PELVIC FLOOR PHYSIOTHERAPY

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What is the pelvic floor?


The pelvic floor is a group of muscles that spans up the underside of your pelvis. The muscles attach to your pubic bone at the front, your tailbone at the back, and your sit bones on the sides. The pelvic floor moves up and down like a trampoline to perform many important functions:

  • Bladder and bowel control
  • Core stability
  • Sexual function
  • Circulation of blood and lymph within the pelvis
  • Support of pelvic and abdominal organs
  • Childbirth
*For more information about the pelvic floor and pelvic floor dysfunction, visit my PELVIC FLOOR 101 page under Resources.




Who should see a pelvic floor physiotherapist?


Anyone who is experiencing signs and symptoms of pelvic floor dysfunction (see below) or who has been diagnosed with a pelvic health condition (see below) can benefit greatly by seeing a pelvic floor physiotherapist. Anyone who is pregnant or postpartum, even those who do not have signs or symptoms of pelvic floor dysfunction, can benefit from a pelvic floor assessment as there are often things that can be done in order to prevent pelvic health conditions from developping in the short and long term. Anyone who feels disconnected to their core and/or pelvic floor and wants to optimize health, function and performance. Anyone who wants to be proactive and reduce the chances of developping common pelvic health conditions later in life.




What does a pelvic assessment involve?


A pelvic assessment involves a lot more than an internal pelvic exam. In fact, internal pelvic exams may not be necessary. During a pelvic health assessment, your physiotherapist will:

  • Chat with you about:
    • The reason for your visit (pain, symptoms, pregnancy, postpartum, etc.)
    • Your medical history
    • Your birth history
    • Your rehabilitation goals
  • Perform a head to toe external physical exam. This may invovle assessment of your:
    • Posture and alignment
    • Breathing mechanics
    • Movements (e.g. squat, lift, sit to stand, turning in bed, coughing), particularly those that cause pain or symptoms)
    • Abdomen, back and pelvis
    • Abdominal scars and associated scar tissue
    • Pelvic floor and abdomen externally using Real Time Ultrasound
      • Note: With real time ultrasound, your pelvic floor is imaged from your lower abdomen. You may have to lower your pants and lift your shift up to expose the lower abdomen but no clothes will need to be removed.
  • Depending on the findings of your external physical exam, your physiotherapist may or may not recommend and internal pelvic exam. The choice to have an internal exam is yours. (Read below for more information about internal pelvic exams)




Is an internal pelvic exam necessary?


Internal pelvic exams can be very helpful in creating appropriate, effective and individualized treatment plans. This is because there are certain things that can only be assessed via internal pelvic exams. This includes information regarding pelvic floor muscle strength, tension, tears, and sphincter closure as well as the position of your pelvic organs. If you do not want to have an internal exam, for any reason, that choice is yours. There are certainly ways to treat pelvic health conditions without performing internal pelvic exams and thanks to Real Time Ultrasound, certain aspects of the pelvic floor can be assessed externally.




Can someone be with me during a pelvic assessment or treatment session?


As long as the clinic's COVID-19 policies allow for clients to be accompanied by a partner or support person, then you are absolutely allowed to have someone else in the room with you. The person joining you will need to complete all COVID-19 screening protocols prior to and upon entering the clinic.




How are pelvic health conditions treated?


Pelvic health conditions are treated with a head to toe approach and can include:

  • Pelvic floor muscle training (strength, endurance, timing, coordination, relaxation etc.)
  • Education
  • Bladder retraining
  • Posture/Alignment adjustments
  • Breathing mechanics alterations
  • Movement strategies for activities of daily living
  • Exercise guidance and modification (especially when certain exercises are causing symptoms)
  • External hands on therapy (releasing muscle tension, scar tissue release, etc.)
  • Core conditioning
  • Strength and/or mobility exercises for other body parts impacting the core and pelvic floor
  • Other physiotherapy treatments (functional dry needling, acupuncture, manual therapy, etc.)




What is pelvic floor physiotherapy?


Pelvic floor physiotherapy (PFPT) is a specialty area of physiotherapy that focuses on PREVENTING, managing and treating symptoms and conditions associated with injury or dysfunction of the pelvic floor muscles as well as other pelvic health conditions.




What training do pelvic floor physiotherapists have?


Pelvic floor physiotherapists (PFPT) are registered physiotherapists who have completed specialized post-graduate training, including practical exams, to provide internal pelvic exams and treatment.




Can I be assessed or treated when I am menstruating?


Yes. Pelvic floor physiotherapists are very comfortable performing internal assessments when you are menstruating. In fact, it can actually be helpful to assess you at varying times during your menstrual cycle as the pelvic floor and pelvic organ prolpase can be affected by hormonal changes. This is particularly important for people who experience symptoms at specific times during their menstrual cycles. If you prefer not to have an internal assessment or treatment when you are menstruating, external assessment and treatments can be done or you can reschedule your appointment, provided you give 24 hours notice.




What are the signs and symptoms of pelvic floor dysfunction?


Signs and symptoms of pelvic floor dysfunction include:

  • Constipation or straining to pass bowels
  • Accidental leaking urine or feces
  • Accidentally passing gas
  • Strong urge to use the bathroom, or not making it in time
  • Frequent need to urinate
  • Difficulty emptying your bladder and/or bowels
  • Feelings of discomfort, heaviness, pressure, bulging, draging or dropping sensations in the vaginal area
  • Seeing a lump or bulge in or coming out of your vagina
  • Painful sex
  • Numbness during sex
  • Pelvic girdle pain (including sacroiliac joint pain, pubic symphysis pain, tailbone pain)
  • Pain in the genital or rectal area
  • Hip and/or low back pain




What conditions do pelvic floor physiotherapists treat?


  • Urinary Incontinence
    • Stress urinary incontinence (SUI)
    • Urge incontinence (UI)
    • Mixed urinary incontinence (a combination of SUI & UI)
    • Urinary frequency
  • Fecal Incontinence (FI)
  • Difficulty urinating
  • Bladder retention (difficulty emptying the bladder)
  • Constipation or straining to pass stool
  • Pelvic Organ Prolapse (POP)
    • Cystocele (bladder prolapse)
    • Urethrocoele (urethra prolapse)
    • Uterine Prolapse
    • Rectocele (rectum/bowel prolapse)
  • Dyspareunia - painful sex
  • Pelvic girdle pain (including sacroiliac joint pain, pubic symphysis pain, tailbone pain)
  • Hip and/or low back pain
  • Sexual Pain & Dysfunction
    • Vaginismus - tightening of the vagina (pelvic floor) muslces
    • Reduced sensation or ability to orgasm
    • Vestibulodynia - sensitivity or pain around the vulva
    • Pain with penetration
    • Pain with orgasm or after sex
  • Vulvodynia - chronic pain in the vulva




Can I change my mind about having an internal pelvic exam?


Absolutely! You can change your mind and revoke consent to an internal pelvic exam at ANY POINT. Communication is key so make sure you let your physiotherapist know how you are feeling. During an internal pelvic exam, your physiotherapist will also continue to check in with you to make sure you are comforable and wanting to procede.




What does an internal pelvic exam involve?


If you consent to an internal pelvic exam, you can expect the following: An internal pelvic exam will NOT involve stirrups, straps, or a speculum and is much gentler than a pap smear test. Before the exam, your physiotherapist will leave the room so that you can remove your pants and underwear and then cover yourself with a sheet. For the internal exam itself:

  • You will be in assessed in a comfortable position
  • You will be asked to notify your physiotherapist immediately if you have any pain, discomfort, or want to stop the exam for any reason
  • Your physiotherapist may observe the outside of your pelvic area to assess:
    • Your skin health and scar healing
    • The response of your pelvic floor muscles as you cough, bear down, and perform a pelvic floor contraction (kegel)
  • Your physiotherapist may start by applying gentle pressure on the outside of your pelvic area (e.g. your inner thighs, pubic bone, either side of the vulva, perineum) to:
    • Assess for tension and/or tenderness in the extrenal pelvic floor muscles
    • Assess your sensation on either side of your thighs and vulva area
  • For the internal component of the exam:
    • Your physiotherapist will explain what they are going to do and where they are throughout the exam
    • With your consent, your physiotherapist will insert 1-2 fingers into your vagina
    • Your physiotherapist will palpate the different areas of your pelvic floor (front vs back, left side vs ride side) to assess for pelvic floor muscle tension and/or tenderness
    • You may be asked to perform a kegal, cough, and bear down (valsalva)
    • This will allow your physiotherapist to assess your pelvic floor strength, endurance, and timing of muscle contractions
    • Your physiotherapist will also assess the position of your bladder, uterus and rectum for prolapse
      • Note: If you are pregnant, only the position of your bladder and rectum will be assessed
    • If necessary, and only with your consent, a rectal exam may be performed to assess:
      • The pelvic floor muscles located at the back of your pelvis
      • The position and mobility of your coccyx
      • The integrity of the back side of your vaginal wall (to assess for a rectocele)
Internal exams are typically started with clients laying down in a comfortable position. For some people, assessing certain things in standing may be helpful as pelvic floor strength and coordination can change when working against gravity, as can the position of the pelvic organs. Internal assessments in standing or other positions will only be done with your consent. After the exam, your physiotherapist will leave the room to let you change. They will then return to review the findings with you.