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Pelvic problems

Information to help you understand your symptoms and who to consult for prevention or treatment.

Pelvic problems can affect both men and women and encompass many conditions, including organ prolapse, overactive bladder, urinary incontinence, or pain related to pregnancy, childbirth, or sex. Perineal and pelvic rehabilitation through physiotherapy is an effective means of treatment to reduce or eliminate your symptoms in order to regain your quality of life.

Problèmes pelviens

What is pelvic pain?

Pelvic pain includes pain in the pelvic region and the perineal region, i.e. the region between the pubis and the coccyx. In women, perineal pain is often located at the entrance or inside the vagina, but it can also extend to the anus.

What causes pelvic pain and problems?

Generally speaking, pelvic pain and problems are caused by dysfunction (for example, weakness or overtightening) of the muscles of the pelvic floor, a group of muscles located at the base of the pelvis between the pubis and the tailbone. Other factors may also be involved, such as ligament damage, a difficult childbirth, certain lifestyle habits or related medical conditions.

What are the causes of urinary incontinence?

The most common cause of urinary incontinence is weak pelvic floor muscles. It most often occurs in connection with aging or childbirth, but can also affect women and men of all ages.

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How do you know if you have organ descent (prolapse)?

An organ prolapse often creates a feeling of pressure or heaviness in the vagina. It may be accompanied by urinary disorders. Depending on the severity, there is sometimes a ball-like mass at the entrance of the vagina. However, these symptoms can take several years to appear and sometimes never appear.

The main cause of organ descent is damage to the structures that support the organs of the pelvis (bladder, urethra, uterus and rectum). Ligaments and muscles may have been stretched or weakened by a difficult childbirth or by certain intense and prolonged physical activities that involve running, jumping or heavy lifting. Returning to sport too quickly after childbirth also increases the risk of organ descent.

How do you diagnose an overactive bladder?

Overactive bladder is characterized by difficulty controlling the sometimes urgent urge to urinate. The cravings are also more frequent, that is to say more than seven times a day and more than once a night, without the bladder being full.

Possible causes of overactive bladder include certain bladder-irritating lifestyle habits (such as consuming caffeine, carbonated drinks, energy drinks, alcohol, and tobacco), a urinary tract infection or hypertonicity, which is characterized by having overly-tight pelvic floor muscles.

What pelvic pain is related to pregnancy or childbirth?

Pregnancy and childbirth can cause discomfort or pain in the perineum, pelvis and abdomen.

Postural changes that occur naturally during pregnancy can lead to pain in the lower back, lower abdomen or at the symphysis pubis (the junction between the left and right sides of the pubis). Changing positions, such as getting up, sitting down, or turning over in bed, can be difficult and painful.>

After childbirth, it is possible to feel pain in the vulva that makes sitting uncomfortable. These pains are generally increased by the evacuation of stools and sexual relations. They occur more often during childbirth if there has been any tearing or an incision (episiotomy), when the pushing time is longer or because of the size of the baby.

The scar after a tear, episiotomy or caesarean can also be painful if it is stiff and does not move well due to tissue adhesion.

Why is there pain during sex?

Several causes can explain pain related to sexual intercourse: hypersensitivity of nerve cells, hypertonicity of the pelvic floor muscles (too tight), a stiff episiotomy scar, a related medical condition such as fibromyalgia, etc.

The pain often takes the form of a burning or razor-sharp sensation and can occur upon penetration, during and after sex.

Several diagnoses are associated with this pain:

  • Dyspareunia: the medical term for pain during sexual intercourse.
  • Vestibulodynia (formerly called vestibulitis): pain at the entrance of the vagina (the vestibule).
  • Vulvodynia: pain in the vulva.
  • Pudendal neuralgia: pain in the pelvic region along the course of the pudendal nerve, on one or both sides.

How is pelvic pain and problems treated?

Expert tip: How do you know if Kegel exercises are right for you?

Kegel exercises are known to strengthen the pelvic floor muscles. These are good exercises, but are targeted at women with actual muscle weakness that requires strengthening. Some women instead have hypertonic (too tight) muscles that need to be relaxed and stretched. To be effective, Kegel exercises must also be performed correctly, which is more difficult than you might think. Ideally, you should consult a physiotherapist in perineal and pelvic rehabilitation who will advise you on the exercises suitable for you and teach you how to perform them properly.

You should know that in the presence of pain, we tend to contract our muscles and block our breathing. To relieve the pain, it is therefore recommended to begin by doing diaphragmatic breathing exercises which consist of breathing slowly and deeply by inflating the belly with each inspiration. You can place a hand on your belly to better feel the movement. Keep all the other muscles in your body relaxed. Do this exercise for about 5 minutes every day.

If you have an overactive bladder, avoid reducing the amount of water you drink each day. To promote bladder control, try to hold back your urges a little longer and consult a physiotherapist in perineal and pelvic rehabilitation.

Perineal and pelvic rehabilitation

Perineal and pelvic rehabilitation is a comprehensive physiotherapy approach based on the rehabilitation not only of the muscles of the pelvic floor, but of all the muscles that have an impact on it, such as the abdominals and the diaphragm.

During the consultation, your physiotherapist may measure the strength and elasticity of your muscles as well as the mobility of your hips and pelvis, assess your posture and ask you questions about your lifestyle habits.

After a detailed assessment of your condition, your physiotherapist will teach you pelvic floor rehabilitation exercises to improve endurance, strength, coordination and/or flexibility. You will also receive personalized advice to reduce or even eliminate your symptoms and thus improve your quality of life.