Physiotherapy for your pelvic floor

Treatments in pelvic floor physiotherapy are not well known here in Canada although a lot of women have short and long term problems after they give birth. When we hear young moms talk about their incontinence problems caused by a birth, we get a good laugh out of it (including the mom). The pelvic floor undergo great trauma during labour and birth, it needs to relearn how to work properly and this takes time. One country that gets the importance of taking great care of this special organ is France. The French government subsidizes up to 20 sessions of perineal reeducation to EVERY women who gives birth. I think that we should at least talk about it more in Canada and that women should have access to this information to be able to take better care of their bodies.

I asked a physiotherapist to talk about it. Lynne Gagnon received her first Bachelor of Science degree from the Saint-Boniface University in 2003 and went on to obtain her Bachelor of Science degree in Physiotherapy (with distinction) in 2007, from the University of Ottawa. In 2014, Lynne completed the post-graduate pelvic and perineal rehab program offered through the University of Montreal.

In general, what is your job?

I’ve been working as a pelvic floor physiotherapist for 10 years now, which means that my work has been focused on the pelvic floor muscle. This group of muscles is situated inside the pelvis and goes from the pubic bone to the coccyx. The pelvic floor muscle has 5 important functions: urinary and fecal continence, sexual health (sensation, orgasm), pelvic organ support, assists in breathing and core stability.

What made you want to work in this field?

When I was a student in physiotherapy at the University of Ottawa, I had the opportunity to work with some of the University’s sports teams. It quickly became obvious to me that this was not my passion. I have to admit that I was a bit lost, questioning my decision to become a physiotherapist in general. The year after I graduated, I decided to contact the owner of Nova Physiotherapy. We met and we talked for hours about pelvic floor dysfunction and about examples of cases seen in her clinic. Since that first meeting, I knew I had found my niche and I started to focus my education and my work on pelvic and perineal rehabilitation.

What type of problems do you treat more often?

I treat women, men and children who are suffering from urinary problems (leakage, bedwetting, urinary urgency), sexual dysfunctions (pain, anorgasmia, erectile dysfunction), pelvic organ prolapse, fecal problems (constipation, leakage of gas and/or stool), pelvic pain (pubic pain, coccyx, hips, bladder, etc.) and during pregnancy (prevention, pain and all pelvic dysfunction before and during the pregnancy and post-partum).

Do you think all pregnant women should receive pelvic floor physiotherapy treatments? And women in postpartum?

This is a great question. I wouldn’t necessarily generalize by saying every woman should seek treatment during pregnancy or after giving birth. However, to maintain a proper functioning muscle and to prevent pelvic dysfunction, it is important that every woman exercise their pelvic floor muscle correctly. I often hear from patients: “Please don’t tell me to do my Kegel exercises. I have tried them and they don’t work.” It is important to understand that a well functioning muscle needs to have good resting tone, a proper contraction (strength/power, endurance, coordination), and a full relaxation following a contraction. If you are not doing a proper squeeze and release of the pelvic floor muscle, that may lead to worsening of symptoms, more dysfunction, and frustration. Because the pelvic floor muscle is so deep in the pelvis, the only way to truly assess its function is through an internal evaluation (vaginally and/or rectally). If you are unsure that you are doing your pelvic floor exercises correctly, I would recommend to get it assessed by a qualified pelvic floor physiotherapist.

When is it the appropriate moment to get treated?

I would say it is more beneficial to start treatment sooner rather than later. It is more cost-effective, both timewise and financially, to work on your pelvic floor efficiently before problems get worse. If I take a patient of mine as an example: she started having urinary leakage after her first delivery but thinking that it would be a waste of time to strengthen her pelvic floor before subsequent pregnancies, she decided to wait until she finished her family before calling me. Unfortunately, her pelvic floor dysfunction worsened with each pregnancy, symptoms of urinary leakage increased and the patient developed a uterine prolapse caused by inadequate pelvic support during her pregnancies and post-partum.

Knee replacement surgery makes a great analogy. Patients are never encouraged to stay in bed and not move their knee before surgery. On the contrary, people are strongly encouraged to work out and strengthen leg muscles in preparation for surgery. Why would we not do the same for the pelvic floor muscle before pregnancy?

What advice would you give to pregnant women, new mothers or anyone else that would like to have a healthy pelvic floor?

Strength is not everything when it comes to exercising the pelvic floor muscle. As I was saying earlier, a healthy muscle has to have proper resting tone, endurance, coordination, complete relaxation, and strength. A good exercise program is one that encompasses all of these components to ensure progression. If you are not sure if you are doing your pelvic floor exercises correctly, I recommend that you get evaluated by a qualified pelvic floor physiotherapist.