Pelvic Floor Physiotherapy

Pelvic Floor Physiotherapy

Pelvic health physiotherapy is a specialized branch of physiotherapy that focuses on the assessment and treatment of conditions related to the pelvic floor muscles and surrounding structures. The pelvic floor muscles play a crucial role in supporting the pelvic organs, maintaining continence, and facilitating sexual function.

Pelvic health physiotherapists are trained to address a wide range of conditions, including but not limited to pelvic pain, urinary and fecal incontinence, pelvic organ prolapse, pelvic floor muscle dysfunction, and pregnancy-related musculoskeletal issues. They utilize various techniques and interventions to help individuals regain optimal pelvic health and function.

Pelvic Floor Physiotherapy

Pelvic health physiotherapy is a specialized branch of physiotherapy that focuses on the assessment and treatment of conditions related to the pelvic floor muscles and surrounding structures. The pelvic floor muscles play a crucial role in supporting the pelvic organs, maintaining continence, and facilitating sexual function.

Pelvic health physiotherapists are trained to address a wide range of conditions, including but not limited to pelvic pain, urinary and fecal incontinence, pelvic organ prolapse, pelvic floor muscle dysfunction, and pregnancy-related musculoskeletal issues. They utilize various techniques and interventions to help individuals regain optimal pelvic health and function.

What to expect at your initial pelvic floor physiotherapy assessment:

Your initial assessment will be booked for 60 minutes. The full time will be dedicated between you and your therapist.

The first thing you and your physiotherapist will do is go through a detailed history to help us better understand the reason for your visit, your past experiences, other injuries, and what your goals are for seeking out care. Much like in other physiotherapy visits, we will ask detailed questions about your medical history, medications, and other current or past treatment you’ve received. In a pelvic floor physiotherapy assessment, we will also ask you questions around bladder and bowel function, your menstrual cycle and history, gynecological history, obstetric history (including any information on a current pregnancy, past pregnancies and/or birth), and questions regarding sexual health.

It is important to know that we ask these questions as they are relevant to getting a holistic picture of your concern, and to accurately diagnose and recommend a treatment plan for you. Your physiotherapist will always approach these conversations through a trauma-informed lens, in a judgement-free and respectful manner. You only have to share what you are comfortable with. Anything that you share always remains confidential.

Following a detailed discussion around your history, your physiotherapist will then complete a physical assessment. What we will look at during the initial physical assessment can vary depending on your concerns and symptoms. A comprehensive physical assessment may include the following:

  • Observation of posture in standing, sitting, and other positions
  • Breathing patterns
  • Low back, hip, and pelvic mobility and range of motion
  • Abdominal wall function: for example, an assessment for diastasis rectus abdominus and/or core strength and function
  • Strength testing of different muscle groups
  • Palpation of muscles around the low back, hips, abdomen, and gluteals (buttocks) to determine any tightness or tender points which can contribute to your pelvic floor function

Another aspect of the physical assessment which your physiotherapist may recommend based on your symptoms, is an internal pelvic floor exam. The pelvic floor is an internal system of muscles, ligaments, nerves, and connective tissue that create a hammock across our entire pelvis. It helps support the pelvic organs, helps us retain continence, helps with sexual function, provides support to the low back, hips and pelvic girdle, and acts as a sump-pump for our pelvic region. The gold standard of care to understand how these structures are influencing our pelvic health is through an internal exam. A vaginal, and/or rectal exam is used to assessed the muscle strength, tone, tension, coordination, and overall function of the pelvic floor.

We would only complete an internal assessment with your informed consent. Please know that it is never mandatory! You can also withdraw your consent at any point in time before, during, or even at subsequent visits. Every measure is taken to make you comfortable during any internal (or external!) exam. We want to make your experience as comfortable as possible, and will always discuss each component step by step throughout. You may also consent to certain portions of the exam and not others, and that is absolutely acceptable as well.

If an internal assessment is recommended and you have consented to proceed, you would be given a sheet to cover up and undress from the waist down while your physiotherapist steps out of the room. A clean technique is always used, with non-latex based gloves. We would first assess the tissue externally and observe for any areas that may be contributing to your symptoms. To assess the tissues internally, 1 or 2 lubricated fingers would be inserted (either vaginally, rectally, or both) to assess structures through the entire pelvis. We do not use speculums or any other metal devices during an internal assessment. Your pelvic floor strength, muscle relaxation, endurance, coordination, tissue laxity/stability, and any tender points in the muscles will be assessed.

We will then discuss all of the findings from your history and physical exam, your diagnosis, and create a treatment plan to clearly outline how we can assist you to reach your goals. We may also begin discussing lifestyle habits that you may have that can be contributing to your symptoms and how we can start adjusting small things to help improve those symptoms. Your physiotherapist will review exercises that they want you to begin with, and go over other educational information so that you fully understand your diagnosis and the plan moving forward.

Your physiotherapist will answer any questions you have about our discussions, and please feel free to ask them throughout the assessment as well. You should leave feeling like you have a better understanding of your symptoms after sharing your story, and how we can work together to reach your goals.

If you have more questions about pelvic floor physiotherapy, or if it is right for you, do not hesitate to reach out to us.

Conditions We Treat:

We have training and experience helping adults with the following concerns: 

  • Urinary incontinence
    • Stress incontinence
    • Urge incontinence
    • Mixed urinary incontinence
  • Fecal/Bowel incontinence
  • Urinary urgency and frequency
  • Pelvic organ prolapse
  • Vulvodynia
  • Vaginismus
  • Dyspareunia (painful intercourse)
  • Endometriosis
  • Pre-natal and postpartum rehabilitation
  • Pre- and post-operative care such as;
    • Hysterectomy
    • Prolapse
    • Vestibuloectomy
    • Endometriosis
  • Overactive bladder
  • Constipation
  • Coccydynia
  • Interstitial cystitis
  • Dyssynergia (urinary or bowel)
  • Bladder pain syndrome
  • Pudendal neuralgia
  • Pre- or post-prostatectomy
  • Chronic non-bacterial prostatitis (Chronic Pelvic Pain Syndrome – CPPS)
  • Persistent back, hip, and/or groin pain