wider and wider as I explain to them what pelvic floor physiotherapy entails. I don’t think it’s because they were scared of the treatment itself, but rather because it was totally new to them. They didn’t know what to expect, or that it even existed at all.
In my experience, going to see a pelvic floor physiotherapist feels more or less the same as when you need to visit a gynaecologist. I cannot speak for men, but I think they get a similar feeling when they need to see a urologist. Having anyone near your genitals can make you feel vulnerable!
What does a pelvic floor physiotherapist do?
We treat conditions such as urinary and faecal incontinence, sexual dysfunction, pelvic and perineal pain, constipation, and over- or under-active pelvic floor muscles in men, women and children.
Common problems we treat include conditions such as pelvic organ prolapse (the descent of the pelvic organs through the vaginal walls) and erectile dysfunction, especially post-prostatectomy (removal of the prostate).
The pelvic floor muscles play a huge roll in most of these conditions, but it’s not the only thing we focus on during assessment and treatment. With all conditions, we follow a bio-psycho-social approach to treatment, which is patient-centered.
What does the pelvic floor physiotherapist look for?
We assess (and treat where indicated) different components that may contribute to a certain condition or dysfunction.
This may involve physical components, such as posture, breathing, general fitness, functioning of the peripheral, central and autonomic nervous systems, and contraction and relaxation of the pelvic floor muscles, diaphragm, abdominal muscles, or other muscles we might think are involved.
This usually includes assessments of the joints, specifically in the pelvic, lumbar and hip region. It is also important for us to note how these muscles, nerves and joints work together and coordinate their movements, as it may cause imbalances and problems in other areas – contributing to the dysfunction.
What does the pelvic floor physiotherapy treatment entail?
We have several ways of investigating and treating the pelvic floor muscles, sometimes using devices that can assist us, as these muscles are located quite deep and are not always visible or palpable from the outside of the body.
Examples of these devices include electromyography, ultrasound, and neuromuscular electrical stimulation. We may also use these in our treatment plan, together with appropriate exercises which usually forms a large part of the treatment plan. The type of exercises done will mainly depend on the aim of the treatment, be it to relax or strengthen the applicable muscles.
We always work as part of a team
As physical therapists we obviously focus a lot on the physical aspects of the treatment, but we also need to address any environmental, social or health factors that may be contributing significantly to the condition.
If we are concerned about medical or psycho-social factors, or have severe cases, we refer appropriately.
The multi-disciplinary team is crucial in the management of pelvic floor dysfunctions, as they can often be quite complex due to different contributing factors. We work closely together with social workers, psychologists, dietitians, general medical practitioners, gynaecologists, urologists, sexologists, gastroenterologists, orthopaedic surgeons, physicians and nurses.
As a team we can provide our patients with the best possible treatment plan and get the best results.
Pelvic floor dysfunction is not something you should be ashamed of
Going to your first pelvic floor physiotherapy session can make you feel anxious and vulnerable, but believe me – by the end of the session, you will feel so much better about it.
Pelvic floor dysfunction is not something to be ashamed of. Help is available for you. By talking about it, you can get the help you need, and stop suffering in silence.
Dr Corlia Brandt (SASHA Executive Committee)
Pelvic Floor Physiotherapist, Senior Lecturer, Researcher.
South African International Urogynaecology Association Physiotherapy Representative.
Chairperson of Pelvic and Women`s Health Physiotherapy (South African Society of Physiotherapy).