Pelvic floor physiotherapy is a specialized area of physiotherapy that deals with treating muscles of the pelvic floor. This involves assessment/treatment of the muscles with internal vaginal and/or rectal palpation. A specially trained pelvic floor physiotherapist can work with you to prepare the pelvic floor for labour and delivery and to rehabilitate these muscles following birth. Your pelvic floor changes after birth and we are here to help you recover. Common postnatal conditions that can benefit from pelvic floor physiotherapy include intravaginal scar tissue, perineal trauma (tearing or episiotomy), excessive pushing, incontinence (bladder, bowel, or gas), pelvic organ prolapse (feelings of heaviness/ pressure or a bulge), painful intercourse, tailbone pain, diastasis recti, vaginal dryness. If you are going towards C section Procedure, our C-section rehabilitation includes scar management, diastasis recti assessment, core functioning, and core stability, pelvic floor strengthening, and client education. We strongly recommend to have a pelvic physiotherapy session at our clinic and get it done before your delivery date.

PELVIC FLOOR PHYSIOTHERAPY FOR DYSFUNCTION
Some women may experience pelvic floor dysfunctions despite never having given birth.   In addition, women that are well past their childbearing days may experience an onset of pelvic floor dysfunction later in life.  A pelvic floor physiotherapist can work with this population to help restore the pelvic floor and treat the dysfunction.  Common conditions treated by a pelvic floor physiotherapist include but are not limited to the following:

• Stress/Urge Urinary Incontinence
• Fecal Incontinence
• Pelvic Organ Prolapse
• Dyspareunia 
• Vaginismus/Vulvodynia
• Diastasis Recti 
• Constipation
• Urinary Frequency
• Nocturia
• Interstitial Cystitis 
• Persistent Pelvic Pain

What is vaginal wall softening/pelvic organ prolapse (POP)?

Prolapse is when structures/organs in your pelvis, such as the uterus, bladder, or rectum, move into the softened walls of your vagina and bulge outside of the vagina. It may feel like a bulge or a pouch or heaviness. There are different kinds:

• Cystocele: This is anterior/the front of your vagina, your bladder and urethra will occupy this space
• Rectocele: this is posterior/the back of your vagina. Your colon will occupy this space
• Uterine prolapse: this is above the cervix – the uterus will move down into the vagina
• Vaginal vault: this is when the vagina relaxes downwards following hysterectomy

Grades of prolapse/vaginal wall softening

Grade 1: Mild, can only be found with examination and straining. These are extremely common with vaginal birth and are usually asymptomatic

Grade 2: Mild/Moderate: Descent of tissue slightly with straining, also very common following childbirth. Especially with instrumentation and quick deliveries

Grade 3: Moderate: Descent of tissue to the opening of the introitus/vaginal opening

Grade 4: Extra moderate (severe): When tissue descends outside of the introitus/vaginal opening.

How do I know if I have it?

Most women who have a vaginal wall softening/POP do not know they have it (unless they look – a surprising amount of us don’t look at our vaginas!). Others may feel pressure or a bulging coming through the opening of the vagina. Your doctor or pelvic health physiotherapist may look for prolapse while examining your pelvis with you lying down or standing up. To help diagnose prolapse, your doctor/pelvic health physiotherapist may ask you to strain (i.e., push as if you are trying to pass urine or stool/baby).

What causes it?

There are many factors that can make prolapse happen. Childbirth may stretch your pelvic muscles and ligaments and cause prolapse. Mild prolapses (Grade 1-2) are VERY common in the first year following vaginal birth/C-birth with pushing. Coughing a lot, being constipated, in-proper lifting loads and technique, abdominal fat, or having had a hysterectomy can also increase the chances of POP development and progressing.

What are my treatment options?

• Pelvic rehabilitation is a first line treatment for POP, especially post partum. Most symptomatic/mild prolapses can resolve within the first year post partum with education, strengthening, and other corrective exercises/manual therapy to manage intrabdominal pressure.

• Another treatment option is called a A pessary is a device that is placed inside the vagina to help keep your pelvic organs in place (think of it as a support bra for your vagina!)

• Always makes a disposable option called an impressa. This is a good option if you are symptomatic post partum while strengthening.
  • https://www.poise.com/en-ca/products/impressa/introduction

• Sinéad Dufor and Nikki Bergan from the Bell Method just did a really nice video on POP and the impressa and it’s use post partum! It’s amazing
  • https://www.instagram.com/tv/CKw03ulhYN6/?igshid=i2cgwc7cs0tg