Physiotherapy for Pelvic Health

The goal of physiotherapy for pelvic health is to help patients with problems with their pelvis or pelvic floor. These problems can include a bladder or bowel problem, prolapse, pelvic pain, pregnancy related pain or difficulties with sexual intercourse.

What can I expect during a pelvic health treatment?

Before your first appointment, we will need to gather health information on the problems you are currently experiencing. A complete questionnaire will help guide your assessment and follow up treatments.

Your initial assessment will be 60 minutes. You will be explained your rights to have a person of your choosing accompany you during your evaluation and treatments. Your physiotherapist will go over the problems you have indicated. They will perform an external examination. With your consent, they may advise an internal examination. This examination is performed by observing and/or palpating the perineal region including the vagina and/or rectum. This evaluation will assess skin conditions, reflexes, muscle tone, length, trigger points in the pelvic floor, strength and endurance, prolapses, scar mobility and function of the pelvic floor region.

Treatment may include, but not be limited to: observation, palpation, use of vaginal weights, vaginal or rectal sensors for biofeedback and/or electrical stimulation, ultrasound, heat, cold, stretching and strengthening exercises, soft tissue and/or joint mobilisation and educational instruction.

You will experience light pressure during your external and internal assessments. If you experience any pain, inform your therapist immediately.

All treatments will be done in a private room.

Who can benefit from pelvic health treatments?

The pelvis is not only responsible for supporting proper bowel movements and urination, it is also important for pregnancy and delivery, and to keep the bladder, intestines and reproductive organs in place. Patients with the following conditions can benefit from the strengthening and rehabilitation of their pelvis and pelvic floor.

Musculoskeletal conditions in women and men include:

• pelvic girdle pain
• back pain
• rib pain
• abdominal pain
• pain in the pelvic region or tailbone
• genital pain
• feeling of heaviness in the genital area
• hip pain

Gynecological conditions in women include:

• stress urinary incontinence
• urgency urinary incontinence
• mixed (stress and urgency) urinary incontinence
• overactive bladder
• bowel incontinence
• pelvic organ prolapse
• pain during sex
• vaginal and/or vulval pain
• constipation (obstructive defecation)
• after 3rd or 4th degree perineal tear

Urological conditions in women and men include:

• urinary incontinence
• not able to make it to the bathroom in time
• urination while laughing, coughing or strenuous exercise
• overactive bladder
• visiting the bathroom more frequently
• voiding dysfunction (difficulty passing urine or fully emptying your bladder)
• bowel incontinence
• constipation (obstructive defecation)

What risks are associated with pelvic health treatments?

There are a few risks with doing an internal pelvic floor exam. These include, but are not limited to:

• Pain/discomfort (during or after the assessment);
• Temporary aggravation of your existing injury;
• Spotting/bleeding (during or after the assessment);
• Anxiety/emotional response;
• Skin reaction/irritation (from gloves and/or lubricant); and
• Vaso-vagal response (nausea or light-headedness).

Will I need pelvic health treatments forever?

No. While each person is different, you can expect longstanding results in 8 to 16 weeks with regular treatments and suggested exercises.

Pelvic health patients see a good success rate and an improved quality of life after treatment. However, efficacy depends on the severity of the condition(s) you are facing.

Frequently asked questions

When should I seek help for pelvic floor disorders?

It is never too late to seek help for pelvic floor disorders. While you may feel uncomfortable talking about your symptoms, they are very common medical problems that can be treated successfully with physiotherapy geared toward pelvic health. Seek out our care and improve your quality of life!

Can I choose not to have an internal examination during my pelvic health assessment and treatments?

Of course! While a complete internal examination will be recommended in order to have the most comprehensive overview of the function of your pelvis and pelvic floor, you always have a choice not to proceed with an internal examination. If you remain uncomfortable after discussing the process with your physiotherapist, alternative options will be made available to you. 

Similarly, you have every right to withdraw your consent during subsequent pelvic health treatments. We ask that you communicate with your therapist at all times during your treatments and inform them of your wish to withdraw consent.

When should I not have an internal examination?

Patients with the following conditions should not have an internal examination:

• 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

Is pelvic health physiotherapy just for women?

No. While it is more common for women, men too can experience symptoms such as urinary incontinence, bowel disorders and sexual dysfunction. Men too have pelvic floors that need attention! 

Can I receive pelvic floor treatments while pregnant?

Absolutely! Pelvic floor physiotherapy can help limit and remove pelvic girdle, pubic bone, groin, coccyx and low back pain, as well as help to open the pelvic floor and prepare it for labour and delivery. This can limit the possibility of tearing, or the need for an episiotomy.

There are no risks to the mother or baby with an internal pelvic assessment or treatment with a healthy and normal pregnancy after the first trimester. However, if you are a high-risk pregnancy and have been placed under medical precautions such as abstaining from intercourse and/or bed rest, then an internal pelvic floor assessment or treatment would not be advisable.

My midwife has already done a pelvic health examination. Why do I need another?

Your midwife likely had a different focus than your physiotherapist when conducting a pelvic health examination. While your midwife checked to make sure there was nothing medically wrong, your physiotherapist will check the function of your pelvic floor.

Can I bring my baby to my appointment?

Yes!

Can I receive pelvic health treatments if I have my period?

Yes. Proper hygienic protocols are used in all treatments. Your cycle will not interfere with your assessment and treatment.

I already tried kegel exercises and they didn’t work. Now what?

In many cases, kegels can make things worse! In many instances, the pelvic floor muscles are already too tight. A kegel is only effective if the pelvic floor muscles can first relax, and continuing to do kegels with a tight pelvic floor can worsen your symptoms.

It may be the case that the kegel is also being performed incorrectly. While you may feel as though you’re completing a kegel, you may actually be compensating with other muscles around the pelvic floor.

Pelvic floor physiotherapy is so much more than a kegel, and your physiotherapist will help you determine which exercises are most appropriate for you!