Even in these modern and open times, it is not easy to talk about sensitive topics such as pelvic floor issues.
This very broad and interesting area is often taboo in therapy. The pelvic floor is a relatively complex structure, both anatomically and functionally. It is a sophisticated system of muscle layers and ligaments at the bottom of the pelvis which are spread like a net between the coccyx, the pubic symphysis and the ischial tuberosities. They hold, protect and support the organs in the small pelvis. They have the shape of a funnel, which forms the internal sphincters of the urethra, vagina and rectum.
In women, the pelvic floor directly influences the ability to become pregnant, is important for the course of pregnancy and plays an important role during childbirth and the six-week period after. In men, it affects the prostate and sexual fitness. In both sexes, it directly affects urinary tract function, the process of emptying and the quality of sexual experience.
Less well known is that a properly functioning pelvic floor is linked to a variety of other life functions. It is the centre to which all the muscles holding the skeleton are connected. It keeps the lumbar vertebrae in a correct and safe position. It is part of the deep stabilization system. It also serves as a breathing muscle and that is why it is also called the pelvic diaphragm. Last but not least, physiologically it allows us to walk.
If the pelvic floor muscles are weakened (hypotone) or tightened (hypertone), we speak of dysfunction. Weakening of the pelvic floor often occurs in connection with hormonal changes, e.g. during pregnancy or menopause, but also with increased physical exertion, such as heavy lifting and repeated childbirth.
A sedentary lifestyle and lack of exercise are definitely not beneficial to pelvic floor physiology. One of the manifestations of weakening is incontinence - unwanted leakage of urine. Most often, it is the so-called stress incontinence, where problems with urinary retention occur when there is a sudden increase in intra-abdominal pressure, for example, when coughing, sneezing, laughing, sudden movement or lifting a heavy load.
Another possible manifestation of pathology is the descent (descensus) of the pelvic organs, i.e. the uterus and vaginal walls. A loose pelvic floor can be related to a distorted leg arch, spinal instability, pain in the hips, cervical spine and headaches.
However, about a third of women deal with pelvic floor tightness, which can cause, for example, pelvic, sacral and coccyx pain, menstrual pain, painful intercourse (dyspareunia) or functional infertility. In men, erectile dysfunction may occur.
Intimate problems in the pelvic area are often both the source and target of emotional tension. It is evident from the above that the pelvic floor problem is far from being a local problem. It requires a holistic approach and co-operation across medical disciplines - with gynaecologists, rehabilitation doctors or physiotherapists.
At our workplace, this issue is dealt with exclusively by women - doctors and therapists.
At My Clinic, physiotherapy is used as the first line of treatment of pelvic floor disorders.
Female patients (less often men) either confide themselves in the rehabilitation examination or come with a referral from gynaecologists, urologists, specialists in psychosomatic medicine, psychologists or psychiatrists. And vice versa - the Department of Rehabilitation and Physiotherapy then refers patients to other branches. Interdisciplinary co-operation is a matter of course.
The initial examination by a Rehabilitation Doctor is important for differential diagnosis and recommendation of physiotherapy strategy. The pelvic floor can be examined externally, but internal examination (per vaginam, possibly per rectum) is much more accurate. It allows to assess whether the patient is able to perform the contraction, its strength and to evaluate the overall condition of the pelvic floor.
Before starting the therapy, the physiotherapist performs a kinesiological analysis and then uses manual, soft techniques to treat local pathologies and imbalances within the so-called "concatenation of functional disorders". It teaches the patient to perceive the pelvic floor - to visualize, relax, facilitate and then properly strengthen it.
Approximately one-third of patients is unable to fully activate their pelvic floor muscles, even though there is no apparent structural disorder. Since the pelvic floor muscles are deep, it is not easy to consciously locate them and their free contraction is challenging. Initially, patients activate other muscle groups, mainly abdominal, gluteal or thigh muscles, which disrupts and slows down the successful progress of the therapy.
The MYO 200 is an important helping device.
It uses biofeedback. The device measures physiological variables and presents them in real time to the lying patient on a computer monitor. To measure and train pelvic floor contractions, a probe with pressure sensors is used, which is inserted into the woman's vagina (the man's rectum) and can measure the pressure exerted by the pelvic floor muscles. This is captured on the monitor by an indicator (e.g. an airplane in the picture), which the woman tries to use to copy the presented curve by activating the pelvic floor. Thus, the patient exercises the muscles at the intensity given by the first measurement, and a sufficient length of contraction is also important. The progress of the exercise is always stored in the computer and the gradual progress of the condition can be monitored.
In some cases, despite all efforts, patients fail to activate the pelvic floor. The pelvic floor can then be stimulated with an electrical impulse, which is painless and is emitted through a probe inserted into the vagina. A pulse of a certain frequency irritates the muscle fibres which react with muscle contraction. This is completely painless, the woman only perceives a muscle contraction.
However, conservative treatment is not always successful. Particularly in urinary incontinence associated with descensus, surgical intervention is often necessary. The choice of surgery is then guided by an algorithm that respects functional and anatomical conditions.
Our gynaecologists will explain everything to the patient in detail, familiarize her with the type of procedure and instruct her on the necessary next steps. Postoperative physiotherapy is strongly recommended.
We are born with an incredible ability to naturally develop the skills of our body, but in the context of civilized habits this natural ability is being suppressed and forgotten. A comprehensive, holistic and multidisciplinary approach can get it started again.
