Pelvic Health Physiotherapy
Pelvic health physiotherapy is a focused area of physiotherapy that assesses and treats dysfunction of the pelvic floor. Pelvic floor dysfunction can occur when your pelvic floor muscles become weak and/or tight, leading to incontinence (leakage from bowel or bladder), constipation, pain in the low back, hips or pelvis, painful intercourse, and other concerns.
What is the Pelvic Floor?
The pelvic floor is made up of muscles, ligaments, nerves and connective tissues and is an essential component of your “core” muscles. They help to support your lower back (preventing low back pain with function), maintain continence of bowel/bladder, allow for sexual function and pleasure and provide support for internal organs (bowel, bladder, uterus).
Why Visit a Pelvic Floor Physiotherapist?
Pelvic floor physiotherapy—sometimes likened to “internal Pilates”—aims, as its name suggests, to strengthen the all-important muscles lining your pelvic floor. These are the muscles you use whenever you control an urge to urinate or defecate; they support the uterus, bladder and rectum.
Pelvic Floor physiotherapists have specialized training in treating range of conditions:
- Stress urinary incontinence (i.e. urinary leakage during coughing, sneezing, laughing, during strenuous activity such as lifting or exercise)
- Urge incontinence (frequent trips to the bathroom, feeling the need to go to the bathroom “just in case”, difficulty controlling bladder for any length of time)
- Mixed urinary incontinence (a combination of both of the above)
- Pelvic pain and pain with intercourse
- Low back, hip pain and SI joint dysfunction
- Pre- and post-natal
- Pelvic organ prolapse (often described as a feeling of “fullness” in the pelvis)
- Post-prostatectomy recovery
What to Expect on Your First Visit
Prior to seeing your physiotherapist, you will be asked to fill out a health intake form, as well as one or more questionnaires regarding your current condition. This gives your physiotherapist a better understanding of your health history and how pelvic health dysfunction is affecting your life.
Pelvic floor physiotherapy session are be held in a private, comfortable room where your privacy is a top priority. Your certified pelvic floor physiotherapist will begin by asking a series of questions regarding your health history and your current condition. Following this discussion, your physiotherapist may recommend performing an external and/or internal (vaginal and/or rectal) examination. During the internal exam, the ability to contract and relax the pelvic floor muscles will be assessed, as well as how these muscles work together with the rest of your body. Assessing the joints, mobility and strength of the lower back, hips, and sacro-iliac (SI) joints are also an important part of the pelvic floor assessment.
Why is an Internal Exam Important?
An internal exam is not mandatory; however, it is the gold standard to assess how your pelvic floor muscles and the connective tissues within your pelvis are working. The pelvic floor muscles are internal muscles and are difficult to properly assess externally. Although it is common for people to blame pelvic issues on weak pelvic floor muscles, that is not always the cause of the problem– sometimes, these muscles can be tight which can be the root of the problem. Without an internal exam, it is impossible to know exactly what is going on.
Research has found that verbal and written instructions of pelvic floor exercises (think: Kegels) are not enough. People are not understanding how to activate their pelvic floor muscles and are often doing exercises incorrectly. An internal exam allows your physiotherapist to recommend the appropriate exercises for you individually and to help ensure you are performing them correctly.
Do I need a doctor’s referral?
Pelvic health physiotherapy, just like any type of physiotherapy, does not require a doctor referral; however, some insurance companies may require this for coverage. It is best to ask your insurance provider about their requirements for physiotherapy coverage.
How long are appointments?
Initial assessments are approximately 60 minutes in length. Follow-up appointments can range anywhere from 30-60 minutes depending on your needs.
Can I come when I’m on my period?
Yes! In fact, sometimes it can be beneficial to assess or treat the pelvic floor muscles while menstruating as pelvic floor muscles and organ positioning can be changed due to hormone changes. It may be especially beneficial if you experience a change in symptoms during menstruation. If, however, you are uncomfortable with having an assessment or treatment while menstruating, your physiotherapist can still provide treatment externally or you may reschedule your appointment. Please be mindful and provide as much notice as possible so others may book in for that time slot.
Can I come when I’m pregnant?
Yes. Though If you have been told by your doctor or midwife that you are restricted from having sexual intercourse during your pregnancy, an internal exam will not be completed. If you are on no restrictions, it can often be very beneficial to have an internal exam during pregnancy so that you can better prepare your muscles for delivery and post-delivery. If you have been placed on restrictions and/or are uncomfortable with an internal assessment or treatment, there are still many other ways we can treat pelvic floor dysfunctions. Your physiotherapist can discuss this further with you.