Therapeutic interventions on pelvic floor dysfunctions

The pelvic floor is a complex of muscles that supports many pelvic organs and acts as a “hammock” for intestine, rectum, bladder, urethra, uterus and vagina.

Medical specialists have ignored this anatomical district for long time. Women still have little awareness about it, because it belongs to an intimate sphere such as sexuality and has correlation with physiological functions such as defecation and urination (often topic of shame and fear).

However, the symptoms resulting from pelvic floor dysfunctions are multiple.

Problems that deserve a particular focus are incontinence, prolapse, urinary difficulties, urinary disorders, pelvic pain, recurrent cystitis, post coital cystitis, pain during sexual intercourse, burning, discomfort, etc.

Few people know that midwives are the professional figure to turn to for an evaluation of pelvic floor and its possible rehabilitation and re-education.

The therapeutic intervention, when necessary, is divided into three stages:

  • the first focuses on learning the activities of the pelvic floor
  • the second is based on the normalization of the pelvic floor to return the right parameters to the muscles (strength, endurance, relaxation, motor coordination of related structures and organs)
  • the third aims to improve or restore the normal functionality of the entire organ complex

There are many techniques and tools and the path must be adapted to the needs of the person.

The best known and used are: therapeutic exercises, manual therapy or manipulations, behavioural treatment and lifestyle changes, home self-treatment and self-massage, biofeedback, functional electrical stimulation and TENS, vaginal dilators, vaginal cones, Swedish therapeutic mat and non-pharmacological topical products.

Let’s see them together:

• Therapeutic exercises

The most important step is to explain to women the connection between the muscular component and the symptoms. Some exercises are made together with the therapeutic professional while others can be done at home. These exercises can be carried out both in a lying position and in a standing position, both detained and in movement and are specially designed to highlight the different actions of the pelvic floor.

In case of hypo tonus, the exercises will be focused on muscular reinforcement. In case of hypertone, they will be focused on relaxation.

In both cases, the awareness of this muscle complex is important to improve coordination. In fact, rehabilitation techniques are aimed at the improvement of proprioception and dynamic re-education of the perineum, rebalancing the perineal muscles through specific exercises with special attention to respiratory coordination.

• Manual therapy

Techniques used include joint and tissue mobilizations, massages, stretching, treatment of scars and adhesions.

Manual therapy for the improvement of problems related to the pelvic floor, mainly involves manipulations:

  • to loosen and increase the space of the vaginal entrance
  • to desensitize the painful area with trigger or tender points treatment. They are points that are painful to the pressure. Tender is a very precise point: when touched, the pain is still limited. A trigger is extremely painful and radiates the pain. The treatment consists of releasing these points until the pain disappearance.

• Lifestyle and behaviour

In case of muscular hyper tonus, as in some cases of vulvar vestibulitis, it may be useful to identify the risk factors that feed this condition.

For example: cystitis, vaginitis, urethritis; sports activities such as exercise bike, spinning, horse riding; use of synthetic clothing, tight clothes, pads use and incorrect habits that can support the disease (excessive cleaning, use of aggressive soaps, use of perfumes or deodorants).

What the professional should do is to inform about the importance of proper eating and habits and promote preventive measures aimed at limiting the occurrence of infections (that often contribute to pelvic disorders).

• Self-treatment

The realization of the exercises learned during the physiotherapy sessions at home is part of this activity. They can include breathing exercises, free body exercises, hands-free massages or with the use of tools (tennis balls, T-Flex, G-Flex, different types of dildos). The very important exercises to perform at home can be considered all those that lead to increase awareness of this part of our body.

• Biofeedback

It is an electromedical instrument that transforms the action of the pelvic muscles, contraction and relaxation, into a visual or sound stimulus. A vaginal probe detects muscle action and the computer transforms it into a signal on the monitor. In this way, the patient and the professional observe the progress of the exercises with greater precision.

• Electrical stimulation

The principle according to which a muscle responds to electrical stimulation with a contraction is used in case of hypo tone. In case of pain-related dysfunctions, on the other hand, is udes the “gate control” TENS: it transmits electrical current through the nerves that send pain signals to the brain and, therefore, interferes with pain signs in a disjointed way to reduce pain. TENS can also help the body to produce more endorphins (a natural pain reliever).

• Vaginal dilators

They are used for progressive dilation of the vaginal canal and the pelvic floor muscle complex – as the anus lifter that surrounds the vaginal canal. They usually consist of a set of 4-5 dilators with increasing diameter and length. They can be replaced, after an improvement, by any dildo on the market. This method uses the ability of tissues to adapt to stretching and that of muscles to stretch.

• Vaginal cones

They are mainly used in case of muscular hypo tonus to increase tone, trophism and resistance. They are sets of cones with an increasing weight that must be introduced into the vagina for a few minutes per day. The exercise is to hold the cone in the vagina in an upright position; tone improvement will be measured in the ability to perform the exercise with a cone of a greater weight.

• Swedish therapeutic mat (for microacupuncture)

Swedish therapeutic mat takes advantage of acupuncture benefits. It can be especially useful when it is necessary to bring the body to a state of relaxation and to improve painful symptoms. The sessions consist of assuming a lying face down position. During the exercise, the production of endorphins and oxytocin increases: the former behave as neurotransmitters and are able to modulate the pain threshold. It acts as natural endogenous antidepressants while oxytocin – that is a hormone that regulates body temperature – controls heart and arterial, facilitating blood clotting and increasing immune defenses.

• Topical non-pharmacological products

Their use is complementary to pharmacological therapy and is used to provide an anti-inflammatory and lubricating action on the vaginal mucosa. These products are used in case of pain, to soothe annoying symptoms and to perform therapeutic massages.

A correct classification of the problem and a specific path may improve the symptoms and quality of life of people who have disorders or dysfunctions of this important anatomical system.

It is essential to carry out an evaluation and a path with trained and competent professionals who know how to model a therapeutic plan on our needs.


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