Understanding Your Pelvic Health

Many clients experience discomfort in the bladder in the form of a strong and sometimes sudden physical urge to urinate or defecate that may be difficult to control.

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

Nocturia is diagnosed when patients need to wake up several times in the night to urinate. In addition to disrupting your sleep, Nocturia can be a sign of an underlying medical condition.

Incontinence occurs when there is leakage of urine or feces that cannot be controlled. 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.

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.

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

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

Pain where the two pubic bones meet.

Such as the low back, groin, and pelvis pains, including water retention, carpal tunnel and numbness/tingling related to pregnancy.

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.

Pain at the sacroiliac joint.

Nerve pain from irritation of the sciatic nerve.

Constipation is typically diagnosed if bowel movements are three days apart or more. The infrequent and difficult passage of hard stools results in discomfort and pain. 

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

Menstrual pain or cramps that occur before or during menstruation.

A disorder that affects the large intestine.

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

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.

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

Pain in the coccyx or tailbone area.

Difficult or painful sexual intercourse.

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

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

Chronic pain in the vulva.

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.

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, including a written 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 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 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.

You will be sent 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. If you don’t have copies of your reports, we can always request them from your MD at a later time.

You may want to 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 gynecologist. 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 the 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.

These are a few of the most common pelvic health issues:

Urgency: A 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 so 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, and 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.

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

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 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. For appointment changes we ask that you ideally provide 1 business day’s notice.

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. We encourage you to follow up with your insurance provider to confirm coverage. Please note that some insurance plans require a physician's prescription in order to be reimbursed for physiotherapy services, even though you do not need a referral to see the Physiotherapist.