Stress and Urge incontinence, as well as overactive bladder

The pelvic floor muscles help to control the sphincters of the bladder and rectum.

Stress Incontinence is the involuntary loss of urine with effort or physical exertion, such as when you strain, cough, sneeze, laugh hard, jump on a trampoline etc. There is no contraction of the bladder (detrusor muscle). There is simply leaking due to increased abdominal pressure (IAP) bearing down on the bladder causing urine to leak. Proper contraction of the pelvic floor muscles reinforces this sphincter and help to prevent leakage. Improved coordination of how the abdominal muscles are turned on during activity can also reduce IAP alleviating stress on the bladder. If you have tried kegels in the past without success, don’t despair! There are many more strategies we can use to get these muscles working more effectively.

Urge Incontinence:  Loss of urine associated with urgency/ inability to get to the bathroom in time.  Urgency is caused by an overactive bladder muscle and it is much worse when the pelvic floor muscles are not functioning optimally to prevent leakage. 

Mixed Incontinence is a mixture of stress and urge incontinence.

Athletes: It is very common for athletes who participate in high impact sports such as running , crossfit, gymnastics etc, to experience leaking during their sport. This is often present even in women who have not had children. Leaking during exercise can be embarrassing and distracting. But it is also a sign that your core is not working well, increasing your risk of injury, and decreasing your performance. A physiotherapist can teach you ways to safely exercise while protecting your pelvic floor (even if you have already tried lots of kegels!)

Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) occurs when either the bladder, uterus or rectum lose their support and descend into the vagina. Symptoms of POP include heaviness or pressure in the vagina or rectum, incomplete emptying of bowel and/or bladder, and / or protrusion of something out of the vagina.

Pelvic floor rehabilitation can be a great alternative to surgery. Properly performed exercises can train the pelvic floor to hold the organs in place and decrease intraabdominal pressure, reducing the feeling of heaviness.

Painful Intercourse

The medical term for painful intercourse is dyspareunia. It is very common in women, but unfortunately many women go untreated for years.

Vaginismus: a condition where there is painful contraction of the vagina when pressure is exerted on the vagina. This can lead to pain with insertion of a tampon, with gynegological exams, or with sexual intercourse. Physiotherapy can be very effective, teaching you strategies to relax and contract your muscles, as well as using dilators to gently stretch and re-educate the pelvic floor muscles.

Vulvodynia is defined as vulvar pain, often described as burning, in the absence of any identifiable cause. Physiotherapy can help to educate you about your pain, as well as teach you how to be aware of your muscles using EMG biofeedback. This can reduce muscle tension and decrease anxiety around penetration of the vagina.

Post partum dyspareunia: up to 25% of women report persistent dyspareunia after childbirth. You may be more at risk if you have had a sutured tear or episiotomy, caesarean section, or vacuum or forceps extraction.

Peri and post menopausal dyspareunia: pain during intercourse is a common complaint in aging women. Changes in hormonal levels can lead to vaginal atrophy and dryness. Pelvic floor muscles can become tight and stiff leading to pain on penetration.

Proper assessment can help determine the cause of your pain and treatment may include learning how to relax and contract the muscles as well as myofascial techniques to stretch scarring and release tight muscles.

Painful Bladder Syndrome / Interstitial Cystitis

Pelvic floor muscle function may contribute to the pain from Chronic Bladder Syndrome and Interstitial Cystitis (IC). Physiotherapy treatment to reduce tension and pain in the pelvic floor muscles can make a difference. Treatment will focus on using various techniques, including EMG biofeedback and myofascial release techniques to re-educate the body on how to reduce tension in the pelvic floor muscles that may be contributing to your pain.

Pelvic Pain Conditions

Vulvodynia is defined as vulvar pain, often described as burning, in the absence of any identifiable cause. Physiotherapy can help to educate you about your pain, as well as teach you how to be aware of your muscles using EMG biofeedback. This can reduce muscle tension and decrease anxiety around penetration of the vagina.

Pudendal neuralgia The pudendal nerve is the nerve that supplies the pelvic region. If this nerve becomes irritated it can lead to symptoms such as itching/burning, genital pain, pain with sitting, discomfort with tight clothing, dyspareunia. Physiotherapy treatment may consist of pudendal nerve mobilization, connective tissue and trigger point release techniques, hip and pelvis range of motion and strengthening exercises, EMG biofeedback.

Male Chronic Pelvic Pain Syndrome or Chronic Prostatitis.

Up to 15% of adult men suffer from pelvic pain. Discomfort and pain are the primary symptoms of male Chronic Pelvic Pain Syndrome (CPPS), sometimes diagnosed as Chronic Prostatitis (CP), which can affect any or all of the following areas: the pelvic floor, perineum, rectum, coccyx (tail bone), prostate, penis, testicles/scrotum, groin, thighs, lower abdomen, and low back. Sometimes it is difficult to describe exactly where the pain or discomfort is, especially if it feels deep inside the pelvis. Symptoms can be intermittent or constant, and wax and wane over time. Sexual dysfunction can include painful ejaculation, testicular pain and pulling, erectile dysfunction, penile pain, premature ejaculation and decreased libido. Urinary symptoms can include pain with urination, hesitancy, interrupted stream, weak stream strength, frequency, urethral burning, and urgency.

Although the prostate is often blamed for many male pelvic problems, there can be many other reasons for bladder, bowel and sexual problems. Pelvic floor muscles, connective tissue and lower lumbar nerves can all be potential culprits in male pelvic pain. In addition, joint and muscle problems such as chronic groin strains, unresolving hip and low back problems can all contribute to chronic pelvic pain.