External Pelvic Floor Massage Therapy

What is the Pelvic Floor?

The pelvic floor is a hammock of musculature located in the bottom of the pelvis. The pelvic floor muscles work together to support the organs of the abdomen, and to stabilize the pelvis and hip joints.

What does an improperly functioning pelvic floor feel like?

Symptoms of improper function of the pelvic floor is changes in urinary/bladder/ bowel function, low back pain, hip pain.

Some patients will report some of the following symptoms, urinary incontinence (control, urgency, and frequency), low back pain, diastasis recti, pain with bowel movements, organ prolapse, pelvic pain related to endometriosis or PCOS, interstitial cystitis, or prostatitis, and pre and post pregnancy pain and scarring. See below for more information about how we can help with these specific conditions.

Under certain circumstances we will refer to a Pelvic Floor Physiotherapist who can work on the internal musculature, if needed.

How can Massage Therapy help with Pelvic Floor instability?

As Massage therapists, we can help with the external muscles surrounding the pelvic floor to help increase function and decrease pain. We do this by assessing the patient through low back, glutes, hip flexors, abdomen and diaphragm, teaching proper breathing and muscle engagement techniques, and then strength training to improve instability and symptoms.

What should I expect with my first treatment?

First, we begin with an in-depth interview regarding your symptoms, health, and functional history. Then we will move into a thorough assessment of the hips, low back, SI joints, and breathing patterns. Your therapist will work to release tight muscles, through clothing, and then begin teaching proper engagement of pelvic floor muscles with breath techniques. Then, we will add on strengthening exercises to help with compensating muscles, like glutes and hip flexors.

Comfortable athletic-type clothing is recommended for this type of treatment.

What treatment length should I book for Pelvic Floor Treatment?

An initial assessment takes about 45 minutes, and a follow-up treatment is about 30 minutes. You may also wish to add on a 30 minute massage as well.

Conditions that may be helped with external pelvic floor massage therapy treatment:

Incontinence

Stress Incontinence:

Leakage following coughing/sneezing, laughing, jumping and running
Due to weak pelvic floor contraction
Patient may have a strong pelvic floor contraction, but their intra-abdominal pressure may be too high (breath holding, poor posture, etc.)
The most common type of incontinence after childbirth
Usually, SMALL amount of urine loss

Urge Incontinence:

Strong urge to urinate even when bladder isn’t full
Leakage due to inability to delay voiding (get to the bathroom on time)
Caused by involuntary bladder muscle contractions (aka. overactive bladder)
Can be large or small urine loss
More common in post-menopausal women

Mixed Incontinence: a combination of the above symptoms,

Pudental Neuralgia

Patient often reports burning, stabbing pain, pinching, twisting or even numbness in genitals to anus area (or move around within the pelvic area) primarily with sitting (commonly seen in cyclists) The pain is often worse at the end of the day but will not wake them up during the night
Causes: –Prolonged sitting (ex. Cycling) –Persistent straining –constipation, childbirth –Poor core control of the pelvic floor leading to SI joint laxity
Treatment: Manual therapy, Pelvic Floor relaxation, Core strengthening

Pelvic Organ Prolapse

Painless condition that only occurs in females Hernia of the pelvic organs through the vaginal opening due to pelvic floor weakness and loss of connective tissue tension
Pelvic organs: Uterus, Bladder, Rectum (bladder most common)
Conservative Management of Prolapse: treat underlying conditions, lifestyle management (weight loss, smoking cessation, avoid constipation, avoid repetitive heavy lifting, hormone replacement therapy) Pelvic Floor Therapy ; Vaginal Pessary

Endometriosis

Abnormal presence of the endometrial tissue (uterine lining) outside of the uterus
Endometrial lesions can be found on the bladder, bowel, intestines, colon, appendix, rectum
Symptoms: chronic pelvic pain and hypertonicity in pelvic floor, GI symptoms, infertility, painful periods
Medical management: hormonal treatment, decrease symptoms by increasing proper function of pelvic floor musculature

Polycystic Ovarian Syndrome (PCOS)

a hormonal condition affecting women of reproductive age
The ovaries produce an abnormally large number of androgens which are male sex hormones that are usually present in a small amount
6-20% women of reproductive age have PCOS (Selma et al, 2019)
Managing symptoms of pain though improving pelvic floor function

Interstitial Cystitis/ Bladder Pain Syndrome

Urge to urinate is combined with pain, discomfort and pressure
Pain worse when bladder more full
Urinate more than 8x per day
Dyspareunia often associated with this condition often postmenopausal
Treatment: Release of pelvic floor muscles internal and external will decrease frequency/intensity of symptoms

Diastasis Recti

Stretching of the connective tissue of the centre of the abdomen resulting in a gap/separation between the rectus abdominal muscles
Occurs most often from pregnancy, but can also happen with excessive adipose tissue or congenitally.

Round Ligament Pain (during pregnancy)

As uterus grows, the ligament can stretch and cause pain in the bottom of the abdomen. Pain is often described as sharp.

Male Conditions

Men’s Health Statistics:

Men are more likely to be obese than women (71% vs 56%)
Obesity is associated with higher risk of erectile dysfunction (ED)
50% of men report intermittent episodes of ED by 50 years of age (Feldmann, 2000)

Prostatitis

inflammation of the prostate
Chronic Non-Bacterial Prostatitis: Due to tight pelvic floor muscles causing inflammation of the prostate, mimicking bacterial inflammation of the prostate

Erectile Dysfunction

Causes: Vascular compromise, natural reduction in testosterone, anxiety/depression, medications, alcohol, smoking, drug use, pelvic floor muscle dysfunction, ex. chronic pelvic pain syndrome (more than half of patients), post radical prostatectomy patients (almost 100%)

Prostatectomy

the removal of the prostate leads to urinary incontinence and erectile dysfunction; Autonomic (Involuntary) control of urinary continence is often lost. Urinary continence needs to be trained into a voluntary system of control through pelvic floor muscle training.