What is pelvic floor physiotherapy?

Pelvic floor physiotherapy is a specialized branch of orthopaedic physiotherapy that focuses on the assessment and treatment of conditions and dysfunctions of the pelvic floor.  

The pelvic floor consists of muscles, connective tissue, joints, nerves, and ligaments. Their architectural design creates a bowl or basin at the bottom of the pelvis and functions to support the organs of the abdomen, stabilize the pelvis and hip joint, and maintain urinary continence and sexual function. 

Pelvic floor dysfunctions occur when these muscles weaken, become lax, or tighten, preventing the muscles from completing their normal functions. Dysfunctions of the pelvic floor could lead to symptoms such as pain in your lower back, hips or pelvis, pelvic pressure or heaviness, constipation, incontinence, and pain with intercourse.

Pelvic health physiotherapy addresses these dysfunctions and symptoms by retraining the structures of the pelvic floor in order to improve their function and strength. 

When can pelvic floor physiotherapy help?

Pelvic floor physiotherapy can help patients in various situations, including, but not limited to:

- Incontinence: it is effective for individuals experiencing urinary or fecal incontinence, whether due to aging, pregnancy, or other factors
- Pelvic pain: patients with chronic pelvic pain or discomfort can benefit from pelvic floor therapy to address underlying musculoskeletal issues
- Postpartum recovery: women can use pelvic floor physiotherapy to aid in recovery after childbirth, improving muscle tone and function
- Pre- and post-surgery: it is beneficial for patients preparing for pelvic surgery or those in the postoperative phase, facilitating a smoother recovery
- Sexual dysfunction: it can be used to address sexual dysfunction, such as pain during intercourse or erectile issues, linked to pelvic floor muscle dysfunction
- Pelvic organ prolapse: patients with pelvic organ prolapse can receive guidance on managing their condition and improving pelvic support
- Chronic constipation: for individuals with chronic constipation, pelvic floor physiotherapy can help enhance bowel function
- Athletic performance: athletes and active individuals can improve their performance and prevent injuries by ensuring strong and well-functioning pelvic floor muscles
- Muscle weakness: patients with pelvic muscle weakness, which may lead to postural problems or lower back pain, can benefit from therapy

Is an internal examination required?

Yes, with your consent, an internal examination is required for a thorough pelvic floor assessment. Internal examination is an integral aspect of pelvic floor assessment and treatment and it is considered the gold standard in pelvic health physiotherapy.

Research has shown that physiotherapists with specialized training in pelvic rehabilitation, including internal palpation, are highly successful in treating pelvic floor dysfunction. Pelvic floor physiotherapy should be the first line of defense - before surgical or any other medical interventions - for pelvic pain, incontinence, and pelvic organ prolapse. 

How many sessions are required?

It will take 5 – 8 sessions before results can be seen.

Is there homework to do in between sessions?

Yes, an individualized, tailored home exercises program will be created for each patient and should be followed to gain maximal results. The exercise program will be based on your symptoms, condition, and goals and aims to improve coordination and function of the pelvic floor and surrounding musculature. 

What if I already tried doing Kegels and they didn't work?

Kegels are not for everyone! Sometimes they may even aggravate your symptoms and even when they are indicated are often not performed correctly.

Pelvic floor Dysfunction can be caused by:

  • Hypertonicity: Pelvic floor muscles have too much tension or a high tone. These tight pelvic floor muscles could lead to symptoms of pelvic pain, painful intercourse, urgency of the bowel and bladder, and constipation.
  • Hypotonicity: Pelvic Floor muscles have low-tone contributing to symptoms of stress incontinence and pelvic organ prolapse. 

Please note, in most cases you can have a combination of muscles that are too tense and too relaxed. 

A kegel is a contraction (increasing the tone) of your pelvic floor muscles.

Performing a kegel, if not indicated, can make your symptoms worse i.e. pelvic floor muscles that are high or a combination of tones. An internal examination by a Pelvic Floor Therapist will determine whether kegels are indicated and will retrain your pelvic floor muscles to function optimally. 

What are contraindications to pelvic floor assessment and treatment?

Pelvic Floor assessment and treatment includes an internal palpation exam to test the integrity of the pelvic floor muscles. There are certain conditions that limit internal palpitations. Please let your pelvic floor therapist know immediately if you have any of the below contraindications.

Contraindications to internal pelvic floor assessment and treatment:

  • Active infection
  • Active rectal bleeding
  • Radiation injury less than 6-12 weeks old
  • Seed implants of radioactive materials
  • Post-operative less than 6 weeks: Post Labour & Delivery; C-section or vaginal
  • Post-operative less than 6 weeks (12 weeks after prolapse repair)
  • If directed by a physician to abstain from sexual penetrative intercourse 

What should I expect at my first session?

With pelvic floor therapy we will be assessing the integrity of your pelvic floor muscles in relation to your core and symptoms. Your certified pelvic floor physiotherapist will utilize internal and external “hands-on” or manual techniques to evaluate the integrity of the pelvic floor muscles in addition to associated joints, connective tissue, ligaments, and muscles within your low back and Sacroiliac joint.

The pelvic floor examination, with your consent, will have a gold standard internal vaginal and or anal examination

Prior to an initial assessment, you will be sent forms and questionnaires to complete. Please fill these forms out to the best of your abilities and bring them with you. These forms will identify and illuminate specific symptoms in addition to contributing factors to your condition. Based on the information collected a thorough, detailed subjective and objective assessment will occur. 

Based on your symptoms, condition, and goals a tailored, individualized treatment plan will be created to help manage pain and discomfort within your pelvic region. 

Time Frame: An initial assessment is 60-75 minutes in length

How do I know if I need a pelvic physiotherapist?

If you are wondering whether your pelvic floor needs help, feel free to answer the following questions

  • Do you urinate more than 5- 8 times a day?
  • Do you feel that your bladder is not fully emptied after urination?
  • Do you have an uncomfortable sensation of wanting to urinate that will not go away?
  • Do you experience urine loss (coughing/sneezing/laughing/jumping/on the way to the bathroom)?
  • Do you feel pelvic pressure and or heaviness?
  • Do you have bowel movements that are challenging to pass or less frequent than every three days?
  • Do you experience pelvic pain?
  • Do you experience painful intercourse?
  • Do you experience pain with pelvic/speculum examinations?
  • Do you experience pain within your hip, low back, sacroiliac joint and/or pelvic pain?
  • Are you pregnant?
  • Have you been diagnosed with any pelvic floor conditions i.e. Dyspareunia?

If you answered yes to any of the above questions, problems with your pelvic floor muscles, connective tissue, ligaments, or nerves may be contributing to your symptoms and or pain. 

You may be a candidate for an assessment from a certified pelvic floor physiotherapist with impeccable training to assess the integrity of your pelvic floor muscles in relation to your core and symptoms.

Is pelvic floor physiotherapy covered by OHIP or my insurance?

Pelvic floor physiotherapy is a specialized training under Physiotherapy. If you have Physiotherapy coverage on your insurance, Pelvic Floor Physiotherapy is covered. Please check your individual plans for more details. The Adelaide Health Clinic will provide you with an invoice to submit to your insurance company for reimbursement.

Pelvic floor physiotherapy is not covered under OHIP plans. 

Do I need a referral for pelvic floor physiotherapy at the Adelaide Health Clinic?

You do not need a referral to see a pelvic floor physiotherapist. If you are in pain, you can schedule an appointment right away. However, every insurance plan is different so if you intend on utilizing your insurance benefits, it is recommended to check what your plan covers. In some cases, a medical referral is needed for coverage when seeing certain disciplines.

Is the Adelaide Health Clinic accepting new patients for pelvic floor physiotherapy?

Yes! Please call 416-367-5200 or click here today to book your appointment.