Pelvic Health Physiotherapy
What is Pelvic Health Physiotherapy?
Physiotherapists trained in pelvic health have taken additional post-graduate courses in the assessment and treatment of pelvic floor dysfunction. This training provides evidence-based, conservative treatment options (outside of medication and surgical intervention) for many common pelvic health concerns. This can include conditions such as urinary and fecal incontinence, prolapse, pelvic pain, post-surgical concerns, pre- and post-partum as well as painful intercourse.
What is the Pelvic Floor and what does it do?
The pelvic floor is a group of muscles and connective tissues located at the bottom of your pelvis (between your tailbone at the back, pubic bone at the front, and between the bones that you sit on from side-to-side).
The Pelvic Floor has 5 main jobs:
- Sphincteric – to avoid leaking urine and stool
- Support for your internal organs
- Sexual function
- Sump-Pump – helps to move fluids back up your body
- Plays a vital role in your core function
Everyone has a pelvic floor and can experience difficulties in any of these areas if it is not working as effectively as it could.
Who can benefit from pelvic health physiotherapy?
We work with both male and female clients experiencing:
- Incontinence (leaking urine and stool)
- Urinary Urgency and Frequency
- New or persistent low back, hip, pelvic, sciatic, tailbone or genital pain
- Pelvic Organ Prolapse (sensations of “pressure” or “heaviness”)
- Pre- and post-partum women (vaginal and cesarean births)
- Dyspareunia (Painful Intercourse)
- Post-operative management (post-prostatectomy, prolapse repair, etc.)
- Chronic Constipation
- Chronic Non-bacterial Prostatitis
And many more! If you have a concern that is not on this list, please contact the clinic to learn more about how pelvic physiotherapy can help!
What can I expect in an assessment/treatment session?
The assessment is the time for you to tell your story and for your physiotherapist to learn more about you, your history and concerns, and how your symptoms have impacted your life. Questionnaires that are completed before your appointment will also be reviewed to help create an individualized, evidence-based treatment plan to help you reach your goals.
Your therapist will also complete a physical assessment that can include evaluation of: breathing, posture, strength/movement assessment, as well as internal and external techniques to evaluate the function of the muscles, joints, connective tissues, nerves, and ligaments in your pelvic girdle, low back, and hips.
Treatment can include education inclusive of pain education, manual therapy, individualized exercises, and connective/soft tissue release techniques. Internal treatment techniques are often performed during follow-up appointments with your consent. By performing internal treatment techniques, your pelvic health physiotherapist can provide more accurate feedback to ensure you are using the optimal technique during exercises targeting relaxation or strengthening of the pelvic floor muscles.
Pelvic health physiotherapists have taken advanced training, passed a practical evaluation, and are registered with the College of Physiotherapists of Ontario to perform internal assessments and treatment techniques. An internal assessment/treatment (with one or two fingers vaginally and/or rectally) is used to evaluate and treat the muscles, ligaments, and connective tissues of the pelvic floor. Evidence-based, best practice guidelines recommend an internal examination as this is the only way to accurately know the state of the pelvic floor muscles, how well the muscles are functioning, and to effectively teach pelvic floor muscle training exercises. Internal examination is ONLY completed with a client’s consent. If you are concerned or uncomfortable with an internal examination, please discuss this with your physiotherapist who will review the risks, benefits, and alternative options. Your comfort and consent will always be a priority.
Research & Pelvic Health Physiotherapy
- 3.5 million Canadians (1 in 4 women, and 1 in 9 men) have urinary incontinence.
- 50% of women at some point in their life cycle experience some urinary incontinence.
- The Cochrane Collaboration recommends that supervised pelvic floor muscle training should be included in the first line of treatment for urinary incontinence (leaking urine with activities like sneezing, laughing, coughing, ugency/frequency, etc.).
Dumoulin C, Cacciari LP, Hay‐Smith EJ. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane database of systematic reviews. 2018(10).
Hannestad, Rortveit, Sandvik, Hunskaar. A community-based epidemiological survey of female urinary incontinence: The Norwegian EPINCONT Study. Journal of Clinical Epidemiology. November 2000; 53(11): 1150-1157.
- 50% of parous women experience pelvic organ prolapse.
- The incidence of prolapse increases with age.
- The International Continence Society recommends supervised pelvic floor muscle training as the first line of treatment and prevention for pelvic organ prolapse. Pelvic floor muscle training has been shown to reduce the level of symptoms associated with prolapse.
Abrams P, Cardozo L, Wagg A, Wein A. (eds) Incontinence 6th Edition (2017). ICI-ICS. International Continence Society, Bristol UK, ISBN: 978-0956960733.
Beck RP. Pelvic relaxation prolapse. Principles and Practice of Clinical Gynaecology, 2nd edn (eds N.G Kase & A.B. Weingold), pp.677-685. Churchill Livingstone, Edinburgh. 1983.
Hagen S, Stark D. Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2011 Dec 7;(12)CD003882 doi: 10.1002/14651858.CD003882.pub4.
Symmonds RE, Williams TJ, Lee RA, Webb JM. Post hysterectomy enterocele and vaginal vault prolapse. American Journal of Obstetric Gynecology. 1981; 140:852-9.
Several studies have found women who engaged in supervised pelvic floor muscle training during 20-36 weeks of pregnancy were more likely to have a reduced second stage of labour (“pushing stage”) compared to those who did not.
Du Y, Xu L, Ding L, Wang Y, Wang Z. The effect of antenatal pelvic floor muscle training on labor and delivery outcomes: a systematic review with meta-analysis. International urogynecology journal. 2015 Oct 1;26(10):1415-27.
Salvesen KÅ, Mørkved S. Randomised controlled trial of pelvic floor muscle training during pregnancy. Bmj. 2004 Aug 12;329(7462):378-80.
A 2018 study found a strong association between persistent low back/pelvic pain and the presence of pelvic floor muscle dysfunction (especially increased pressure-pain sensitivity in those muscles).
Dufour S, Vandyken B, Forget MJ, Vandyken C. Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice. 2018 Apr 1;34:47-53.
Frequently Asked Questions
Evidence-based, best practice guidelines recommend an internal examination as this is the only way to accurately know the state of the pelvic floor muscles, how well the muscles are functioning, and to effectively teach pelvic floor muscle training exercises. An internal exam allows for direct evaluation of the state of the pelvic floor muscles and how they are functioning. This information is used to create a more accurate, targeted treatment plan than external techniques alone. An internal exam does not involve equipment commonly seen in medical examinations (e.g. a speculum) rather, it is performed using one or two fingers. By performing internal treatment techniques, your pelvic health physiotherapist can provide feedback to ensure that you are using the optimal techniques during exercises to target relaxation or strengthening of the pelvic floor muscles.
No. Everyone (males, females, and women who have not had children) has a pelvic floor and the potential to experience dysfunction. We are here to support individuals throughout different stages in their life.
Yes, our physiotherapists are comfortable treating clients during this time. If an internal exam is performed, extra protection can be used for your comfort. Other treatment options are usually available if you are uncomfortable having an internal examination at that time.
An internal examination should not be painful. There may be mild pressure or discomfort if there is a tension point that needs to be released. It is essential that you communicate these feelings/sensations to your therapist, so that the techniques can be modified.
Generally, an internal examination is safe as long as you have not been advised by a physician or midwife to abstain from intercourse or internal examinations. If you have any concerns, speak with your midwife or physician about this.
Absolutely! Pelvic health physiotherapy is well suited to virtual care. A key part of physiotherapy is learning more about the strategies, exercises, and techniques that you can do at home to see changes in your symptoms. For individuals with a busy schedule, a longer commute time to the clinic, or who require childcare to attend appointments, virtual care can be a great fit. If there is a need for in-person care, your physiotherapist can discuss this with you.