Pelvic Floor Physiotherapy

What is your pelvic floor and why does it matter?

Your pelvic floor is a group of muscles that line the bottom-most portion of your pelvis, running from your tailbone at the back to your pubic bone at the front. The pelvic floor acts like a hammock to support the weight of your various pelvic organs, including the bladder, rectum, the uterus in female-assigned individuals, and the testicles and prostate in male-assigned individuals. Due to its relationship with the pelvic organs, the pelvic floor plays a vital role in bowel and bladder function as well as in sexual function. It also assists in providing support for the joints of the low back and hips and is often overlooked when it comes to individuals who are experiencing low back or hip-related pain.

 

What can happen when the pelvic floor isn’t functioning optimally?

If the pelvic floor is not working well, whether it be habitual or due to trauma (e.g. childbirth, surgeries), a number of symptoms can arise including:

  • Pain in your pelvis, low back, tailbone, and/or hips

  • Leakage during exertion (e.g. running, jumping, lifting, sneezing, coughing, laughing)

  • Urinary/fecal urgency or the feeling that you can’t control the urge to void, or need to void more frequently

  • Feelings of heaviness or pressure in your pelvis

  • Painful intercourse

  • Erectile dysfunction

How can a pelvic health physiotherapist help?

A pelvic floor physiotherapist has specialized training to be able to assess your pelvic floor musculature and determine whether there is increased tension, weakness, or a lack of connection to these muscles that are contributing to the symptoms you are experiencing. Your physiotherapist can then provide you with some recommendations to address these contributing factors. These may include some self-release strategies, strengthening or relaxation exercises, and/or lifestyle/habit changes.

 

What does a pelvic health physiotherapy assessment involve?

After submitting your questionnaires your pelvic floor physio session will be in a private room. The pelvic floor physiotherapist will ask you about your symptoms, listen to your story and ask you your goals for treatment.

Treatment for pelvic floor conditions is always 1-1 and individualized to you. Restorative Sports Therapy uses a biopsychosocial approach During your pelvic assessment, your physiotherapist will take lots of time to discuss the nature and history of your symptoms and uncover underlying factors contributing to what you are experiencing. They will then guide you through an external assessment looking at overall posture and trunk positioning, movement patterns and control, breathing, and muscle tension and weakness around your pelvis. If you are comfortable with it, your physiotherapist will then perform an internal vaginal and/or rectal digital examination. This is the most accurate for your pelvic floor musculature to be assessed. HOWEVER, you are always the one in control during these assessments, and you can choose whether or not to continue with these exams at any point.

Statistics show that 1 in 3 Canadian women suffer from some form of pelvic floor dysfunction, including chronic pain, incontinence, or discomfort during intercourse. Yet very few women tell their primary care physician that they are having symptoms and even fewer people seek help.

  • Research indicates that internal vaginal and anal assessments are the “gold standard” method to assess pelvic floor dysfunction.

The pelvic floor physiotherapist will then summarize their finding and together you develop a plan based on your client-led goals. This comprehensive approach involves taking a whole-person approach and treatment can include education, behaviour modification, manual therapy, internal vaginal or anal treatment and we will discuss all aspects of your life that may be contributing to your pelvic floor health.

  

When would an internal exam not be in my best interest?

Although an internal vaginal and anal exam are the gold standard for assessing pelvic floor dysfunction, some examples of when an internal pelvic floor exam are not appropriate are: if the patient does not consent to have an internal pelvic floor exam, an active urinary tract infection, poor skin integrity of the perineum or vulva, pain with light touch or pressure, pregnant women who are on pelvic floor rest(such as if they have an incompetent cervix) or women who have never had penetrative vaginal intercourse.

 

Should I cancel my appointment if I am menstruating?

There is no need to cancel your pelvic floor physiotherapy appointment if you are menstruating. Every pelvic floor physiotherapy treatment does not require internal vaginal or anal work. If it is your first assessment and you have a very heavy menstrual flow, you may want to consider re-booking.

 

How often and how many treatments will I need?

Post pelvic floor physiotherapy assessment the pelvic floor physiotherapist will discuss your individualized plan. Depending on your symptoms, treatment frequency can vary. In the beginning, it is common for patients to have 1-3 treatments per month and decrease the frequency as they improve.