Caring for Your Pelvic Health

Next, your Pelvic Physiotherapist will begin a series of physical assessments. These may vary depending on your symptoms, and may not all be completed on the first visit. 

She may assess your low back, SI joints, connective tissue of the abdomen and thighs, and your pelvic floor itself.

A pelvic floor assessment is an internal exam looking for trigger points in the pelvic floor, and assessing the strength of the pelvic floor.

Your physiotherapist will start by collecting a detailed history of your symptoms. She will then ask about the many other potential symptoms that can go with pelvic floor dysfunction, such as sexual function, bladder, bowel, low back, hip and tailbone symptoms.

These questions may seem very personal and unrelated, but if there are problems in any of these areas, they are often related to pelvic floor dysfunction.

Your Pelvic Physiotherapist may also ask you to fill out a questionnaires, which will give her a better idea of what is contributing to your specific symptoms.

Once your Pelvic Physiotherapist has completed the exam, she will explain her findings to you. She will give you exercises or other "homework" to do, and explain how often you should return for treatment.

She will explain what changes you should expect to see, and how long you should expect your treatment to take. She will give you time to ask questions.

If you have recently had surgery, or have scar tissue from a previous injury, a pelvic physiotherapist may be able to help you recover function and comfort.

Chronic pelvic pain can include any pain in or around the pelvic region that is present for three or more months with no physical diagnosis or medical explanation.

Pain in the coccyx or tailbone area.

Constipation is the infrequent and difficult passage of hard stools. You should not be going for more than 3 days without a bowel movement; if you are, you may be suffering from constipation.

Separation of the rectus abdominus muscle, leading to a weakening of core function and strength.

Menstrual pain or cramps that occur before or during menstruation.

Difficult or painful sexual intercourse.

A condition resulting from the appearance of endometrial tissue outside the uterus and causing pelvic pain.

Urinary Frequency is the need to urinate with a frequency that disrupts your normal routine.

Leakage of urine or feces that cannot be controlled is called incontinence. The severity ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you don't get to a toilet in time.

Pain or burning with a full or filling bladder, or with emptying the bladder.

A disorder that affects the large intestine.

If you need to wake up several times in the night to urinate, you may be suffering from Nocturia. Nocturia not only disrupts your sleep, it can be a sign of an underlying medical condition.

Pelvic organ prolapse is when one or more of the pelvic organs (the bladder, uterus, or rectum) encroach on the vaginal space.

Pain in the low back that hasn’t been successfully treated with conventional physio.

A condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. The piriformis muscle can also irritate the nearby sciatic nerve and cause pain, numbness and tingling along the back of the leg and into the foot.

Low back, groin, pelvis pains, including carpal tunnel, water retention, numbness/tingling, related to pregnancy pregnancy.

An uncommon source of chronic pain, in which the pudendal nerve (located in the pelvis) is entrapped or compressed.

Pain at the sacroiliac joint.

Nerve pain from irritation of the sciatic nerve.

Dysfunctin pain at the pubic bone.

A strong and sometimes sudden physical urge to urinate or defecate that may be difficult to control. This causes a discomfort in your bladder, and can make it difficult to delay using the toilet.

A condition that affects a woman's ability to engage in vaginal penetration, such as sexual intercourse, insertion of tampons or menstrual cups, and the penetration during gynecological examinations (pap tests).

Chronic pain in the vulva.

The inability of a man to maintain an erection.

There are a variety of issue that could cause pain after urination and ejaculation in men, many of which can be treated with pelvic physiotherapy.

If you are suffering from groin pain after a hernia operation, a pelvic physiotherapist can help.

Loss of urine commonly experienced after prostate surgery.

Testicular pain and pulling as a result of sexual dysfunction.

We are very careful to create a private and sterile environment during assessment and treatment. We utilize a private treatment room, non-latex gloves and hypoallergenic gel, and wash or dispose of equipment properly. Your dignity and comfort is our highest priority. There is a risk that you might feel discomfort in the pelvic area after a treatment, particularly if it has involved stretching or trigger point massage to tight or tender muscles. Not all physiotherapists are certified to treat Pelvic Floor dysfunction. In order to perform internal examinations, your Physiotherapist has taken specific training, has written a certificate exam.

Yes. Your physiotherapist and our team welcome you to bring your baby with you for your appointment; you can even nurse during certain treatment techniques.

Your initial assessment is one on one in a private room. It will be approximately 60 minutes with your Pelvic Floor Physiotherapist. Follow up visits will be determined during your assessment, as they are catered to your particular needs but generally between 30 to 45 minutes per session. We highly recommend booking your appointments ahead to ensure your preferred time.

You should wait approximately 6-8 weeks after delivery before having an internal pelvic floor exam. This is true for vaginal deliveries and C-Section births. It is important to allow your body time to heal. During this time, you will also see spontaneous healing of a rectus diastasis, which should be checked at your follow-up appointment 6-8 weeks post-partum.

This will depend on your condition and its complexity. In general, for simple incontinence or prolapse (without any exacerbating factors), you will require 6-12 treatments. If you have a complex pain issue, this will likely take longer.

As the patient coordinator, I will send you some forms to collect relevant personal information about you and your medical history. Along with this, please bring any reports from special investigations or testing such as urodynamic or MRI reports. Don’t worry if you don’t have them, we can always request them from your MD at a later time.

You may bring a change of clothes to be most comfortable. There isn’t much to prepare for the internal assessment, you will be asked to undress from the waist down, we have gowns for you to change into, and you will always be draped to your comfort level.

No, it is not necessary to avoid an internal examination when pregnant. If your doctor or midwife has not told you to avoid intercourse during pregnancy, an internal exam should be safe. If unsure, speak with your doctor or midwife directly prior to having an internal exam.

Yes. Our pelvic physiotherapist has undergone and continues to seek post graduate training to provide internal assessment and treatment services. The College of Physiotherapists of Ontario requires physiotherapists to be listed on the roster in order to perform internal assessments and treatments.

No, pelvic health physiotherapy is very different than an exam done by your physician or gynaecologist. First, we have much more time to do the assessment and second we do not use any big equipment (no speculum here!). Your physiotherapist will walk you through what they are doing every step of the way to make sure you are comfortable at all times.

An internal examination is the gold standard for assessment and treatment of conditions related to the pelvic floor. Without feeling the muscles, your pelvic floor physiotherapist will be unable to identify if you have trigger points, or if you can contract your pelvic floor effectively.

That being said, there are generally many parts of the assessment and treatment that can take place without an internal exam. Some patients have been treated successfully without ever doing an exam.

Though the most benefit will be derived if your pelvic floor physiotherapist completes an internal exam, you will still benefit from coming if you are uncomfortable with or unable to have an internal exam.

Yes, there is homework. Some examples of homework you may have include stretches, strengthening exercises or tracking things like bladder or bowel habits, diet, and fluid intake.

• Urgency: an strong physical urge to urinate or defecate that may be difficult to control.
• Nocturia: waking at night frequently to urinate.
• Constipation: infrequent and difficult passage of hard stools.
• Frequency: the need to urinate with a frequently that disrupts your normal routine.
• Incontinence: leakage of urine or feces that cannot be controlled.
• Chronic pelvic pain: pain in or around the pelvic region present for three or more months with no physical diagnosis or medical explanation.

Depending on the type of severity of your condition, your Pelvic Physiotherapist may employ different combinations of the following treatments:

Manual Therapy: Manual therapy involves a range of hands-on techniques such as: soft tissue massage, mobilization, stretching, facilitation, as well as various trigger point release techniques.  

Exercise & Stretching: An individualized exercise program will be designed for you by your physiotherapist. This will include strengthening exercises, stretches, good posture and breathing techniques, all of which are essential for good pelvic health.

Hypopressive Exercise: Hypopressive Exercises are specific postures and breathing techniques that decrease pressure to the abdomino-pelvic area, recruiting the pelvic floor muscles. These types of exercises can help prevent and treat urinary incontinence, prolapse conditions, and general posture.

Electrical Muscle Stimulation: EMS uses electircal impulses to stimulate pelvic floor muscle contractions, to improve their strength, and to treat issues like urgency and pelvic pain.

Nerve Stimulation: Percutaneous Tibial Nerve Stimulation (PTNS) uses neuromodulation to stimulates the posterior tibial nerve at the ankle via a fine acupuncture needle connected to a hand held machine that emits electrical impulses. Nerve stimulation has been shown to be effective in treating overactive bladder and incontinence.

Education: Understanding how various aspects of your lifestyle, diet, and urinary and bowl hygiene can affect your pelvic floor health, is important in maintaining it! 

Pelvic floor physiotherapy is so much more than just kegels (pelvic floor muscle training). If you have tried doing kegels in the past but have not noticed any improvement, there could be many reasons.

Firstly, up to 30% of women are unable to do a kegel when asked. Many women instead contract their abdominals, glutes, or adductors. Or they bear down (push). If this is the issue, you may have been attempting to do kegels, but you have actually been strengthening the wrong muscles. A pelvic floor physiotherapist will check vaginally or rectally so they can actually feel your kegel, and teach you how to locate and contract your pelvic floor.

If you have been doing kegels with no effect, the problem could be that your pelvic floor is actually too tight, or has trigger points. For a muscle to be effective, it needs to have strength, but it also needs to be able to relax. For instance, if you can’t open your fist, strengthening your hand is not going to help. In this case, doing kegels may have actually made your symptoms worse. Instead, your physiotherapist will release the tension or trigger points in your pelvic floor muscles, and give you stretches or other exercises to do at home. Your physiotherapist will also help you determine what other factors may be contributing to the tension or trigger points in your pelvic floor.
 

Your therapist can assess and treat the pelvic floor even if you currently have your period. It can actually be beneficial as the pelvic floor muscles and pelvic organs can be affected by the hormonal fluctuations, especially if you notice a cyclical relationship to your problem. If you feel uncomfortable having your assessment during your period the therapist can either proceed with the assessment or treatment externally or you can reschedule your appointment, provided you give 1 business day’s notice.

The pelvic floor includes muscles, ligaments, nerves and connective tissue. It plays an important role in the body by providing support for the bladder, genitals, uterus and anus.

Internal examinations and treatments should be avoided if you have:

• Active hemorrhoids or infections
• Rectal bleeding
• Seed implants
• Radiation injuries less than 6-12 weeks old
• Undergone pelvic surgery less than 6 weeks ago
• Undergone prolapse repair surgery less than 12 weeks ago
• Been told by your doctor or midwife that you must abstain from intercourse or internal examinations during pregnancy

Pelvic floor physiotherapy falls under the domain of physiotherapy, regardless of the area being treated. If you have insurance coverage for physiotherapy then pelvic floor physiotherapy will be included. But we encourage you to follow up with your insurance provider to confirm coverage.  Please note  that some insurance plans require a physician prescription in order to be reimbursed for physiotherapy services, even though you do not need a referral to see the Physiotherapist.