What is the “pelvic floor”?

The “pelvic floor” contains a group of muscles that span the bottom of the pelvis. There are three layers of pelvic floor muscles that contribute to five important functions: stability of the pelvis, support to the pelvic organs (e.g., bladder and rectum in men, and the bladder, bowel and uterus in women), sphincteric functions (e.g., continence or leaking of the bladder and rectum), sexual functions (e.g., arousal and orgasm) and decongestive functions (e.g., lymphatics in men and women, and menstruation in women). Normally, we don’t give much thought to these muscles as they silently do their job and assist our bowel, bladder and sexual function. These muscles also contribute to the function of our core, abdominal, hip and back muscles. 

Could I benefit from Pelvic Floor Physiotherapy?

Pelvic physiotherapy (physio) is a specialization in physiotherapy that focuses on assessment and treatment of problems such as pelvic pain, incontinence (i.e., bladder leaking), pelvic organ prolapse (i.e., the decent of the pelvic organs), low back pain, diastasis recti, gastrointestinal issues (e.g., constipation), and more in both women and men (yes - men have pelvises too!).

Pelvic physios can play a large role in pelvic dysfunction pre- and post-partum and throughout pregnancy. 

It is a misconception to think that it is normal to have urinary leakage after childbirth.

It is a misconception to think that it is normal to have increased urinary leakage as you age.

It is a misconception to think there’s nothing you can do about it.

Pelvic physiotherapy might be right for you if you experience things like:

• leaking urine when you cough, laugh, sneeze or exercise

• the inability to control an urge to use the washroom

• urinating > 8 times per day

• waking in the night to urinate

• difficulty urinating

• feeling like you can’t empty your bladder

• pain in or around the pelvis

• low back, hip or tailbone pain

• difficulty having a bowel movement (constipation) or pain

• pain with intercourse or difficulty with penetration

• painful periods

Examples of pelvic pain dysfunctions include:

Vulvodynia, Vestibulodynia, Dyspareunia, Vaginismus, Interstitial Cystitis, Dysmenorrhea, Endometriosis, Persistent genital arousal disorder, Pelvic congestion syndrome, Coccydynia, Prostatitis, Pudendal neuralgia, Orchialgia, Penile pain, Irritable Bowel Syndrome , Diastasis Recti

While many of these pelvic floor dysfunctions are common, they are not normal and we can do something about them!

For more information about different pelvic floor dysfunctions see the Pelvic Health Solutions webpage.

What does a pelvic floor Physiotherapist do?

Pelvic physios can assess how the pelvic floor may be affected by tension or pain, weakness, or asymmetry. The pelvic floor is influenced by local and distant muscle actions. Our assessment of your pelvic floor includes a comprehensive screen that includes questions about you and YOUR story. When you come for an assessment with a pelvic floor physio we’ll start by just talking. This is an important part of understanding your goals and what matters most to you.

Next, we do a screen of your muscle function (external and internal muscles, if appropriate). This includes assessing your breathing pattern, your posture and movement, range of motion, gait and strength. We can gain a lot of understanding about what is happening in your pelvis from observation of these things, but we are also rostered to perform internal assessments of both the vagina and rectum if this might be appropriate for you! Performing an internal exam is a controlled act in Canada and pelvic floor physiotherapists are trained to perform these exams with your permission and if YOU are comfortable. 

From here, we can discuss with you all the treatment options that might work for you. This might include any combination of: education, pelvic floor muscle training, tracking (e.g., bladder diaries), bladder training, UTI prevention, breathing and mediation training, prolapse specific treatments, electrical stimulation, biofeedback, and manual therapy.

Why would a Pelvic Physiotherapist do an internal exam?

I get it, you’d probably rather not. It’s important to consider internal examination because the muscles of the pelvic floor are like the other muscles in your body. That means they can be strengthened or relaxed with cueing.

Internal examination is an integral part of treating the pelvic floor and is the gold standard. I will never perform an internal examination on any patient that does not want one. My number one priority is that you feel safe and comfortable! Even without performing an internal examination there is still a lot we can do and colleagues and mentors have reported that their patients still have high levels of success without internal exams (for example, through telehealth during the COVID-19 pandemic).

In an internal exam a pelvic physio uses a clean technique to feel the muscles inside your pelvic floor to identify potential weaknesses, tightness or asymmetries that could be causing your dysfunction. We can then monitor changes over time to note the effectiveness of our treatments. During an internal exam you remove your bottoms, have draping covering your lower half and lay on an exam table. The exam involves visual observation and palpation (touching) of the groin and genitals. For internal exams, gloves and lubrication are always used to keep things as clean and comfortable as possible. 

Can I just do kegels to have a healthy pelvic floor?

Nope! Pelvic floor physio is more than kegels, which were proposed by Dr. Arnold Kegel in 1948 as an alternative to surgery for women experiencing incontinence (leaking) and prolapse (organ decent).  Kegels are NOT for everyone and are not always indicated for all pelvic floor problems. Sometimes they can do more harm than good and they are very often performed incorrectly. Kegels are used to strengthen weak pelvic floor muscles, but it’s important to consider that many pelvic floor problems are not caused by weak muscles, and are actually caused by muscles that are too protective, and as a result, tense or contracted already.