Medicosnext
Ms. Antima Sonju Shrestha
She is a Lecturer at the Department of Physiotherapy, Dhulikhel Hospital. She is a passionate physiotherapist with a strong professional interest in women’s health, pelvic floor health, and community physiotherapy. She is committed to promoting awareness and healthy practices that can help address common women’s health concerns, facilitate early recognition of problems, and encourage timely access to appropriate care. Through physiotherapy, Ms. Shrestha focuses on knowledge sharing, community education, preventive care, and accessible, integrated health interventions. She believes that empowering women with the right information and support can significantly improve their health and quality of life. Her work reflects a commitment to bridging the gap between clinical physiotherapy and community health, while promoting a holistic and patient-centered approach to women’s and pelvic floor health.
For many people, talking about problems related to urine, bowel movements, childbirth, sexual function or pain in the pelvic area can feel uncomfortable or embarrassing. As a result, many continue to live with these problems without seeking help. These pelvic floor problems are a growing health concern these days. They significantly affect an individual’s physical, emotional and social well-being. Even though these pelvic problems are common, they are still unrecognized and underreported. Since the condition is treatable and it should not be considered as something a person simply has to live with.
The pelvic floor is a group of muscles at the bottom of the pelvis. These muscles do much more than most people realize. They help support the bladder, uterus and rectum, control urine and bowel movements, contribute to sexual function, and work together with breathing and the muscles of the back and abdomen to provide stability. When these muscles do not work properly, a person may experience problems such as urine leakage, difficulty controlling bowel movements, a feeling of heaviness or pressure in the pelvis, pelvic pain or difficulties related to sexual activity. Pelvic organ prolapse is a medical condition where pelvic organs descent downwards from its normal anatomical position and cause pressure or a bulging sensation and even urine leakage.
Globally, pelvic floor disorders represent a substantial burden, and affect nearly one in three women during their lifetime, while urinary leakage is reported in about 25 to 45 percent of adult women. In Nepal, the situation also deserves greater attention. One of the community-based survey of post-partum women reported urinary leakage, pelvic organ prolapses, a feeling of pelvic heaviness and pain during sexual activity. Yet only 2.4 percent of the women surveyed were aware of pelvic floor muscle training. These findings point to an important gap, not only in treatment, but also in awareness. Pregnancy and childbirth are important times when pelvic floor problems may develop, some may think urine leakage after childbirth is normal, while others may consider pelvic heaviness, pain or bowel problems to be simply part of ageing.
One of the biggest challenges is that people may not talk about these symptoms. Embarrassment can also prevent people from discussing these concerns with healthcare professionals. The result is that a problem that could often be managed remains hidden and may affect a person’s daily activities, confidence and quality of life and this is the area where pelvic floor physiotherapy play an important role.
Pelvic floor physiotherapy is a first line of treatment in the management of a range of pelvic floor disorders. These include stress urinary incontinence, mild to moderate pelvic organ prolapse, overactive bladder, fecal incontinence, chronic pelvic pain. Pelvic floor physiotherapy is also useful for men with problems following prostate surgery besides for women with pelvic floor problems related to pregnancy and childbirth. The key physiotherapy interventions include pelvic floor muscle training, bladder and bowel retraining, lifestyle modification and multidisciplinary rehabilitation. These approaches help improve symptoms and quality of life and may reduce the need for surgical intervention in appropriate cases.
Understanding the person’s symptoms and daily difficulties and depending on the problem, a physiotherapist assesses the strength, endurance, coordination, tone of the pelvic floor muscles and pelvic floor rehabilitation are planned according to the individual’s needs. Pelvic floor training help people learn how to correctly tighten, relax and use these muscles. Bladder retraining, core strengthening, pelvic rehabilitation focused on relaxation, breathing, gentle stretching, reducing pelvic floor muscle tightness, pain management and education also form a part of pelvic floor rehabilitation. Early identification, timely and early pelvic floor rehabilitation help manage symptoms, improve pelvic function, and prevent problems from becoming more severe.
Looking Ahead
The multidisciplinary pelvic health care extends beyond management and rehabilitation in the hospital setting. Community-based education and awareness help people recognize pelvic floor symptoms early, access appropriate care, and seek timely professional support. This is particularly important in communities where such symptoms may be considered a normal part of life, overlooked, or too sensitive to discuss openly. Creating a supportive environment and providing clear, accurate information can help reduce stigma and promote timely and appropriate management of symptoms related to pelvic floor disorder.
Pelvic floor disorders should not be viewed simply as isolated problems involving individual organs. They affect function, participation, confidence and quality of life. Greater awareness, appropriate assessment, evidence-based physiotherapy and multidisciplinary collaboration help individuals regain function and confidence. Pelvic floor physiotherapy represents an essential component of comprehensive pelvic floor care, supporting individuals not only to manage symptoms, but also to return to meaningful daily activities and improve their quality of life.
