Pelvic Health

Pelvic health, or pelvic floor physiotherapy, is a branch of physiotherapy that focuses on the pelvic floor muscles, pelvic organs, and surrounding areas - such as the low back, the hips and the abdominals.

Muscles of the pelvic floor can become weakened, overreactive, painful or damaged for many reasons. For instance, pregnancy, giving birth, prostate surgery, chronic constipation, sexual trauma, a back injury, or a mental health condition can all create pelvic health issues.

Pelvic health physiotherapy can cure or help manage these issues.

It's About the Pelvic Floor And So Much More

Your pelvic floor is like a sling of muscles, nerves, and fascia at the bottom of your pelvis. These muscles support the pelvic organs, such as the bladder, bowel, uterus, vagina, small bowel, and rectum. These muscles also affect how these organs function, such as by controlling urination, defecation and sexual function.

The health of your pelvic floor affects the rest of your health. For example:

  • Urinary leakage when lifting may mean you’re scared to lift weights at the gym, so you get out of shape.
  • Bowel incontinence may mean you’re scared to leave the house to bike ride with friends, because you’ll be away from the toilet for too long.
  • Pain during sex may affect your relationship, and consequently, your social life and mental health.

Pelvic health physiotherapy can help! It’s about so much more than your pelvic floor.

What does Pelvic Floor Physiotherapy Treat?

All genders with the following concerns may benefit from seeing a pelvic health physiotherapist:

  • pelvic pain,
  • weak or tight pelvic floor, 
  • stress incontinence – of the bowel or bladder,
  • urge incontinence – of the bowel or bladder,
  • overactive bladder,
  • increased urinary frequency/urgency,
  • leakage,
  • dribbling,
  • dyspareunia - pain during intercourse, and/or
  • pelvic organ prolapse – when pelvic organs drop down into the vaginal canal or anus.

Those who are pre- or postpartum are also likely to benefit from pelvic health physiotherapy.

In fact, a check-up with a pelvic health physiotherapist is medically recommended for anyone:

  • Postpartum, to prevent or address any pelvic floor conditions associated with pregnancy, delivery and recovery.
  • Recovering from surgery to pelvic organs, such as a hysterectomy or pelvic organ prolapse repair.

Read more about pelvic health conditions in our Pelvic Health Guide - click here.

Pelvic Health Physiotherapy During Pregnancy

During pregnancy, your body is adapting to the growing human inside of you. These changes include relaxing connective tissues (such as the ligaments in your hips, knees, and back), a shift in your centre-of-mass (which can affect your balance), and increased arch in your low back.

Despite all the information on the internet, it can be hard to figure out what is useful information, and what is misinformation. Common questions during pregnancy include:

  • What should I do about my back pain?
  • I want to stay fit, but how should I modify my exercises?
  • Can I continue doing the sports I love, such as running or tennis, without affecting my baby? For how long into my pregnancy?

Our pelvic health physiotherapist can answer questions about your physical health during pregnancy, based on evidence – not internet misinformation. We can also design a customized exercise program for you, that changes as your pregnancy progresses, so you can stay healthy before and after your baby is born.

Pelvic Health Physiotherapy Post-Partum

Pregnancy creates major physical changes, including injuries and trauma to the body. While all this is natural, that doesn’t mean you have to suffer alone.

Medically, a check-up with a pelvic health physiotherapist is recommended for anyone post-partum. That’s because we can assess for common post-partum conditions, plus design a treatment plan unique to you and your goals. For instance, common conditions post-partum include bladder incontinence, urinary leakage, pelvic organ prolapse, joint pain, diastasis recti, low back pain, pelvic pain, and pain during intercourse.

We also find people have a hard time finding accurate information on what they can or can’t do post-partum. For instance, when is it safe to try running again? Is it okay to do crunches or not?

Our job is to answer your questions about your body post-partum, treat any problems, make sure you’re doing everything you can to avoid further complications, and get you to your physical goals.

We’re also here to support you with post-partum issues long after giving birth, such as scar tissue discomfort, persistent back pain, or shoulder or neck pain from carrying your child.

Pelvic Pain

Pelvic pain can include pain from a specific condition, or any persistent pain in the abdomen or low back.

Painful conditions that can be relieved by pelvic health physiotherapy include:

  • Bladder pain
  • Interstitial cystitis
  • Endometriosis
  • Vaginissmus
  • Abdominal pain
  • Low back pain
  • Tailbone pain
  • Hip pain
  • Groin pain

These painful conditions are frequently related to the pelvic floor.  It helps to have a physiotherapist who is skilled in treating the pelvic floor as well as the rest of the body.

Frequently Asked Questions About Pelvic Health Physiotherapy

What do you do at pelvic health physiotherapy?

We start with an initial assessment. We’ll ask you questions to better understand your medical history, your pelvic health condition, how it’s affecting your life, and your goals for physiotherapy.

We’ll answer your questions and concerns about your condition, and explain the risks and benefits of proceeding with physiotherapy.

Your physiotherapist will also do a physical assessment, which may involve:

  • Assessing how you move or walk,
  • Checking your core and pelvic floor muscle strength and muscle control, and/or
  • An internal assessment, meaning a vaginal or rectal exam.

Finally, they’ll work with you to develop a treatment plan, designed to achieve your goals. A treatment plan could include many things, including exercises, hands-on treatment of muscles, drug-free pain relief techniques, advice about your day-to-day activities, or education on good bladder and bowel habits.

Your physiotherapist’s assessment and treatment will be based on the best scientific evidence for treating pelvic symptoms. 

Isn't pelvic floor physiotherapy just for women who have had a baby?

Absolutely not! Pelvic floor physiotherapy is for all genders, including men and women. It can treat conditions that may have nothing to do with pregnancy, such as bladder incontinence, bowel incontinence, constipation, painful digestive issues (e.g. irritable bowel syndrome), prolapsed bowel, erectile dysfunction, pudendal neuralgia, painful bladder syndrome.

Giving birth can cause trauma to the pelvic floor, and physiotherapy is medically recommended post-partum for that reason. That’s one of the reasons pelvic floor physiotherapy is better known for treating women who have had a baby.

We need your help to spread the word! Pelvic health physiotherapy can help so many people, to treat conditions they’re often too scared or shy to talk to anyone about. Despite being a well-established branch of physiotherapy, medically recognized to help, most people have never heard of pelvic health physiotherapy. No one should not have to suffer alone, without realizing a pelvic health physiotherapist can help them.

I’m nervous about having my pelvic floor assessed

Many people are uncomfortable discussing their pelvic health, and your physiotherapist is trained to ensure you’re in control and as comfortable as possible.  You're the boss!  It’s your physiotherapist’s job to give you the information you need to make decisions about your health, and your physiotherapy treatment plan. 

Like all physiotherapy, you may remove your consent at any time during your assessment or treatment, for any reason.  

Good physiotherapy requires good communication, so you shouldn’t hesitate to ask questions, seek clarification, and share your story with your physiotherapist.

So I don’t have to just live with leakage?

Urinary leakage is not a normal occurrence and you can do something about it. There is good scientific evidence to suggest that a health professional taught and supervised pelvic floor training program should be the first-line management for stress and mixed urinary incontinence as well as pelvic organ prolapse.  

Which physiotherapist will I be seeing?

Julia McDaniels, BMR-PT, leads our pelvic health physiotherapy practice. 

On top of her university level training in physiotherapy, Julia has completed specialized training and certification to assess and treat conditions involving the pelvic floor.  Her certifications and competence meet the current standard for internal assessment and treatment established by the College of Physiotherapists of Manitoba.

Julia has over a decade of experience as a physiotherapist, and is skilled at integrating your pelvic health treatment with your overall health and well-being.

Do I need a referral from my doctor?

No, a referral is not required for any physiotherapy, including pelvic health physiotherapy.

In Canada, physiotherapists are primary health care providers, which means you can come to us first for problems we specialize in, such as pelvic health. You don’t need to see your doctor first.

By coming to physiotherapy first, you get the care you need right away. Plus, you reduce strain on Manitoba’s health care system, freeing up your doctor’s time for patients who do need them. And we keep your doctor in the loop (with your consent, of course), to make sure they are aware of your condition and your physiotherapy progress.

If your pelvic health physiotherapist does discover an issue that is better treated by a doctor, they will let you know – and refer you to your doctor at that time.

What if I have my period at the time of my scheduled appointment?  Should I reschedule?

Having a period is part of being a healthy human. If your pelvic health appointment involves an internal assessment or treatment, we just ask you to remove tampons or menstrual cups so they don’t get in the way.

There’s no need to reschedule your appointment, unless you’d prefer to do so for your own comfort. We request 24-hours notice for rescheduling or cancelling any physiotherapy appointments, so we have time to squeeze in another patient who may need urgent care.

Do I have to get an internal pelvic floor exam if I don't want to?

Absolutely not. At all physiotherapy appointments at our clinic, you’re the boss, and you can remove your consent to treatment at any time.

That said, ask your physiotherapist why they’re recommending an internal examination for you. You should understand why an internal exam could be useful to you and your future decisions about your pelvic health.

For example, a lot of people think their incontinence issues are from having a weak pelvic floor. They hear about kegels, and they come to physiotherapy after months of doing regular kegels, with no impact on their incontinence. In this case, a pelvic health internal exam can assess

  1. Do you really have a weak pelvic floor, or is the problem that you can’t relax your pelvic floor?
  2. If kegels are the right treatment for you, are you doing them correctly?

The truth is, there is some information about your health that we can’t get from an external exam, or from a conversation about your medical history. But without this information, we can likely still help you. Talk about it with your physio.

What if I had a C-Section?  Is pelvic health physiotherapy still recommended for me post-partum?

Yes. There are a lot of reasons a pelvic health physiotherapy check-up can be useful after a C-section.

Regardless of how you delivered, your body changed significantly during your pregnancy. The presence of your baby could have:

  • put pressure on your pelvic organs, like your bladder & bowels,
  • strained your low back,
  • stretched your abdominals, and
  • strained your pelvic floor – particularly if you laboured prior to your C-section surgery.

Pelvic health physiotherapy can help you recover from any damage done by this pressure.

Pain during intercourse is common after a C-Section, often related to the scarring associated with the surgery. This can be difficult to deal with, physically and emotionally. Your pelvic health physiotherapist is a confidential resource to help you relieve your pain.

Can I do pelvic health physiotherapy virtually?

Yes! In fact, we find some pelvic health conditions are better treated virtually. For instance, with sensitive issues such as pain during intercourse, complex pain following trauma, or incontinence, these can be easier to talk about when you’re in the comfort of your own home.

For busy people, including those with kids at home, it can be difficult to make the time to come into the clinic. Virtual physiotherapy means you get the care you need, without having to leave your home.

Virtual physiotherapy isn’t just for talking! We have online tools that help us see how you’re moving, such as how you can bend at the waist, raise your arm, breathe, or walk. We can also watch you do many of your exercises and give you feedback and more challenges.

Learn more here about our virtual physiotherapy software, Physitrack, designed for confidential conversations about your health.

Can I bring my baby or child to the appointment?

We recommend you come to your appointment alone. We love babies and children, but your physiotherapy appointment is all about you. Babies and children can be distracting, for you and your therapist.

We find patients who bring their children to the clinic have a harder time focusing on their treatment, and therefore get slower results.

That said, if your childcare options fall through unexpectedly, it can be better to bring your child than to skip your appointment all together. Alternatively, consider switching your appointment to virtual physiotherapy, if you think you can focus better on your appointment with your child in your home.

How should I, um, groom my pubic hair before a pelvic health exam?

Please don’t worry about it! As healthcare professionals, we are focused on your health, not your pubic hair style.

We find it frustrating that esthetic trends put pressure on clients to look a certain way and spend money on expensive hair and skin maintenance. We focus on your health.

Is pelvic health physiotherapy covered by insurance?

Most insurance providers cover physiotherapy – including pelvic health physiotherapy.  However, check with your insurance provider before your appointment to ensure your particular plan does indeed cover physiotherapy.  Read more insurance tips here.

I’m still not sure whether pelvic health physiotherapy is for me.

Call us at 204-982-9191 to arrange a FREE 15-minute phone consultation with Julia McDaniels, a pelvic health physiotherapist, to ensure this type of physiotherapy is right for you.

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