Women’s Health Physiotherapy is a specialized field of physical therapy focused on the health and wellness of women across their lifespan. Practitioners receive additional training to address conditions unique to the female body, involving the pelvis, abdomen, and musculoskeletal systems. This rehabilitation considers physiological changes women experience from adolescence through pregnancy, postpartum recovery, and menopause. The goal is to evaluate, treat, and educate women to improve function, manage pain, and enhance physical well-being.
Core Focus: The Pelvic Floor
The pelvic floor is a complex group of muscles, ligaments, and fascia stretching like a hammock from the pubic bone to the tailbone. These structures support the pelvic organs, including the bladder, uterus, and bowel, preventing them from descending. A functional pelvic floor allows for the voluntary control of bladder and bowel movements.
When these muscles become weakened, overstretched, or damaged, it can lead to two common forms of pelvic floor dysfunction. These include urinary or fecal incontinence (the involuntary loss of urine or stool due to insufficient muscle strength) and pelvic organ prolapse, where lack of support causes organs to drop from their normal position.
Weakness often results from factors like childbirth, chronic straining, or hormonal changes associated with aging. Physiotherapy aims to restore the strength, endurance, and proper coordination of the levator ani and coccygeus muscles. Improving the function of this muscular sling helps women regain continence and structural support.
Managing Musculoskeletal Issues During Pregnancy and Postpartum
Pregnancy and childbirth introduce significant mechanical and hormonal changes that frequently lead to musculoskeletal discomfort. Nearly all women experience some degree of muscle or joint pain, and approximately 25% have symptoms severe enough to interfere with daily life. This discomfort is due to weight gain, altered posture, and the hormone relaxin, which increases joint laxity, especially in the pelvic region.
A common condition is pelvic girdle pain (PGP), which includes discomfort in the sacroiliac joints or the pubic symphysis. PGP and low back pain affect up to 50% of pregnant women, and the pain can persist for years postpartum for about 20% of these women. Physiotherapists address these issues through joint alignment, targeted strengthening exercises for stabilization, and education on posture and body mechanics.
Another specific postpartum concern is Diastasis Recti Abdominis (DRA), the separation of the rectus abdominis muscle bellies. This separation occurs when the connective tissue, the linea alba, stretches and thins under the pressure of the growing uterus. Physiotherapy guides the rehabilitation of the deep abdominal muscles to restore core strength and function, which is important following delivery.
Addressing Chronic Pelvic Pain and Sexual Dysfunction
Women’s Health Physiotherapy addresses chronic pelvic pain states not related to pregnancy or recent injury, often focusing on muscle hypertonicity. Hypertonicity refers to muscles that are chronically tight, shortened, or in spasm, which differs from the weakness seen in incontinence cases. This excessive tension can decrease blood flow to the muscles and nerves, leading to localized or referred pain.
Conditions like vulvodynia (chronic pain or discomfort in the vulvar area) and dyspareunia (painful intercourse) are frequently associated with overactive pelvic floor muscles. A high percentage of women diagnosed with provoked vestibulodynia exhibit underlying pelvic floor dysfunction. The pain is often linked to the muscles’ heightened responsiveness to pressure and inability to relax.
Non-maternity-related pelvic issues, such as interstitial cystitis and persistent bladder pain, can also involve related muscle tension that physiotherapy helps manage. Treatment for these complex pain syndromes often requires a multidisciplinary approach, focusing on down-training the muscles to enhance relaxation and reduce hypersensitivity.
Common Treatment Techniques Used
Women’s Health Physiotherapists employ a variety of specialized techniques to address the range of dysfunctions encountered. Education and lifestyle modification form a foundation, helping patients understand their anatomy, manage daily habits, and learn strategies for pain management. This includes instruction on proper fluid intake, bowel and bladder habits, and body mechanics to reduce strain.
For muscle retraining, therapists frequently use Biofeedback and Real-Time Ultrasound (RTUS). Biofeedback uses sensors to provide visual or auditory feedback on muscle activity, allowing a patient to see or hear when they are correctly contracting or relaxing their pelvic floor muscles. This provides an immediate, objective way to improve muscle control and technique.
Manual therapy involves hands-on techniques to address muscle tension, scar tissue, and joint alignment. This can include external soft tissue manipulation, trigger point therapy, and, with patient consent, internal vaginal or rectal techniques to directly assess and release muscle hypertonicity and adhesions. These methods help mobilize tissue, improve circulation, and restore the muscle’s resting length and flexibility.