Women’s Health Physiotherapy

Pelvic Floor Physiotherapy

In females, the “pelvic floor” muscles support the pelvic organs, which form the birth canal and also the passages for urine and faeces (see image below):

The Female Pelvic Floor Muscles
Img Source: The Injury Clinic

These muscles need to contract effectively to hold the urine, but they must also relax enough to allow for urination, bowel movements, sexual intercourse and childbirth.

Pelvic floor physiotherapy helps in the rehabilitation of the pelvic floor muscles by using techniques like electrical stimulation of the pelvic floor, biofeedback, strengthening and relaxation of the pelvic floor muscles and vaginal weight training.

Following an assessment, the treatment of a hypertonic pelvis would include:

• Internal manual therapy techniques to relax the pelvic floor muscles, including trigger-point release, myofascial stretches
• Myofascial release of the connective tissue of the abdomen, hips and pelvis, which support the pelvic floor
• Relaxation and breathing techniques
• Advice on toileting and positional modifications
• Provision of vaginal dilators, pelvic floor educators to assist in the release and relaxation of pelvic muscles
• Assessment and treatment of any unresolved low back, hip or pelvic pain

Physiotherapy During Pregnancy/Prenatal Physiotherapy/Antenatal Physiotherapy

It is strongly recommended that you start strengthening your core muscles even BEFORE you become pregnant! This would ease back pain during the pregnancy, help with post-pregnancy recovery and also ease breast-feeding.

The term “natal” refers to the birth of a baby, so “prenatal/antenatal” are the medical terms for pregnancy, while “postnatal” refers to the post-pregnancy phase.

During the prenatal phase, 1 in 3 women experience low back pain and 1 in 5 experience pelvic girdle pain. These symptoms often occur due to hormonal changes and the ever-increasing weight of your foetus and uterus.

A Gynecological Physiotherapist ensures that you are doing the correct prenatal exercises in a safe manner, in order to maintain a strong lower back and pelvic floor. Treatments include:

• Mobility exercises for the spine
• Connective tissue release of the abdomen, back, hips and pelvis
• Pelvic stability exercises
• Advice on sleeping positions, exercise and movement modification

Postnatal Physiotherapy/Physiotherapy after Childbirth

The immediate weeks after childbirth (“postnatal stage”) are an important time for your body to heal, as it would have undergone many changes during pregnancy. It is also crucial to address any issues that occur in this phase, so as to prevent problems in the future. Childbirth can lead to pelvic floor trauma, perineal tears and pudendal nerve injury (the nerve carrying sensation to your bladder and pelvic floor). Consequently, the pelvic floor can become dysfunctional and one may experience urinary or bowel urgency, incontinence, urinary frequency, incomplete emptying and/or pain during sexual intercourse.

A pelvic floor assessment is important to establish the cause of these symptoms. A Pelvic Floor Therapist can conduct this assessment after the 6-week postnatal gynecological check up. Treatment may include:

• Pelvic floor re-training and exercises in the future.
• Provision of pelvic floor educators/muscle stimulators to improve muscle activation and the power of your pelvic floor contraction
• Internal manual therapy techniques to relax the pelvic floor muscles, including trigger-point release, myo-fascial stretches, scar massage, neural mobilisations
• Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor
• Myo-fascial release of the connective tissue of the abdomen, hips and pelvis which support the pelvic floor
• Relaxation and breathing techniques
• Provision of pelvic floor exercises and general exercise to assist in release and re-training of the pelvic muscles
• Provision of vaginal dilators, pelvic floor educators or muscle stimulators to assist in the release and relaxation of pelvic muscles
• Assessment and treatment of any unresolved low back, hip or pelvic pain

Diastasis Recti and Exercise After Pregnancy

After pregnancy, almost all women want to lose weight and get a flat tummy. However, prior to starting any exercise, it is extremely important for the new mother to be thoroughly examined for the condition called “Diastasis Recti” by a Gynecological Physiotherapist. Left unaddressed, it can lead to lower back pain, constipation and urine leaking. In some rare cases, the tissue may tear and form a hernia, too.

Diastasis recti is the partial or complete separation of the rectus abdominis muscle, or the “six-pack” muscles, which meet at the midline of the stomach. There are various types of Diastasis Recti (see image below):

When these muscles get overstretched during pregnancy, they often separate, making it harder for the woman to regain her flat tummy. Therefore, it is advisable for a new mother to be assessed, and if necessary, be treated for diastasis recti, before starting regular abdominal workouts. This assessment can be carried out after approximately six weeks for a vaginal (“normal”) delivery or after eight weeks for a C-section.

Jaya Physio Clinics has a dedicated gym called “Trans-Form PRO”, to ease your pregnancy and also enable faster postnatal recovery. You would have the advantage of exercising under the guidance of a skilled Gynecological Physiotherapist.