The role of Physical Therapy in pelvic health

Physical Therapy in Women’s Health is a specialty recognized for 13 years by the Conselho Federal de Fisioterapia e Terapia Ocupacional (“Federal Council of Physical Therapy and Occupational Therapy” - COFFITO) Resolution No. 372/2009¹, which determined its fundamental role for care during women’s life stages, beginning in childhood and adolescence, through pregnancy, labor, puerperium, and, finally, following the aging process². Women’s care is necessary because of the hormonal, social, physical, and emotional changes they go through over the years. The physical therapist is a health professional qualified to meet the specific demands of these women in each of these stages.

COFFITO’S Resolution No. 401, dated August 18^th, 2011², regulated the professional specialty of Physical Therapy in Women’s Health by defining five areas of practice: physical therapy assistance in Urogynecology and Coloproctology; Gynecology; Obstetrics; Female Sexual Dysfunctions; and Mastology. Within these areas, the physical therapist can perform different roles, such as management, coordination, supervision, teaching, research, care in hospitals, outpatient clinics, homes, philanthropic services, third sector, and military services, for example.

International guidelines recognize the role of the physical therapist as essential to the rehabilitation of pelvic dysfunctions, such as urinary, coloproctological, and sexual dysfunctions. For urinary incontinence (UI), for example, the International Continence Society recommends conservative treatment, which includes physical therapy techniques such as pelvic floor muscle training (PFMT), electrostimulation, and behavior therapy as the first line of treatment, and should be indicated by physicians for women of all ages (pregnant, postpartum, and older adults) with any type of UI^3),(4.

Regarding sexuality, Physical Therapy has developed a lot, but it still faces challenges in dealing with the difficulties of a topic that, culturally, is permeated by taboos and prejudice. We know that the physical therapist has the resources to act in the different stages of the sexual response cycle, in a humanized way and together with a multidisciplinary team, offering a better body response, not only from the point of view of pelvic muscle performance, but also of body awareness and understanding⁵. Research is needed to establish our importance in this area, including issues related to different populations, such as LGBTQIA+ people.

The area of coloproctology has also been consistently advancing in the field of Physical Therapy, especially in the treatment of dysfunctions such as anal incontinence, dyssynergic defecation, prolapses, pain, and constipation.

It is also worth mentioning the importance of Physical Therapy in the area of mastology. Physical therapy for patients undergoing treatment for breast cancer has as its main objective the prevention of complications by home care and guidance, diagnosis, and early intervention, aiming to improve the quality of life and reduce personal and hospital costs.

Finally, it is necessary to reinforce the performance of Physical Therapy in Men’s Health. The literature brings important references for the rehabilitation of post-prostatectomy voiding dysfunctions⁵, with some data in the area of sexuality and others regarding pelvic pain. There is not yet a specialty recognized by COFFITO, but the community includes this activity within the pelvic therapy.

Over the past few years, this area has shown important growth, both in coverage and in its representativeness in the teaching and research sectors. Moreover, the specialty has been increasingly included in outpatient and inpatient services and in referrals from health care teams. From the teaching and research point of view, in addition to its presence as a compulsory subject in undergraduate courses, we have seen the creation of new graduate courses, as well as the publication and presentation of important research in journals and national and international congresses.

REFERENCES

• ¹
  Conselho Federal de Fisioterapia e Terapia Ocupacional (BR). Resolução nº 372, de 6 de novembro de 2009: reconhece a Saúde da Mulher como especialidade do profissional fisioterapeuta e dá outras providências. Diário Oficial da União [Internet]. 2009 Nov 30 [cited 2023 Mar 22];1:101. Available from: https://www.coffito.gov.br/nsite/?p=3135
  » https://www.coffito.gov.br/nsite/?p=3135
• ²
  Conselho Federal de Fisioterapia e Terapia Ocupacional (BR). Resolução nº 401, de 18 de agosto de 2011: disciplina a especialidade profissional de Fisioterapia na Saúde da Mulher e dá outras providências [Internet]. Brasília (DF): Coffito; 2014 [cited 2023 Feb 6]. Available from: https://www.coffito.gov.br/nsite/?p=3164
  » https://www.coffito.gov.br/nsite/?p=3164
• ³
  Nambiar AK, Bosch R, Cruz F, Lemack GE, Thiruchelvam N, Tubaro A, et al. EAU Guidelines on assessment and nonsurgical management of urinary incontinence. Eur Urol. 2018;73(4):596-609. doi: 10.1016/j.eururo.2017.12.031.
  » https://doi.org/10.1016/j.eururo.2017.12.031
• ⁴
  Dumoulin C, Adewuyi T, Booth J, Bradley C, Burgio K, Hagen S, et al. Adult conservative management. In: Abrams P, Cardozo L, Wagg A, Wein A, editors. Incontinence: 6th International Consultation on Incontinence, Tokyo, September 2016. Bristol: ICS; 2017. p. 1443-628.
• ⁵
  Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current management of post-radical prostatectomy urinary incontinence. Front Surg. 2021;8:647656. doi: 10.3389/fsurg.2021.647656.
  » https://doi.org/10.3389/fsurg.2021.647656

Publication Dates

• Publication in this collection
  17 Apr 2023
• Date of issue
  2023