Physiotherapy
Pelvic Health Conditions
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Pelvic Health
Urinary Incontinence
What is Urinary Incontinence?
Many women and men believe that urinary incontinence and bladder health concerns are something that they have to live with. The fact of the matter is, while urinary incontinence impacts 10% of Canadians¹, and 1 in 3 women², there is something that can be done to manage, and in many cases, treat their symptoms.
Urinary incontinence is the involuntary loss of urine resulting from our continence system not being able to control urine passage through the urethra. This continence support system consists of the pelvic floor muscles, the connective tissue of the pelvic organs, the bladder and urethra, and the pelvic bones.
The Role of the Pelvic Floor in Urinary Incontinence/Bladder Health
When bladder and pelvic health symptoms are present, the pelvic floor muscles are either underactive or overactive. Underactivity refers to when the muscles are not contracting as efficiently as they need to be, and tend to be hypotonic (too relaxed) and weak. Overactivity occurs when muscles activate too much, and too frequently, which results in hypertonic (tight) muscles that over time, may become weak as well, as their state of hypertonicity leads to an inability to further contract. Either state can result in the following types of incontinence and bladder conditions.
Types of Urinary Incontinence and Bladder Health Conditions
Urge Incontinence:
Urge incontinence is urine loss associated with a strong & sudden urge to pee that cannot be controlled. You have to go pee NOW! You aren’t able to delay peeing.
Stress Incontinence:
Stress incontinence is urine loss associated with actions that increase intra-abdominal pressure. These actions include but are not limited to: sneezing, coughing, laughing, jumping and running.
Mixed Incontinence:
Mixed incontinence is a combination of urge and stress incontinence.
Overflow Incontinence:
Overflow incontinence involves a constant loss of a small amount of urine from the bladder. This is most often associated with a large distended bladder.
Urinary frequency (Overactive bladder)
This refers to the chronic need to urinate more frequently than every 2-3 hours.
Urinary Urgency
Similarly to urge incontinence, urinary urgency refers to if, once the urge to pee comes into our mind, we have to make it to the bathroom IMMEDIATELY. Urinary urgency does not mean there is urinary leakage.
Incomplete emptying
This refers to the sensation, or diagnosis, of incomplete emptying of the bladder after urinating. It may feel as if we have to stay on the toilet for a long time to fully empty, or that we have to urinate again after a few minutes because our bladder did not completely empty.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Diastasis Recti Abdominis retraining
-
Pelvic Organ Prolapse management strategies
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Neuromuscular Stimulation for the Pelvic Floor
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Fecal Incontinence, Bowel Health, and Pelvic Health Physiotherapy
Fecal incontinence is a complex condition that severely impacts the daily lives of 2-3% of the Canadian population⁵
Bowel health conditions are often not discussed openly and frequently, as the topic may be considered taboo. As a result, many people prolong reaching out for treatment, or never do, as they may not know where to turn to, or may think that they are the only ones experiencing their symptoms. However, research and evidence shows us the commonality of bowel health conditions:
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Fecal incontinence is a complex condition that severely impacts the daily lives of 2-3% of the Canadian population⁵
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Constipation impacts 20% of the general population⁶
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Rectoceles are found in more than half of women presenting with pelvic floor disorders⁷
At Mississauga Pelvic Health, we normalize the topic of bowel health, and work with individuals on a daily basis to diagnose, manage, and treat their bowel related symptoms and conditions.
Bowel Health Conditions:
Fecal Urgency
Fecal urgency occurs when there is a sudden uncontrollable urge to defecate, and you are running to the washroom in order to make it. You can have fecal urgency by itself or coupled with fecal incontinence.
Fecal Incontinence
Fecal incontinence occurs when there is uncontrollable passage of fecal matter.
Obstetrical Anal Sphincter Injuries (OASIS)
OASIS refers to injuries sustained to the pelvic floor during childbirth- most often including 3rd and 4th degree tears and instrumentation assisted delivery. The most common symptoms involved with OASIS injuries is double incontinence (urinary and fecal).
Constipation
Constipation is a complex condition that includes 2 or more of the following criteria: forcing to defecate, pellet like stool, sensation of incomplete emptying, sensation of blockage, less than 3 defecations a week, or having to use manual maneuvers to pass stool
Rectal Prolapse (Rectocele)
A rectocele is the prolapse of the rectum into the vaginal wall. This often occurs as a result of chronic straining to pass stool or childbirth related anal injuries.
Hemmrroids & Anal Fissures
Hemorrhoids and anal fissures are often the result of chronic straining to pass stool and increased pressure in the pelvic floor.
Anal Pain & Spasms
Anal pain and spasms can occur due to a plethora of conditions often related to hypertonic or “tight” pelvic floor muscles ano-rectally.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
• Education regarding your symptoms, condition, assessment findings, and treatment plan
• Bladder retraining
• Constipation management and bowel retraining
• Rectal Balloon Technique
• Targeted manual therapy of the myofascial system
• Visceral mobilizations
• Pelvic floor muscle downregulation and relaxation
• Pelvic floor muscle strengthening and training
• Motor control training and strengthening of the deep core musculature
• Motor control training and strengthening of the abdominal wall, hips and thorax
• Postural education and retraining
• Pelvic Organ Prolapse management strategies
• Functional retraining of the neuro-muscular system to achieve movement and activity goals
• Neuromuscular Stimulation of the Pelvic Floor
• Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Health
Pelvic Organ Prolapse
What is a Pelvic Organ Prolapse (POP)?
A Pelvic Organ Prolapse (POP) refers to the descent of a pelvic organ into the vaginal canal, or past the vaginal opening. This can occur to varying degrees, from Grades 1-4, 1 being the mildest, and 4 being the most advanced form. The main direct cause of POP’s is chronic or sustained increases in intra-abdominal pressure, which creates downward pressure on the pelvic organ. Examples of this include vaginal childbirth(s), chronic constipation, chronic coughing, excessive heavy lifting, and holding our breath while lifting/carrying. These factors, coupled with pelvic floor muscle or tissue dysfunction¹⁰, can result in the POP signs and symptoms that many women experience. Additional risk factors include older age, menopause, connective tissue and hypermobility conditions, smoking, and abdominal/pelvic surgery.
Pelvic Health Physiotherapy is one of the main nonsurgical options for women with POP¹¹ Research shows that women who perform pelvic floor muscle training experience an improvement in both symptoms and severity of a POP¹².
Let’s dive in further into what a POP is, and how Pelvic Health Physiotherapy can help.
Types of Pelvic Organ Prolapses
● Cystocele: prolapse of the bladder
● Urethrocele: prolapse of the urethra
● Uterine prolapse: prolapse of the uterus
● Vaginal vault prolapse: prolapse of the vagina
● Enterocele: small bowel/intestine prolapse
● Rectocele: rectal prolapse
Symptoms of a Pelvic Organ Prolapses
● Heaviness, pressure, or fullness in the pelvic region
● A sensation of ‘something being there’ in the pelvic region
● Urinary frequency, urgency, or incontinence
● Urinary retention
● Fecal incontinence
● Constipation
● Using manual techniques to help evacuate stool
● Pain with intercourse
● Altered sensation during intercourse
● Back/pelvic pain
● Inability to keep a tampon in
● Noticing a bulge at the vaginal opening
The role of the Pelvic Floor in Pelvic Organ Prolapses
Pelvic floor dysfunction can occur when these muscles are not activating enough and are hypotonic (too relaxed), or if they are working too much and become hypertonic (too tight). In either state, the muscles are unable to produce adequate force to support the pelvic organs, which may contribute to a POP.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Pelvic Organ Prolapse management and treatment
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Discuss appropriate supportive devices
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular Stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Painful Intercourse (Dyspareunia)
Painful intercourse, or dyspareunia, is a prevalent pelvic health condition that can have a significant impact on person’s life. It is a term that describes pain before, during, or after penetrative intercourse, affecting women and men. The prevalence of dyspareunia varies from 3 to 18% worldwide, and can affect 10-28% of the population in a lifetime. (19,20)
While there are many possible causes of dyspareunia, it is often associated with pregnancy, childbirth, abdominal and/or genitourinary surgery, accident/trauma, hormonal imbalances, stress and anxiety, and pelvic floor muscle overactivity.
Whatever the cause of the pain, painful intercourse is not something you have to suffer with for the rest of your life, as Pelvic Health Physiotherapy can help.
Pelvic Health
Specific Pelvic Health Conditions associated with Painful Intercourse
Women’s health:
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Vaginismus: Inability to penetrate vagina due to muscle spasm
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Vulvar pain & Vulvodynia: Pain & discomfort (burning & sensitivity) in the external vaginal structures (vulva) occurring constantly or when provoked
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Vestibulodynia: Pain & sensitivity of the vestibule (opening of the vagina) to touch and pressure
Men’s health:
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Chronic Nonbacterial Prostatitis/chronic pelvic pain syndrome: a condition that causes long-term pelvic pain and urinary symptoms. Pain is often in and around the prostate gland.
Symptoms associated with Painful Intercourse
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Burning/sharp pain at the vulva
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Sensitivity of the vulva to different stimuli ex. Clothing, touch, penetration
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Bleeding and cracking of the vestibule (opening of the vagina)
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Painful intercourse
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Inability to have vaginal penetration (tampons, speculum, penis)
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Unwanted genital arousal unrelated to sexual desire
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Clitoral pain and sensitivity
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Decreased vaginal lubrication and pelvic floor muscle atrophy
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Altered sensation during intercourse
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Back/pelvic/hip pain
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Noticing a bulge at the vaginal opening
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Ejaculatory pain
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Dilator therapy
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Pelvic Organ Prolapse management and treatment
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Discuss appropriate supportive devices
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Pain Conditions
What is Pelvic Pain?
Pelvic pain is a prevalent, and unfortunately, not often talked about, pain condition. It is an umbrella term referring to pain occurring in the lower abdomen, lower back, pelvis and its associated ligaments/tendons, and pelvic floor muscles. Pelvic pain can be chronic and consistent, or occur with certain activities. While there are many causes of pelvic pain, it is often associated with the following: pregnancy, childbirth, abdominal and/or genitourinary surgery, accident/trauma, hormonal imbalances, and pelvic floor muscle overactivity.
Whatever the cause of the pain, pelvic pain is not something you have to suffer with for the rest of your life, as Pelvic Health Physiotherapy can help.
Pelvic Pain Conditions
Female Pelvic Pain
Vaginismus: Inability to penetrate vagina due to muscle spasm
Dyspareunia: Painful vaginal penetration
Vulvar pain & Vulvodynia: Pain & discomfort (burning & sensitivity) in the external vaginal structures (vulva) occurring constantly or when provoked
Vestibulodynia: Pain & sensitivity of the vestibule (opening of the vagina) to touch and pressure
Persistent Genital Arousal Disorder (PGAD): unwanted genital arousal unrelated to sexual desire
Genitourinary Syndrome of Menopause (GSM): collection of signs & symptoms involving changes to the vulva and vagina as a result of menopause
Male Pelvic Pain
Chronic Nonbacterial Prostatitis/chronic pelvic pain syndrome: a condition that causes long-term pelvic pain and urinary symptoms. Pain is often in and around the prostate gland
Male and Female Pelvic Pain
Coccydynia (Tailbone pain): Pain at the tailbone most often with prolonged sitting
Pudendal Neuralgia: pain associated with the structures innervated by the pudendal nerve
Symptoms of Pelvic Pain
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Burning/sharp pain at the vulva
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Sensitivity of the vulva to different stimuli ex. Clothing, touch, penetration
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Bleeding and cracking of the vestibule (opening of the vagina)
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Painful intercourse
-
Inability to have vaginal penetration (tampons, speculum, penis)
-
Urinary urgency & frequency
-
Unwanted genital arousal unrelated to sexual desire
-
Clitoral pain and sensitivity
-
Decreased vaginal lubrication and pelvic floor muscle atrophy
-
Altered sensation during intercourse
-
Constipation
-
Back/pelvic pain
-
Inability to keep a tampon in
-
Noticing a bulge at the vaginal opening
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Ejaculatory pain
The Role of the Pelvic Floor in Pelvic Pain
Our pelvic floor muscles, just like any other muscles in the body, can become too tight. This can occur due to many reasons, including overuse from activity, stress, pregnancy, constipation, bladder issues, and surgery. When muscles are tight, they do not function optimally, resulting in issues such as potential weakness, neural compression, decreased blood flow, and altered movement mechanics. In certain cases of pelvic pain, the pelvic floor muscles can also be too relaxed, and not be providing adequate support for its surrounding structures.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Dilator therapy
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Pelvic Organ Prolapse management and treatment
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Discuss appropriate supportive devices
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Low back, Hip, Pelvic pain, and Pelvic Health Physiotherapy
Many people know that Physiotherapy can help with low back, hip, and pelvic pain, but not many know that Pelvic Health Physiotherapy can be a key component of their recovery plan. In fact, several studies have linked low back pain to pelvic floor dysfunction, including one study that demonstrated that 78% of women with low back pain had urinary incontinence (25), and another study showing that 95.3% of women with low back pain experienced pelvic floor dysfunction (26). These studies have guided the world of rehabilitative therapy to further explore the role of the pelvic floor in low back pain.
Common Pelvic Health Symptoms that may be linked to Low back, Hip, or Pelvic Pain
● Urinary incontinence, urgency or frequency
● Urinary retention or incomplete emptying
● Fecal incontinence, urgency, or frequency
● Constipation
● Sensation of pressure or heaviness in the pelvis
● Pelvic Organ Prolapse
● Burning, stinging, itching in the pelvic region
● Sexual pain and dysfunction, vaginismus
● Dysmenorrhea: menstrual pain
● Pre- and post-partum pelvic pain and dysfunction
● Diastasis recti abdominis
● Endometriosis
● Vulvodynia and Vestibulodynia
● Chronic low back, hip, pelvic, or hamstring pain
The Pelvic Floor and the Core
The pelvic floor muscles sit within the pelvis, attaching to the pubic bone, tailbone, and sitting bones, acting as a hammock to support our organs. In addition, their functions include bladder and bowel control, sexual health, circulation, and, importantly, core strength.
The core is made up of our pelvic floor muscles, transverse abdominis, diaphragm, and multifidus. These muscles act in coordination to support our back, abdomen, pelvis, hips, and thorax. They are essentially our support system, have good endurance, and help us maintain good posture and movement mechanics throughout the day.
Pelvic Floor Dysfunction
When pelvic health symptoms are present, including low back, hip, or pelvic pain, the pelvic floor muscles may either be underactive or overactive. Underactivity refers to when the muscles are not contracting as efficiently as they need to be, and tend to be hypotonic (too relaxed) and weak. Overactivity occurs when muscles activate too much, and too frequently, which results in hypertonic (tight) muscles that over time, may become weak as well, as their state of hypertonicity leads to an inability to further contract.
The link to Low back, Hip, and Pelvic pain
Either overactivity or underactivity of the pelvic floor can result in low back, hip, or pelvic pain, as a dysfunction in these muscles can lead to altered coordination and activation of our core muscles. This will cue other muscles in the body to try to take over for the core (such as muscles in our low back, our glutes, our hamstrings), and because these latter muscles are not meant to act as our endurance support system. This can result in pain due to 2 main reasons:
1) They become overworked, tight, and may develop trigger points, which can become a source of pain.
2) They activate when they are not necessarily supposed to, resulting in altered postures and movement patterns, which can over time, become a source of pain.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Breathing coordination and training
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Diastasis Recti Abdominis retraining
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Endometriosis/Adenomyosis and Pelvic Health Physiotherapy
What is Endometriosis/Adenomyosis?
Endometriosis is a complex chronic pelvic pain condition that impacts 10% of women of reproductive age globally (29). It is characterized by the presence of endometrial tissue outside of the uterus. These endometrial lesions can implant on various structures in the lower abdomen including but not limited to: the reproductive system, the urinary system and digestive system. The pain pattern associated with endometriosis is often cyclical in nature with most women reporting pain associated with their periods (dysmenorrhea). However, it is important to note that the disease varies greatly among women and not all women will experience the same symptoms.
Similarly to endometriosis, Adenomyosis is a complex chronic pelvic pain condition characterized by the presence of endometrial tissue in the muscular wall of the uterus.
Symptoms of Endometriosis
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Painful periods (dysmenorrhea)
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Heavy and excessive periods
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Cyclical pain associated with the menstrual cycle (before, during, after)
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Constant or intermittent pelvic &/or low back pain
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Abdominal pain and bloating
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Fatigue, mood disturbances
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Painful intercourse (dyspareunia)
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Constipation, diarrhea, rectal bleeding
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Pain with voiding or bladder/bowels
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Pelvic Organ Prolapse management and treatment
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Discuss appropriate supportive devices
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Interstitial Cystitis
Bladder Pain Syndrome
Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS), is a chronic and debilitating condition of the urinary bladder. It is officially defined as ‘An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.” (32)
The causes and treatment options of IC/BPS have been deeply researched in the last few years, with new evidence and understanding regarding its causes and treatment options coming to light. The Interstitial Cystitis network has stated that ‘Pelvic floor physical therapy is now considered one of the best therapies for IC/BPS and research studies have found it to be more effective than oral medications and/or bladder treatments for many patients’. In fact, 3 out of the 5 subtypes of IC/BPS can be managed through Pelvic Health Physiotherapy.
Interstitial Cystitis/Bladder Pain Syndrome Subtypes (IC/BPS) (33)
*Pelvic Health Physiotherapy can help with subtypes 3-5
1 - Hunner’s Lesions
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Wounds on the bladder associated with inflammation
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Can be very painful
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Occurs in 5-10% of patients with IC/BPS
2 - Bladder Wall Injury
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The injury leads to urine being able penetrate into the tissues, causing irritation
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Causes Include: UTI, chemotherapy, poor dietary habit, and chemical exposure
3 - Pelvic Floor Injury/Hypertonicity*
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A tight pelvic floor can tighten around the bladder, nerves, and blood vessels, resulting in bladder symptoms, pain, and pelvic symptoms
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Causes Include: trauma to the pelvic floor from an accident, stress (which can result in chronic subconscious tightening of the pelvic floor muscles), childbirth
4- Pudendal Neuralgia*
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Results from pelvic floor muscles being so tight that they press on the pudendal nerve
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Causes include: bike riding, stress, trauma to pelvic floor
5 - Chronic Overlapping Pain Conditions / Central Sensitization Syndrome*
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This describes patients who have 2 or more Pain Conditions
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Other pain conditions include vulvodynia, prostatodynia, IBS, TMJ syndrome
Symptoms of Interstitial Cystitis/Bladder Pain Syndrome
- Urinary frequency and urgency
- Painful urination
- Nocturia (waking up excessively at night to urinate)
- Pain associated with intercourse (before, during, after)
- Chronic supra-pubic (lower abdomen) pain/pelvic pain
- Prostatitis-like symptoms
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment.
Treatment options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Stress management, relaxation techniques, and pain management techniques
● Central Nervous System remapping exercises and strategies
● Postural education and retraining
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Health
Diastasis Recti Abdominis
What is Diastasis Recti Abdominis (DRA)?
Diastasis Recti Abdominis (DRA) is defined as a horizontal separation of 2 muscle bellies of the rectus abdominis (the 6 pack muscles in the abdomen). This occurs when the linea alba, which is the white connective tissue that runs down the center of the abdomen and connects the rectus abdominis, expands against pressure, creating space between the muscles. This pressure could be the result of an increase in intra-abdominal pressure, such as if we hold our breath to lift something heavy, or some direct mechanical pressure from the abdomen, such as during pregnancy.
It is important to know that some degree of DRA is found in 100% of women at 35 weeks of pregnancy.(15) It is one of the body’s way of adapting to the growing bump. That said, a DRA during pregnancy does not mean that a woman will have a DRA postpartum.
DRA’s are also found in men, women who haven’t been pregnant, and children.
A DRA could occur above, at, or below the belly button, or in all 3 of those regions.
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Common Symptoms of DRA
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A separation of the rectus abdominis muscle, that may be visible or felt
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Low back, pelvic, or hip pain
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Poor trunk posture
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Feeling weak through the midsection, unable to activate the core
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Doming or tenting of the middle of the stomach. This can occur during activities such as lifting, rolling over in bed, or certain exercises
The Pelvic Floor, the Core, and their role in Diastasis Recti Abdominis
The pelvic floor muscles sit within the pelvis, attaching to the pubic bone, tailbone, and sitting bones, acting as a hammock to support our organs. In addition to supporting organs, their functions include bladder and bowel control, sexual health, circulation, and, importantly, core strength.
Given that the pelvic floor is part of our core (along with the transverse abdominis (TA), multifidus, and diaphragm muscles), it plays an important role in the rehabilitation of a DRA. Specifically, this is due to its association with the TA muscle.
TA is a broad muscle that is located just beneath the linea alba, connecting to this connective tissue through fascia. When TA contracts (activates), it transmits tension to the linea alba, helping rebuild the strength and integrity of the tissue.
When the pelvic floor contraction is paired with a TA contraction, there will be a greater TA recruitment (16), which transmits more tension to the linea alba.
Take home: a pelvic floor contraction creates a stronger TA contraction, creating more tension in the linea alba, helping to further improve the strength and integrity of the tissue and in turn, resolve a DRA.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Diastasis Recti Abdominis retraining
● Pelvic Organ Prolapse management strategies
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular Stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.