The pelvic floor is a group of muscles and connective tissue that span the underside of the pelvis and attach from your pubic bone to the tail bone and between your sit bones. The purpose of these muscles is to support your internal organs - including supporting a baby when pregnant along with several other functions. These muscles play a part in stabilizing your pelvis, hips and lower back; have a roll in sexual function; impact circulation and the lymph system to pump fluid out of the pelvis; and impact your ability to hold and expel urine, gas and faeces.

Pelvic health physiotherapy is focused on the deep core and pelvic floor musculature, specifically. As I believe that no part of the body is an island, I take on a holistic, full body approach that assesses not only the pelvic floor but your body in its entirety.

Pelvic health physiotherapists have specific post graduate training which includes using internal and external hands-on techniques to evaluate how your pelvic floor muscles are working and coordinating with the rest of your body.

A pelvic health physio can help prevent and treat many conditions including:

—incontinence or leaking of urine, stool or gas when you cough, laugh or exercise
—urinary urgency and frequency
—difficulty initiating urination or passing stool
—internal pelvic pain such as that caused by: endometriosis, vaginismus or pain during intercourse, interstitial cystitis or painful bladder syndrome, pain or heavy cramping with menstruation
—pain in clitoris, vagina, rectum or perineum
—pelvic organ prolapse
—heaviness or pressure in the pelvis
—pain associated with the low back, pelvic girdle, sacroiliac joint (SIJ), public symphysis or tailbone
—diastasis recti (abdominal separation)
—pregnancy related pelvic pain.

A pelvic health physio can also provide guidance to help prep your body for pregnancy and birth, ensure a comfortable pregnancy, efficient postpartum recovery, and years to decades past the postpartum period and into menopause.

A comprehensive virtual pelvic health physiotherapy assessment will include: discussion of medical conditions and history, birth history, birth preferences, details about your current pregnancy (if pregnant), physical observation and tests to gauge your mobility, strength, flexibility and tension. From here we address any goals you have for movement or exercise, movement in pregnancy, injury recovery or efficient postpartum recovery.

Your therapist will discuss the findings of your assessment, go through strategies to help alleviate and manage symptoms, provide education, a home exercise management plan and recommend a treatment plan going forward - whether virtual or in-person appointments would be ideal and may recommend an internal pelvic exam.

Yes all initial pelvic health assessments are virtual. There is a lot of information gathering, education and movement strategies that we go through in that first session and we’ve found that it can be helpful to have you in your own space to best set you up for success.

Clients find that virtual appointments can be extremely convenient, but more than that, effective at starting you on your pelvic health journey.

Follow-up appointments can be either in-person or virtual depending on your preference, your individually tailored treatments and your specific goals for treatment.

Based on your reported symptoms your physio will perform a thorough external exam of your back, hips, abdominals and pelvis to evaluate movement, structure, mobility, strength and tone. If necessary, an internal vaginal/rectal exam will then be performed to evaluate tension, strength and coordination of the pelvic floor musculature.

Your physiotherapist will first explain why they believe an internal exam would be helpful along with other pros and cons of internal palpation. They will then guide you through the exam and provide feedback throughout.

You must provide consent before any step of the exam and you are able to withdraw consent at any time.

During the internal portion of the pelvic floor exam, your physiotherapist will gently insert one or two gloved fingers into your vagina or one finger into your rectum. This allows the therapist to palpate each muscle group and evaluate its tension and function. There is no speculum nor instruments inserted into the vagina or rectum.

Depending on concerns presented and information that was gathered from your history and external exam, an internal exam may not be necessary. However, an internal exam is usually recommended as it is the gold standard for assessing pelvic floor muscles and associated structures.

If you choose not to proceed with an internal exam the physiotherapist will make recommendations for treatment from your subjective history and external exam to work towards your goals.

It’s up to you.

Pelvic floor assessment and treatment can be provided even if you’re on your period. Pelvic organ position and muscle tone can be affected by hormonal changes and it can actually be helpful to assess this during this time.

If you’re not comfortable with an internal assessment or treatment when you’re menstruating, we can complete the session with external techniques or you can reschedule your appointment with at least 24 hours notice.

Absolutely. You’re welcome to bring your baby to your appointment and I completely understand if you need to attend to them during your session. We appreciate your understanding that we are unable to extend physiotherapy sessions past their allotted time due to other booked clients.

If you have coverage for physiotherapy through extended health benefits, you will be covered for pelvic health physiotherapy. We will provide you with a receipt at the end of your session that you can submit for reimbursement or retain for tax purposes.

For years I worked in both orthopaedic and neurological physiotherapy. During this time I developed an appreciation for treating any injury by looking at the whole person holistically and in more than just a physical sense.

Following the birth of my first child I attended pelvic physiotherapy for treatment of my own issues. At the time there was very little support for postpartum women available. It was hard to understand why during pregnancy there are such frequent appointments, but six weeks after you’ve given birth, you’re discharged.

I realized that a lot of what we’ve been told is a “normal” part of pregnancy, postpartum and aging is not normal at all and there are ways to have success in improving our pelvic health. I began taking post-graduate courses in pelvic health and pilates and my passion ignited.

My mission is to make sure every woman feels heard, seen, hopeful, and show that although something may be common, it doesn’t need to be your new normal.

Let me support you on your Journey to Wellness here at Trail Physio.
- Laine