Urogynecological physiotherapy is a field of physiotherapy that deals with dysfunctions and ailments related to the pelvic area, pelvic floor and pelvic organs. It is focused primarily on ailments and prevention of female problems. It aims to treat and prevent pelvic floor problems, such as.: urinary incontinence, lowering and prolapse of the genitals, pelvic area pain or sexual dysfunction.
The following depends on the functioning of the pelvic floor muscles.: the proper functioning of the reproductive organs and the excretory system. However, urogynecological physiotherapy involves not only work with the so-called “Kegel” muscles, but with the whole body of the patient! Although, in fact, we pay special attention to the area of the pelvis and internal organs. Urogynecological physiotherapy is widely used and is recommended to every woman, regardless of age. Especially in the perinatal period, i.e., before pregnancy, during pregnancy and after childbirth!
What does urogynecological physiotherapy do?
- Prevention and treatment of urinary incontinence and dysfunction of the bladder and urethra (e.g., excessive pressure on the bladder).
- Prevention and treatment of disorders of the statics of the reproductive organ (such as uterine prolapse or lowering of the vaginal walls).
- Elimination of ailments associated with the period of pregnancy.
- Preparation for childbirth and for the period after childbirth.
- Preparation for gynaecological surgery and postoperative rehabilitation.
- Working with postoperative scar/caesarean section/incision or perineal rupture.
- Working with the separation of the rectus abdominis muscle.
- Assessment and help in returning to physical activity after childbirth.
- Treatment of painful intercourse.
- Treatment of dysmenorrhea.
- Working with excessive tension of the pelvic floor muscles.
- Treatment of pain in the pelvis, perineum, labia, urethra and spine.
- Treatment of endometriosis.
- Pelvic floor prophylaxis.
How to prepare for the first appointment?
- Observe and prepare details about your ailments, illnesses, medications taken, surgeries, injuries, births, etc.
- Pay attention to the habits of everyday life and habits in the toilet (in what position you defecate, whether you do not put pressure to the bottom of the pelvis, whether you do not accelerate the stream of urine).
- Observe how many times during the day you go to the toilet, or do you defecate every day?
- How much water and fluids do you drink per day?
- If you are pregnant, take your pregnancy card with you and ask your doctor for a certificate of the absence of contraindications to physiotherapy.
- If you are after pregnancy and have a hospital discharge and a birth card, take them with you.
- Take a comfortable outfit in which you will be able to freely perform exercises and, if necessary, you will be able to take off.
- When it comes to preparing the body, basic hygiene is enough. You don’t have to shave before your visit!
- Prepare the questions you want to ask.
How does the visit look like and what tests does the urogynaecological physiotherapist perform?
At the first visit, a detailed interview is carried out, which is very important in the diagnosis and further therapeutic procedure. One can expect questions about: pregnancy, childbirth, menstruation, intercourse, past operations and injuries, chronic diseases, medications taken, the presence of scars, pain, physical activity and previous treatment.
Another element is examination.
At the beginning, the body posture, joint mobility ranges, pelvic alignment and respiratory tract, appearance and function of abdominal muscles and scars, if any, are checked. The pelvic region is examined by palpation to assess possible tensions in this area. If necessary, tests for bone and ligamentous structures of the pelvis are performed. Then, depending on the problem and if the patient agrees, a per vaginum examination is performed.
- The patient must agree in writing to perform the per vaginam examination.
- Before performing the examination, the physiotherapist explains what it will look like and what will be assessed.
- The examination is performed in a gynaecological skirt and in an atmosphere comfortable for the patient.
- The examination is painless and non-invasive.
- If necessary, the test may be discontinued at any time.
Per vaginam test
Per vaginam is an important diagnostic test for the urogynecological physiotherapist. This is a completely different examination than in the case of a gynaecologist, because the physiotherapist deals with the so-called functional examination! Internal techniques allow the best assessment of pelvic floor muscles. It also allows access to a number of hard-to-reach external structures that need to be relaxed to reduce pain or strengthened to improve the function of the muscles and organs of the pelvis.
- The position of the urethra.
- The position of the minor pelvic organs and their possible lowering.
- Basic tension and elasticity of the pelvic floor muscles.
- Perineal incision scarring.
- The behaviour of the pelvic floor when coughing.
- The presence of pain points (so-called trigger points).
- Functions of the pelvic floor muscles.
During the examination, the patient performs exercises of the pelvic floor muscles, so that the function of the pelvic floor muscles can be assessed using the PERFECT scheme. The following parameters are subject to this assessment:
P (power) – muscle strength,
E (endurance) – muscular contraction maintenance time,
R (repetitions) – the number of contractions performed,
F (fast) – the number of rapid contractions,
E (elevation) – the presence of MDM lift,
C (contraction) – the presence of compensation from other muscles,
T (timing) – the presence of reflexive muscle activity, e.g., during coughing.
In addition, the physiotherapist checks the correctness of pelvic floor muscles exercises and teaches the correct activation of these muscles! Very often it turns out that, unfortunately, we incorrectly exercise the muscles of the pelvic floor, thus harming ourselves instead of helping!
What can pelvic floor therapy look like?
After the interview and examination, a lot of conclusions can be drawn and a preliminary diagnosis can be made. After the examination, the physiotherapist explains what to focus on at the beginning of the therapy in order to be able to solve the problem and tries to outline an action plan. She teaches the correct activation of the pelvic floor muscles and gives recommendations for everyday activities, autotherapy or exercises to do at home. The therapy is always tailored to the patient. In the pelvic floor therapy process, your own work between visits is crucial! The frequency of subsequent meetings and the time needed for therapy depends on the type of the problem with which the patient comes and her complaints, as well as the patient’s involvement in therapy and homework. If you still have any questions about your visit to the urogynaecological physiotherapist, feel free to write!