is a branch of physiotherapy dealing with problems of the musculature of the pelvis, also called perineum or pelvic floor. This musculature extends from the pubis to the coccyx and includes the urinary and anal sphincter, as well as the vaginal entrance. Its role is therefore multiple, ensuring urinary and fecal continence, organ support and sexual function.
Like all muscles, those of the perineum can be weakened, tense, injured or uncoordinated, which can result in urinary incontinence, increased frequency and urges to urinate (urinary urgency), pain or burning during sex, or even the impossibility of having full intercourse, constipation or fecal incontinence.
What does an assessment look like?
Whether we consult for problems related to pregnancy or postpartum, menopause, aging, a fall or symptoms that appear gradually for no apparent reason, the physiotherapist will describe the changes noted and their behaviors. Medical tests are useful at this stage to eliminate pathological causes, in the event of a urinary or vaginal infection, for example.
This is followed by an external assessment of the condition of the pelvis, abdomen, hips and back in search of imbalances, joint or muscle problems. Always with the consent of the client, the internal evaluation targets specific functional disorders of the perineum, quantifies strength, endurance, control, pain points, muscle tension and organ descents that can reproduce the symptoms.
Following the assessment, a treatment plan is established and discussed with the client, which may include:
- education on lifestyle habits that can help or aggravate symptoms;
- strengthening, control, flexibility or desensitization exercises;
- manual techniques to relieve muscle tension;
- tools like biofeedback and electrical stimulation can also be used to better target muscle learning and practice;
- accommodators or dilators to allow a gradual return to sexual relations.
A perineal problem affects the person affected in very private spheres of their life, with consequences on their quality of life and relationships. It is with this awareness that the perineal rehabilitation physiotherapist works in constant collaboration with the patient and her doctor, and proceeds with respect and consent for the assessment and treatment. Consent can be withdrawn at any time, and the spouse is welcome to the treatments, if the couple so wishes.
Magali Scheubel, physiotherapist in perineal rehabilitation
To learn more about perineal rehabilitation, here are some useful links.
For pregnant clients:
To find a physiotherapist in perineal rehabilitation, visit the Professional Order of Physiotherapy of Quebec: https://oppq.qc.ca/trouver-un-professionnel/