Pelvic physiotherapy: what it is, what it's for and who can benefit from it

Urinary leakage, pelvic pain or a feeling of heaviness in the lower abdomen are more common than many people think. However, this doesn't mean they're normal.

In many cases, these symptoms are related to changes in the pelvic floor and can be treated with appropriate monitoring of the Pelvic Physiotherapy.

O pavimento pélvico é um conjunto de músculos e tecidos que formam uma "rede" no fundo da pélvis. Ele suporta os órgãos pélvicos (como bexiga, útero e reto) e ajuda a controlar a micção e a defecação.

Furthermore, it plays an important role in the control of urine and faeces, abdominal stability, and also in sexual function.

When these muscles do not function well, whether due to weakness, excessive tension, or lack of coordination, different symptoms can arise.

What signs can indicate a change?

Some signs are quite frequent and should be taken seriously:

• urine loss when coughing, laughing or straining
• urgent or very frequent urge to urinate
• Feeling of heaviness or pressure in the pelvic area
• Constipation or difficulty passing stools
• Persistent pelvic pain
• Discomfort during sexual intercourse

These symptoms can appear in isolation or combination and often end up interfering with daily life.

When should you seek help?

It is important to seek assessment when symptoms persist over time or begin to affect your routine. It also makes sense to seek help after pregnancy, childbirth, or surgery, or whenever there is doubt about how to correctly contract or relax this musculature.

The sooner there is follow-up, the simpler recovery tends to be.

Pelvic physiotherapy works by using a range of hands-on techniques and exercises to address issues related to the pelvic floor muscles and surrounding structures. This can include: * **Assessment:** A physiotherapist will typically start by gathering a detailed medical history and may perform an internal and/or external examination to assess the strength, tone, and coordination of your pelvic floor muscles. They might also assess your posture, breathing, and how your abdominal and back muscles work. * **Manual Therapy:** This involves the physiotherapist using their hands to massage, stretch, or mobilise muscles and soft tissues in the pelvic area. They might also perform internal pelvic floor muscle manipulation to release tension or improve muscle function. * **Exercise Therapy:** This is a core component and involves tailored exercises to strengthen, relax, or improve the coordination of the pelvic floor muscles. This can include: * **Pelvic floor muscle exercises (Kegels):** Learning to correctly identify and contract and relax the correct muscles, often with the help of biofeedback. * **Core strengthening exercises:** Working on the deep abdominal muscles, back muscles, and diaphragm to support the pelvic floor. * **Functional movement training:** Integrating pelvic floor function into everyday activities like lifting, coughing, and sporting movements. * **Biofeedback:** This technique uses sensors (either internal or external) to provide visual or auditory feedback on your pelvic floor muscle activity. This helps you to better understand when you are contracting or relaxing the correct muscles and to improve your control. * **Electrical Stimulation:** In some cases, a mild electrical current can be used to help strengthen weak muscles or to reduce pain and spasms in overactive muscles. * **Education and Advice:** The physiotherapist will provide guidance on lifestyle modifications, bladder and bowel habits, fluid intake, and strategies to manage symptoms and prevent recurrence. They will also educate you about the anatomy and function of your pelvic floor. The specific approach will depend on your individual condition and symptoms, which can include issues like urinary incontinence, faecal incontinence, pelvic organ prolapse, pelvic pain (such as pain during sex or conditions like endometriosis), or problems following childbirth or surgery.

A Pelvic Physiotherapy It begins with a detailed conversation about symptoms, habits, and medical history.

A physical assessment is then carried out, which may include posture, breathing patterns, and the ability to contract and relax the pelvic floor muscles.

One of the most common difficulties is not being able to correctly identify these muscles. Therefore, an important part of the process involves learning to recognise them and use them in everyday life.

What are the sessions like?

The sessions are always tailored to each individual. They typically include simple explanations about the body, exercises performed during the consultation, and guidance for practical application in daily life.

In most cases, they are not painful. The goal is to improve muscular control progressively.

What techniques can be used?

Practising at home is fundamental for achieving results.

Who can benefit?

Pelvic physiotherapy can be useful at various stages of life.

In women, it is common during pregnancy, postpartum, or menopause, but also in situations of pain or urinary changes.

In men, it is common after prostate surgery or in cases of pelvic pain and urinary changes.

In children, it can help in situations such as nocturnal enuresis, difficulty with sphincter control, or constipation.

And during pregnancy and postpartum?

During pregnancy, monitoring helps prepare the body for childbirth, improving muscle control and relaxation ability.

In the postpartum period, it's important to regain muscle function, prevent urine loss, and facilitate overall recovery.

How long does it take to see results?

The results vary from person to person, but often start to appear after a few weeks.

Consistency, especially in carrying out exercises outside of sessions, makes all the difference.

Pelvic floor changes are common, but they should not be ignored or considered normal.

With proper management, it is possible to improve symptoms, regain control, and increase daily comfort.

A Pelvic Physiotherapy It is a safe and effective approach, with a real impact on quality of life.