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What Happens When Your Pelvic Floor Doesn’t Work Properly?

Updated: Feb 18


Did you know incontinence impacts more than one in three Australians? Not exactly dinner party conversation, is it? Everyone has a pelvic floor, and if it isn’t working properly, it can affect the most fundamental aspects of our quality of life. It’s better to investigate than remain polite and not speak up!


Incontinence, associated with the bladder or bowel, is one of the symptoms under the umbrella title of ‘pelvic dysfunctions’. As well as bowel or bladder related incontinence, pelvic dysfunctions can produce other symptoms including pelvic pain, pelvic pressure or pain during sex. If you recognise any of these symptoms, feel free to contact us to discuss your situation.

Your Pelvic Floor

The pelvic floor is a bowl-shaped set of muscles located in the floor of your pelvic area that support the organs in the pelvis and create a sling around the rectum and genitals. Your pelvic floor can impact your bladder, uterus (in women), prostrate (in men) and rectum as well as the joints of the pelvis and spine.


Myth Breaker

Pelvic disorders and conditions don’t merely fall under the heading ‘women’s problems’ but also affect people of the opposite gender and can impact children or adults.


What is Pelvic Dysfunction?

In a nutshell, pelvic dysfunction is when the pelvic floor muscles and ligaments don’t work the way they should (they don’t contract and relax properly). You need to be able to contract and relax your pelvic floor muscles to enable bowel and bladder movements.


These pelvic dysfunctions are often hard to diagnose, yet they can affect your quality of life if left untreated. The good news is treatment isn’t necessarily surgical; in fact, physiotherapy can offer effective treatment, education and support.


When to See a Physiotherapist?


If you have severe symptoms relating to your pelvic area, please consult your health practitioner or doctor. As physiotherapists — specially trained in the pelvic region, including bladder and bowel health — we can diagnose and treat you, as well as communicate with other medical professionals as required.


Take the first step towards relief, book an appointment to discuss your pelvic pain or associated symptoms.


Treating your pelvic pain

Our management of your pelvic pain or related symptoms may include:

a thorough assessment of your symptoms, medical history and current health, including diet and fluid intake

  • a gentle physical assessment to check how well your pelvic floor is functioning such as testing its strength, endurance and your ability to contract and relax your pelvic muscles

  • a musculoskeletal assessment of your posture, pelvis, lower back, legs and body

  • use of Ultrasound imaging and biofeedback to help facilitate your rehabilitation

  • education, pelvic floor exercises, pain-free stretches, soft-tissue release, trigger-point therapy, pain management if needed, core muscle re-education and training

  • recommendations on how to have pain-free intercourse

  • self-management strategies for long term care, bladder management, as well as recommended changes to your lifestyle.

Examples of Pelvic Dysfunction

Below are examples of pelvic dysfunction, many of which include experiencing pelvic pain.


IN MEN AND WOMEN


Incontinence

Urinary incontinence is when you experience an involuntary loss of urine and urgency to get to the toilet.


Faecal incontinence is the involuntary loss of faeces (poo) or wind and feeling you need to go to the loo.


Stress incontinence is one of the most common types. With stress incontinence, you leak urine when you do something that stresses or strains your bladder such as sneezing, coughing, laughing, lifting something, or changing position.


Bladder Frequency and Urgency

When you need to urinate more than five (5) to seven (7) times a day, suddenly feel like you have to empty your bladder, or need to empty your bladder multiple times overnight, you may have an ‘overactive bladder’. In this instance, your bladder contracts too often and mightn’t empty completely when you urinate. Prostrate problems can also cause frequent urination in men.


In cases of incontinence or bladder frequency, we provide Pelvic Floor Muscle Training (PFMT). Research shows that this can dramatically improve bladder and bowel control.


Pudendal Nerve Pain

Pudendal nerve pain, known as pudendal neuralgia (PN), is chronic pelvic pain caused by the pudendal nerve which is the nerve supplying sensation to the skin between your pubic bone and your tailbone, as well as the sphincters (muscles that keep the openings of the bladder and bowel closed).


Pudendal neuralgia can include:

  • pain when sitting, increasing as the day goes on, which typically improves overnight or when lying down

  • problems with the bladder or bowel

  • pain with intercourse

  • feeling like you need to open your bowel urgently.

  • Intense physical exercise or sport, childbirth or some types of surgery can cause pudendal neuralgia.

Coccydynia

Coccydynia is tenderness and pain around the tailbone or coccyx area exacerbated by sitting. Coccydynia can be caused by trauma to the coccyx from a fall, prolonged sitting, degenerative joint changes or natural childbirth in women. Women are five (5) times more likely to develop coccydynia than men.


Hypertonic Pelvic Floor Muscles

Hypertonic (overactive) pelvic floor muscles can result in pain, difficulties with intercourse and trouble emptying the bladder.


Osteitis Pubis

More common in men than women, this is an inflammation of the pubic symphysis (a type of cartilaginous joint) and surrounding muscles. It is a well-known complication of invasive procedures about the pelvis. It can also occur in athletes as an inflammatory process.


Sacroiliac joint (SIJ) dysfunction

Too much movement (hypermobility) or too little movement in the sacroiliac joint (the joint connecting the tail bone to the pelvic bone) can lead to pain and make the pelvis feel unstable. Pain from too much motion is typically felt in the lower back and or hip and can radiate into the groin area. Although more common in women, sacroiliac joint dysfunction can affect both men and women of all ages.


Remember the earlier you obtain treatment, the better your chances are of locating and alleviating the pain or discomfort before it becomes chronic. Whether pelvic pain or pressure, incontinence or difficulty during sex, book an appointment with our trained physiotherapists, who can assess, pin-point and treat your pelvic dysfunction.


IN WOMEN ONLY


Endometriosis

Endometriosis is when the cells lining the inside of your uterus (the endometrium) move to other parts of your body, most commonly the pelvis. The endometrium comes away from the body during the menstrual cycle. Even though these cells aren’t in the uterus, they still respond to the messages from the ovary during menstruation and bleed. Endometriosis is often painful. At least one in ten women have endometriosis, which can result in difficulty and even an inability to get pregnant.


Sensitive Scar after Birth

Some women experience trauma to the perineum (the area between the urethra – the tube carrying urine from the bladder – and the anus, including the vaginal opening) during childbirth. Receiving an episiotomy (a surgical cut) or tearing during birth can lead to scarring which can become painful, sensitive or thickened and raised. A physiotherapist trained in women’s health and care after having a baby (postpartum care) has successfully used a range of manual therapy techniques to help new mums regain a pain-free life after birth.


Pelvic Organ Prolapse (POP)

A woman's pelvis contains the uterus (womb), bladder, bowel, and vagina, which are usually held in place by the pelvic floor. When the pelvic floor starts to weaken and sag, it can no longer support those organs and will cause them to prolapse or drop, which is called pelvic organ prolapse (POP).

The symptoms of POP can include:

  • a heavy, dragging feeling or ache

  • a lump in the vagina, bladder, or bowel

  • general pelvic discomfort

  • lower back pain

  • discomfort during sexual intercourse.

Stats show that one in five Australian women will have POP in their lifetime. Pregnancy and childbirth, menopause and age, constipation, being overweight, smoking, a chronic cough or an inherited condition can increase the risk of POP developing.


Physiotherapy can help improve the symptoms of mild to moderate prolapse over time by assisting with strengthening the pelvic floor through pelvic floor exercises.


Pelvic Girdle Pain (PGP)

Pelvic Girdle Pain (PGP) is pain experienced mostly in your external pelvic structures, such as the sacroiliac joints (SIJ) or the pubic symphysis. It is more prevalent during pregnancy when it’s called Pregnancy Related Pelvic Girdle Pain (PR PGP).


Dyspareunia

Dyspareunia is a recurrent or persistent genital pain that is felt just before, during, or after having intercourse. Both physical and psychological problems can cause dyspareunia (painful sex).


Physical causes can include skin infections, inflammation, illness, surgery, or not using enough lubrication. Psychological causes can include stress, anxiety, or issues with your partner. Psychological problems can also make dyspareunia from physical causes worse.

Unmanaged dyspareunia can affect your mood and sexual interest. Getting a diagnosis can help you identify what is causing the problem and also identify what treatment can help you.


Postpartum Abdominal Muscle Separation (Diastasis Recti Abdominis)

During pregnancy, the growing uterus stretches the two long, parallel muscles that meet in the centre of the stomach (the rectus muscles). Sometimes they to separate more than usual, a condition called diastasis recti abdominis.


The abdominal muscle separation may result in a bulge where the muscles separate. Sometimes, the bulge is only felt when the muscles are tensed like when they are used to help you sit up from a lying position. The condition can weaken the abdominal muscles resulting in lower back pain and making it difficult to do some activities. You can rebuild some of your abdominal strength through specific exercises, which your physiotherapist can help you identify.


Vaginismus

Vaginismus is when the vagina involuntarily tightens and is usually triggered by touching the genital area. Sufferers may experience vaginismus before sex, when attempting to insert a tampon, or when getting a gynaecological examination. The reasons behind vaginismus could be physical or psychological, for example, childbirth, thrush, sexual abuse or rape, unpleasant sex, fear. The cause of the vaginismus will determine the treatment.


Other causes of pelvic pain

There can be other causes of pelvic pain in men and women, including urinary tract infections, appendicitis, sexually transmitted diseases and other conditions that require early or simultaneous medical attention with your physiotherapy.

Pelvic Physiotherapy

By offering specialised Pelvic Physiotherapy, we can help you by:

  • diagnosing the cause of your symptoms

  • putting together a treatment plan which may include manual therapy, education, exercises and self-management strategies

  • help to educate you on your pelvic floor.

Early diagnosis and treatment can help improve or rectify the problem before it becomes chronic.


Among the approaches and techniques, you may encounter in treatment with us are real time ultrasound for assessment and biofeedback of the deep muscles of the trunk and pelvis.


Meet Angela, Our Pelvic Floor Physiotherapist


Angela Rodwell started learning about physiotherapy from a young age, watching her mother work as a physio. She grew up with a keen interest in being able to help people recover from their injuries and improve their health and wellbeing. Angela focuses on:

  • Women's Health

  • Pelvic floor physiotherapy, including pain, incontinence, pre and post-natal issues

  • back and neck pain

  • sports injuries, and

  • post-operative rehabilitation.

Angela draws on her extensive knowledge of your body’s anatomy and physiology to assess and treat your pelvic floor issues. She can help to restore aching, stiff and dysfunctional muscles and joints. (Remember to select Angela when booking your appointment for pelvic floor pain and support).


Book an Appointment



Phytness Healthcare is here to help you with your Pelvic Floor Dysfunction

We’ve developed a reputation for being passionate about helping our patients get better. We are committed to longer consultation times and continuous staff education and training. We believe you should receive tailor-made programs, modern treatments and prevention based on your needs and research. With Phytness HealthCare, you have an ally to help you reach your goals.


We offer the convenience of:

  • longer opening hours

  • 8 am-7 pm Monday - Thursday

  • 8 am - 6 pm on Friday

  • and Saturday mornings

  • free easy parking at all clinics

  • HICAPS on-site health fund claims.


The information in this article is general in nature and is intended for general educational purposes only. We recommend you book an appointment with your health practitioner to ensure you receive the correct diagnosis and treatment for your individual situation.


Resources

https://www.scripps.org/

https://ranzcog.edu.au/

https://www.practicalpainmanagement.com

https://www.emedicinehealth.com

https://choose.physio/

https://www.healthline.com/

https://www.healthdirect.gov.au/

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(02) 4285 1725

50 Princes Hwy

Fairy Meadow, NSW 2519

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(02) 4221 3057

URAC, University of Wollongong

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Wollongong, NSW 2500

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