Misunderstandings about Pelvic Floor Physiotherapy

We find it sad so few people know about Pelvic Floor Physiotherapy and how it can help.

This type of physiotherapy treats conditions that can be awkward to talk about, even to your closest friend. This includes urinary leakage, bowel incontinence, and pain during intercourse. If people don’t know a pelvic health physiotherapist can help resolve these issues, they suffer alone, without help, unnecessarily.

We interviewed Julia McDaniels, a pelvic floor physiotherapist at our clinic, about common misunderstandings about pelvic floor health. Julia has over a decade of experience as a physiotherapist and has taken advanced training to be certified to practice pelvic health physiotherapy at our clinic in Winnipeg, Manitoba.

Hi Julia! Thanks for agreeing to talk to us about misconceptions about pelvic health physiotherapy. You treat pelvic health patients every day. What would you say is the top misunderstanding about pelvic health physiotherapy?

“Often, they ask me something like, ‘Is this a real thing?’ As in, how common is pelvic health physio? Is this really an established type of physiotherapy? Patients are surprised they haven't heard about this before,” says Julia.

Why do you think that is?

“I think it’s partly because of the intimate nature of the problems pelvic health physiotherapists treat. Most people have no problem telling their friends about the ankle sprain they got hiking last weekend and how their physiotherapist helped them get back to the trails. But it’s pretty rare to talk about urinary leakage, pain during sex, or bowel incontinence with your friends. Or at least it’s super awkward to talk about.

“I’m not saying people should open up more about these sensitive topics. It’s okay to keep private matters private. But it does explain why the benefits of pelvic health physiotherapy still aren’t well known – people just don’t want to talk about their issues, and that means the success they’ve had with a pelvic health physiotherapist stays secret too. And if they don’t talk about their issues, there’s no opportunity for a friend, family member, or healthcare provider to tell them about pelvic health physio.

Do you think this will change?

“It already is changing a little bit with people who are pregnant or post-partum. Seeing a pelvic health physiotherapist is becoming the norm, and that’s good, since medical professionals recommend getting a post-partum check-up with a physiotherapist. And it’s more and more common to tell your pregnant friends about your pelvic health physio and how they helped you.”

What else do you think gets in the way of people getting help from pelvic health physiotherapy?

“Many patients want to have their doctor’s approval before doing any physio treatment. They are used to seeing their doctor for all their health issues and don’t realize it’s better to come straight to physiotherapy, including pelvic health physiotherapy, if they have an issue we can treat.

“Physiotherapists and physicians work as a team and have complementary skillsets. If you're recovering from bone, muscle, nerve, and joint conditions, physiotherapists have a lot more in-depth training on how to do this, drug-free, compared to doctors. That’s why doctors refer to us for these conditions.

“It’s the same for pelvic health physiotherapy – we have more in-depth training on the bones, muscles, joints and nerves of the pelvis, and how to help patients recover from dysfunction or injuries to these structures.

“If a patient is unsure about pelvic health physiotherapy, I always offer a free phone consultation to make sure it’s right for them. And if I’m treating someone and they’re not responding the way I expect, or if I think they need further assessment, I’ll refer them to their doctor then.”

What happens if someone does go straight to their doctor for pelvic health issues?

“Most of the time, physicians just refer them to me. But I've seen several patients after who’ve gone through more risky and invasive treatments, such as surgery, botox, and medication. They come to physio only once everything else has failed.

“Pelvic health physiotherapy should be a first-line treatment. Like all physiotherapy, it’s low-risk and drug-free, and it treats the root of the problem, not just the symptoms.

“Only after someone has tried pelvic floor physio, completed their physio treatment plan, and has not achieved their goals, do we consider more risky options. I’ll always refer a patient back to their doctor for re-assessment if we’re not seeing results.”

Among your patients, what are the most common misconceptions about your work as a pelvic health physio?

“Patients often think pelvic floor physio is just Kegels. And they figure since they’ve already practiced Kegels, coming to see me won’t help.

“Similarly, people seem to think all pelvic floor issues are related to pelvic floor weakness. But actually, pelvic floor issues can be related to so many factors, including weakness, poor muscle control, difficulty relaxing the pelvic floor, fear, trauma, post-surgical scarring, back pain… it’s complex.

“So for the record, pelvic health physiotherapy is more than just Kegels! Kegels are a pelvic floor contraction - their role is to strengthen the pelvic floor. But more commonly, problems come from not being able to relax the pelvic floor. In that case, then doing more Kegels can make the problem worse.

“I can teach strengthening exercises, relaxing exercises, and I have many other techniques that I customize to the patient. But first I need to assess the patient’s problem properly, so I can match the solution to the problem.

“If I do recommend Kegels to a patient, this is just the first building block of their individualized pelvic floor training program. As they progress, we’ll build on this with more challenging exercises and functional pelvic floor training – that means exercises designed to help them meet their demands of everyday life.

“Another common misunderstanding is that I can just give exercises without doing a full assessment. Quite a few patients just want me to show them the right exercises without assessing them.

"If they’re nervous about an assessment, that’s one thing. I can talk them through the information I get from doing a proper assessment, and let them decide whether to proceed. But if they think pelvic health physio involves just giving them a few exercises and sending them off, that’s just not how it works. It’s much more in-depth.”

What you mean by ‘in-depth’?

“I need to know about more than a patient’s pelvic floor. Pelvic floor conditions are usually connected to other physical conditions, a person’s medical history, their day-to-day behaviour, their fears, and their mental health. I ask about these things to help me make sure I’m treating the whole patient, and I have all the information I need to help them get to their goals for physiotherapy.

“Some patients do have trouble opening up. Especially if they are coming in for something like urinary incontinence, and I start asking questions about bowel movements, sexual activity or mental health. They have trouble understanding the connection, at first.“

What are some other misconceptions about pelvic health?

“I find many older women think they’re too old for pelvic health physio. They hear about pelvic health physio for pregnant women, and assume that’s all it is.

“There are a lot of conditions I can treat that are super common among elderly women. For instance, urinary leakage, bowel incontinence, and low back pain respond well to pelvic health physiotherapy. Even if they’ve had the problems for decades, say, after giving birth 30 years ago, I can still help.

“Also, there’s a big misconception that pelvic physio is just for women, but really, it can be for anyone. Men, or people of any gender can benefit from pelvic health physiotherapy. They suffer from conditions like incontinence, pelvic pain, and post-surgical scarring, just like women. I can help.”

Curious if pelvic floor physiotherapy can help you?  Call us at 204-982-9191 to book a FREE 15-minute phone consultation with Julia.