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At In Step Physical Therapy, we have been successfully treating various pelvic floor dysfunctions in both male and female populations for the last decade . We have Certified Rost Therapy Clinician and Certified Pfilates ( pelvic floor pilates) clinician on board to meet our client needs in time.

Pelvic floor physiotherapy

Specialized Physiotherapy is becoming more established in the literature as a first-line of defence against Incontinence and Pelvic Pain. Pelvic Floor Dysfunction can be caused by:

Hypotonicity (Weak pelvic floor muscles):

Contributing to stress incontinence, urge incontinence and pelvic organ prolapse. Incontinence is NOT a normal part of aging

Hypertonicity (Tight pelvic floor muscles):

Contributing to Urinary and Fecal Urgency, Urge Incontinence, Chronic Pelvic Pain, Dyspareunia, Vaginismus, Vulvodynia, Pudendal Neuralgia, Interstitial Cystitis and Chronic Prostatitis
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The Cochrane Collaboration 2010 concluded that Physiotherapists with specialized training in pelvic floor rehabilitation (using internal examination to teach the exercises) should be the first line of defence, before surgical consultation, for stress, urge and mixed incontinence in women.

Many people with pelvic pain have pelvic floor dysfunction, but specifically hypertonic muscles, or muscles that are too tight. The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women).

These muscles must be able to contract to maintain continence and relax to allow for urination, bowel movements, and in women, sexual intercourse.

When these muscles have too much tension (hypertonic) they will often cause pelvic pain or urgency and frequency of the bladder and bowels. When they are low-tone (hypotonic) they will contribute to stress incontinence and organ prolapse. You can also have a combination of muscles that are too tense and too relaxed.

Hypertonic muscles can cause the following symptoms:

  • Urinary frequency, urgency, hesitancy, stopping and starting of the urine stream, painful urination, or incomplete emptying
  • Constipation, straining, pain with bowel movements
  • Unexplained pain in your low back, pelvic region, hips, genital area, or rectum
  • Pain during or after intercourse, orgasm, or sexual stimulation
  • Uncoordinated muscle contractions causing the pelvic floor muscles to spasm
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Pelvic floor dysfunction is diagnosed by specially trained doctors and physiotherapists by using internal and external “hands-on” or manual techniques to evaluate the function of the pelvic floor muscles. They will also assess your ability to contract and relax these muscles. Your bones and muscles of your lower back, hips and sacro-iliac joints will need to be assessed as well since these joints can stress your pelvic floor muscles.

If an internal examination is too painful, the connective tissue of your abdomen, thighs, groins and low back are often very tight. The connective tissue forms the container of the muscles, and this tissue often needs to be relaxed before any internal work can be done.

When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed, if appropriate.

Self-care is an important part of treatment. Avoid pushing or straining when urinating and ask your health care provider about how to treat constipation. Relaxing the muscles in the pelvic floor area is important, and doing reverse kegels may be one way to help lengthen and relax these muscles. Using methods such as warm baths twice daily can also be helpful.

Medication such as compounded vaginal or rectal diazepam can be quite helpful and may be prescribed by your doctor. These medications can be used as local muscles relaxants in the vagina or rectum. Good posture to keep pressure off your bladder and pelvic organs, and other stretching techniques such as yoga, can be helpful to avoid tightening and spasms in the pelvic floor muscles as well.

Persistent pain education is an important part of treating pelvic floor dysfunction since the pelvic area is an area that we often hold our stress. Anxiety, stress and our thoughts, attitudes and beliefs can perpetuate the pain in our pelvis; understanding how our pain system works has shown to be an effective way of reducing the threat of ongoing pelvic floor dysfunction.

Men’s Pelvic Health

Pelvic floor physiotherapy can be extremely helpful to address some of the challenges that men may have when their pelvic floors are not working properly including:
  • Post-Prostatectomy Incontinence
  • Erectile dysfunction
  • Pelvic Pain including Chronic Prostatitis, Testicular and Penile pain syndromes
  • Nocturia (frequent urination at night)
  • Symptoms of retention which can often be associated with Benign Prostate Hyperplasia and/or a tight pelvic floor
  • Tight Pelvic Floor
  • Chronic Constipation

Mens pelvic health has fallen behind in research and recognition of pelvic floor muscle problems as they relate to overall health, specifically urogenital health. Pelvic health problems have received more attention from the medical community in general for women, leaving men confused, isolated and searching for answers. Please click on the links on this page to get more information on each of these pelvic health problems and follow the links throughout this website to get some real answers and potential solutions.

Rost Therapy: Treatment for Pelvic Girdle Pain

Developed by Cecile Röst

Rost Moves Mamas!

Pelvic Girdle Pain (PGP) affects many pregnant and postpartum women and affects function and quality of life. It is also under-recognized and under-treated, and many women are told that back, pubic and/or hip pain is just a normal part of pregnancy, which will most likely improve after delivery. In fact, in one study, 71% of the pregnant women with self-reported lumbo-pelvic pain told their health care professionals about their pain, and only 25% received any type of treatment for their condition. Pierce 2012. The reality is that PGP can be significantly improved in pregnancy and postpartum, allowing pregnant women to function well and enjoy their pregnancies.
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What is Rost Therapy?

Rost Therapy consists of an assessment which identifies asymmetry and/or muscle imbalance of the pelvic girdle and unhelpful movement patterns and postures. Treatment includes therapist hands-on treatment to improve pelvic girdle symmetry and muscle support, followed by a home exercise program to properly balance the pelvic girdle joints and muscle patterns. Postural and movement advice for daily activities is an important part of the program. Because the home program is simple to do, adherence is extremely high: women have less pain when they follow the exercises and advice, and are only too happy to lead a 'normal' life with less pain and restrictions! A small number of treatments sessions are needed for treatment and to learn the program. This active approach gives women back control of their symptoms and function.

Rost Therapy is a very effective treatment program with quick and lasting results, with effectiveness tested in a large follow-up study (Röst et al 2006). Within a few weeks, women with PGP using Rost Therapy could function normally, and return to work and exercise. In fact, 98% of 430 women treated with Rost Therapy in pregnancy reported benefit from the treatment (Rost et al). Only a small percentage of Rost patients required additional treatment after delivery. In the last twenty years, there has been a continuous demand for Rost Therapy training in Holland, Europe and North America. Many treated patients have educated other women about the method and have encouraged their health professionals to become trained in Rost Therapy.

With conventional treatment, 35 percent of women with PGP were symptom free within a month after birth, but 7 to 18 percent had serious complaints up to eighteen months after delivery (Ostgaard et al. 1991). However, less than 2 percent (n=7) of women treated with Rost Therapy (Röst et al.) during pregnancy had serious complaints eighteen months after delivery, of whom five were at the end stage of a next pregnancy or had recently delivered. The sixth woman experienced postnatal depression, and the seventh had stopped the treatment and home exercises after two sessions.

Within weeks or months, most women, even with prolonged pelvic pain, can function normally again and (depending on the stage of pregnancy or maternity leave) can go back to their work and sports. Only a very small percentage of the patients required additional treatment elsewhere.

Many of the Rost patients who were treated while they were pregnant had since become pregnant again. Some of these women started developing symptoms of PGP in subsequent pregnancies, and so they came in for a refresher Rost Therapy session to review the exercises needed to restore pelvic symmetry. They went on to have great pregnancies with their PGP symptoms under control. These women were able to then exercise and participate in daily activities.

What exactly is Pfilates?

Pfilates is a program of neuromuscular conditioning based on extensive EMG recordings taken from the pelvic floor. Pfilates was created by an American Urogynecologist to provide a method of home pelvic floor fitness training accessible to a broad population.
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Pfilates program

The Pfilates program is a simple program consisting of ten movements presented in the same order in three different phases (beginning, intermediate, and advanced). Each of the Pfilates movements includes a series of repetitions followed by a hold phase and a pulse phase at the point of peak engagement of the pelvic floor. As such these movements encourage the development of the three essential elements of neuromuscular performance: strength, endurance, and coordination.

If you have concerns, Please book an appointement with us.

We have Certified Rost Therapy Clinician and Certified Pfilates ( pelvic floor pilates) clinician on board to meet our client needs in time.