How can a pelvic floor physiotherapist help me?

Do you leak urine when you cough, sneeze, jump or run? Do you have a strong urge to void that you can’t control? Do you go to the bathroom more often than 8 times a day or once at night? Do your feel pressure at the base of your pelvis? Do you have pain in your low back or pelvic
region or painful intercourse? If so, pelvic floor physiotherapy could be helpful for you.

Optimal pelvic floor function allows you to maintain continence (not leak urine or feces and not have a need to void frequently), have your pelvic organs in a good position and be pain free. This requires good posture, proper breathing mechanics, balanced muscle activation of the
pelvic floor, trunk and hips, good integrity of the bones, ligaments and connective tissue of the spine and pelvis as well as normal nerve function. If any one of these things is not functioning well, it can lead to incontinence, prolapse and/or pain.

Pregnancy, delivery, menopause, surgeries, injuries and stress, are a few things that can affect the function of the pelvic floor. There is strong research to show that pelvic floor muscle training can cure or improve symptoms of stress and other types of urinary incontinence. There is also good evidence that it can reduce prolapse symptoms and is recommended as a first line management for prolapse.

What about Kegel Exercises?

Often people are told to do Kegel exercises to help strengthen their pelvic floor, but many people have internal muscles that are actually too tight (a tight muscle can also be a weak muscle) from injury, birth or poor postural patterns and this can make some forms of incontinence worse and can lead to pain. In this case, releasing the muscles that are too tight and then retraining them to function from a good position is necessary usually with a lot less effort that you think.

Pelvic floor therapy will assess and use techniques to help optimize muscle function. In fact, the Society of Obstetricians and gynaecologists of Canada recommends that “proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback.” At
Trimetrics, we have pelvic floor physiotherapists who have special training in performing internal vaginal exams. We also have a real-time ultrasound machine which can be helpful to see how the external abdominal muscles (transversus, oblique abdominals and the muscles that lift the bladder) are contracting, and whether they are contracting symmetrically (very desirable) or whether there is dominance of one side or muscle which can over time lead to incorrect SI/spine /hip / knee issues.

What can I expect during a session with a pelvic floor physiotherapist?

An initial visit will be 1 hour long in order to do a thorough assessment. The assessment will comprise taking a comprehensive history of your symptoms and behaviours. You will fill out a questionnaire before your appointment. It might seem quite detailed but your answers can be very helpful in determining what might be contributing to your problem and will help determine the best treatment for you.

The physiotherapist will then perform a physical evaluation which will include looking at your posture, breathing, mobility, stability, motor control and depending on your symptoms, may include an internal vaginal and possibly rectal examination. Pelvic floor muscles are located inside your pelvis and help to support your internal organs. These muscles can most effectively be accessed through a gentle internal vaginal and, or rectal exam. This will be done only with your permission and with as little discomfort to you as possible. The goal of this assessment is to determine the cause(s) of your symptoms as well as the best treatment plan for you so you.

Follow-up treatments will be between 30 & 60 minutes depending on what the therapist feels is best for your recovery and meeting your goals .As your symptoms improve your exercise therapy and fitness plan (including return to running and sports) will be developed using Clinical Pilates (our choice for its full body effectiveness and results) simple progressive home exercise or gym work.