Who can help me if I have pelvic floor problems?

which doctor to visit before a pelvic floor problem? Incontinence, prolapse, hemorrhoids… when these alterations related to the state of health of the pelvic floor occur, many people doubt which specialist they should visit. It is a very common doubt.

Specialists who treat the pelvic floor

The pelvic floor is the territory of three medical specialties: urology, gynecology and proctology. If we add to this that the pelvic floor symptoms are very varied, we already have fertile ground for confusion. Let’s put some order.

The urology is the medical specialty in voiding problems: urethra and bladder, mainly. That is, I go to the urologist when I have urinary incontinence, urinary urgency, infection… gynecology treats gynecological problems in the vagina, uterus and ovaries, such as prolapse, pain in the vulva, pain in the vagina, menstrual problems… The proctology is specialized in defecation problems, such as hemorrhoids, anal fissures, constipation… The pelvic floor physiotherapy. Medicine is invaluable in case of illness, but when it comes to the world between the legs, we often don’t talk about disease or pathology, but about systems that don’t work, disconnected muscles, painful scars, bladders that have turned crazy…. We talked about the functionality of the system, and this It is the territory of pelvic floor physiotherapy.

Why visit the physiotherapist

The gift of a specialty is that you know a lot about something. You know the subject or area perfectly. The price of a specialty is that you lose the global vision. And the pelvic floor, if there’s anything you need, it’s a global vision.

We have already seen in another article that the pelvic floor is part of something larger, of a functional unit: the abdominal-pelvic sphere. The pelvic floor is the lower part of this sphere, therefore, most of the problems it has come from imbalances in this sphere:

a sagging abdominal girdle is directly related to urinary incontinence. tense diaphragm, a sunken posture… They are directly related to prolapses and hemorrhoids.

In the world between the legs, it makes more sense face any problem that arises from a broad perspective, to run after the different symptoms and go to the different specialties.

When can pelvic floor physiotherapy help?

Physiotherapy should be the first option when faced with a problem, since the therapeutic path should go from less to more, from less invasive to more invasive. The first therapeutic options should be those that are most respectful and functional with the body, those that stimulate their re-education to return to proper functioning.

And this is what physiotherapy (pelvic floor physiotherapy) does. If it is necessary to go further, the same physiotherapist will refer to the appropriate medical specialty.

Medicine solutions are sometimes very forceful and you have to do what is necessary to avoid them. Surgery for urinary incontinence, beta-blockers for an overactive bladder…these are good tools, but they should be used when all else has failed.

When pelvic floor re-education has failed to solve incontinence and when relaxation of the stressed bladder without chemical means has failed. When all else fails, we take out the artillery and we are grateful to have it, but not as a first option, that is killing mosquitoes with cannon shots.

Do I go to the gynecologist or pelvic floor physiotherapist?

The assessment of a gynecologist and that of a pelvic floor physiotherapist are not at all alike. They only coincide in the area to be explored. Basically because we look for different things.

The gynecologist checks that the tissues are fine, take samples, analyze results. The gynecologist looks for pathology, looks for things that are not right. She looks at objective results.The physiotherapist checks that the tissues work well, study the body, assess its functioning.The physiotherapist looks for imbalances and tensions, seeks to improve blood circulation to enrich the tissues, to reduce inflammation… Physiotherapy is not so interested in what level on the Oxford Scale (1), but how you get it.

For example, Maria, 6 months after delivery, receives a 4 on the Oxford Scale from the gynecologist. She is happy because she has been told that everything is fine and she has a lot of strength. She comes to physiotherapy because a friend has recommended it and when we evaluated her, her brand new 4 became a fair 2, we also saw a grade I bladder prolapse.

Why that difference? Because we see and value different things. The gynecologist assessed how much maximum strength María had, a 4, but the physios assessed how she achieved that 4. When we removed all the parasitic contractions of other muscles, we made her breathe and taught her to contract only the pelvic floor, the 4 collapsed to a 2. The reality of Maria is that her pelvic floor was not there to get excited about.

And the prolapse? The gynecologist probably didn’t even see it, because a grade I prolapse is nothing, it doesn’t matter, it doesn’t cause problems, it doesn’t mean anything…. Therefore, it is not remarkable from a medical point of view. For physios, a grade I prolapse is candy, it is something easily recoverable, with a job well done and perseverance.

The choice between physiotherapy and medicine does not exist. In health and in life, common sense is important: in case of fever, acute pain or simply restlessness, always see a doctor, but to find solutions, consult a pelvic floor physiotherapist.

Grades:

1. The Oxford Scale is a validated test to assess muscle strength through a contraction of the pelvic floor. It goes from 0 (absence of contraction) to 5 (optimal strength).