Pelvic Floor

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Restoring Full Pelvic Functionality and the Freedom to Live Your Life

Remember a time when you were able to go for a run, sneeze or lift without leaking? Do you experience pain with intercourse or decreased sexual function?  Chronic constipation?

You don’t have to suffer in silence and accept this as your “normal”. Pelvic Floor Physiotherapy is here for you, to help you get from where you are to where you need to be. 

Whether you just had a baby, surgery to remove your prostate, have reached menopausal age, or are a young adult wondering why it hurts to use a tampon – your concerns can be helped with pelvic floor physiotherapy.

The Ultimate Guide to Pelvic Floor Physiotherapy

A pelvic floor physiotherapist spends quality time listening to your concerns, assesses the function of your pelvic floor, and investigates where your symptoms are coming from. They will help you understand how your symptoms can be helped and create a care plan that is specific to your needs – no cookie cutter approaches here!

Recommendations of 100+ kegels a day, surgical procedures without rehab first, just accepting that ‘its normal’ or just popping a pill are all a thing of the past. Get down to fixing the real issues and start living your life the way you want.

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Tell us what hurts, and we will treat your pain in the shortest time possible. Get effective treatment for your condition in less than 30 minutes so you can get back to doing what you live… pain-free.

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Get a personalized care plan so you can feel better in as few as 3 visits. We use advanced therapy techniques proven to ease pain, accelerate recovery, improve mobility and overall health.

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Expert Therapists

Our award winning team of licensed physiotherapists, chiropractors, registered massage therapists are professionals and experts in human anatomy and biomechanics. You will get the perfect care plan to target the root of your pain so you can get back to doing what you love, everyday! 

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This appointment is your opportunity to tell us what hurts and discover whether physiotherapy is a good fit for you! During this session, you will talk with a physiotherapist on a phone call (or online) and create the right care plan specifically for your pain. There is no obligation, this session is only to find out if physiotherapy can help you getting back to doing the things you love in life.

Why PainHero?

Improve the way your body moves so you can continue to do the things you love. PainHero is Canada’s largest network of physiotherapists, chiropractors, and registered massage therapists. Our mission is to make it easy for you to find the top clinics in your community. We handpick the top clinics using our 50 point inspection based on patient reviews, complaints, and patient outcomes. 

Whether you’re seeking pain relief or preventative care, you can expect our patient-centric approach to be new and different from any healthcare experience you’ve had before. Perhaps even life-changing.  

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The Ultimate Guide to Pelvic Floor Physiotherapy

Who Is Affected by Pelvic Floor Disorders?

It is not just women who are affected by pelvic floor dysfunction. Pelvic floor dysfunction can affect anyone with a pelvic floor. There are a few risk factors that increase the risk of developing a pelvic floor dysfunction,  childbirth is in the top 3. 

Simply having biological female anatomy, having experienced trauma (ie. childbirth, surgery, etc), menopausal, or even chronic constipation can also contribute to pelvic floor dysfunction. 

33% of women experience incontinence at some point in their lives, over 50% experience prolapse, and 25% deal with pain related to sexual activity. 

Although the statistics are more well known with the female population, men can also experience chronic pain, difficulties with urinating, sexual dysfunction, and incontinence. Furthermore, those who undergo gender confirmation surgery need further rehabilitation to restore function to the pelvic floor. 

Check out this post and learn who is at risk of pelvic floor problems courtesy of Athlete’s Care Sports Medicine Centres.

What is the Pelvic Floor?

The pelvic floor is a hammock-like set of muscles that make up the bottom part of your core. They span from the pubic bone in the front, tailbone in the back, and reach to the sit bones and even the hips. These muscles function to support the pelvic organs, the spine, and the hips. They help with the functional control with bowel movements, urination, and sexual activities. 

To find these muscles you can contract like you are trying to stop the stream of urine or hold back gas. It can be helpful to use a mirror to help you see where these muscles are. Also, try this exercise to feel the pelvic floor muscles move with your breath: 

Step 1: seated, laying on your back, or in child’s pose. 

Step 2: take a deep breath that allows your belly to expand

Step 3: notice the pelvic floor stretch, expand, and/or move down

Step 4: exhale slowly 

Step 5: notice the pelvic floor muscles lift, engage and/or move up

Your diaphragm and pelvic floor work very well together. The diaphragm is dome shaped at rest. When your diaphragm contracts, it flattens, drawing air into the lungs. This also causes the pressure in the abdomen to shift downwards, therefore the pelvic floor muscles stretch to accommodate for this sift. As you breath out, the diaphragm returns to that resting dome shape and the pelvic floor muscles contract slightly to where they need to be at rest. 

Check out this great post that talks more about what exactly your pelvic floor is, courtesy of Athlete’s Care:

Why Is Your Pelvic Floor Important?

why is your pelvic floor important​

If you have urinary leakage, painful intercourse, sexual dysfunction, chronic low back or hip pain you already know why the pelvic floor is important. But until there are issues we didn’t need to think much about it. 

The pelvic floor can react to stress, injury, pain, childbirth etc by having increased tension (hypertonicity), less tension (hypotonicity), weakness and/or poor coordination. Unfortunately, the longer these challenges continue, there is a higher chance of developing pelvic organ prolapse, incontinence, and pelvic girdle pain. 

Pelvic floor physiotherapy can help these issues. They help with improving strength and coordination, pelvic floor awareness, decreasing pain and restoring function. They will help you reach your goals, improving your quality of life and preventing need for surgery in the future. 

Now, doesn’t that sound encouraging? Let’s explain further how pelvic floor physiotherapy can help specific conditions. 

Book Your FREE BACK NECK SHOULDER KNEE ELBOW HIP WRIST FOOT Pain Consult

Find out whether physiotherapy can help you get back to doing the things you love in life. 

6 Common Conditions Related to Your Pelvic Floor

You have heard these terms and conditions, but sometimes the information out there can be difficult to understand or no one has taken a moment to explain it. We are here to help!

1. Pelvic Organ Prolapse

“bulge”

“heaviness”

“pressure”

“like there is a golfball in there”

Theses are all phrases we hear from our pelvic floor patients with a prolapse.

A prolapse is when the pelvic organs (rectum, uterus, and bladder) have moved downwards causing them do bulge into the vagina or sometimes all the way out of the vagina. This can be from a weakening of the supportive ligaments, weakening of the muscular supports, a weakening of the vaginal walls, or a combination.

Good news! If you have been diagnosed with a prolapse most patients have significant improvement to not only prolapse symptoms but also better bowel and bladder control with pelvic floor physiotherapy. 

Check out this post by Donald Physiotherapy to learn more about Pelvic Organ Prolapse:

2. Urinary Incontinence

This is so very common, but did you know it doesn’t have to be normal? Typically urinary incontinence can be broken down to stress incontinence or urge incontinence.

Leaks with a cough, sneeze, or jumping? That is stress incontinence. This is typically because the incredible increase in pressure issues too much for the pelvic floor muscles to handle – therefore hindering the active closure of the urethra. Urge incontinence is slightly different, where typically someone would feel a sudden strong feeling to pee but can’t make it to the bathroom in time.

Through muscle strengthening or down training, movement corrections, and behaviour modification both stress and urge incontinence can be helped!

Check out this UI infographic (courtesy of SOS Physiotherapy):

 3. Fecal Incontinence

Incomplete emptying, decreased muscle strength and coordination, too much pelvic floor muscle tension, digestion issues, and poor toileting habits can all contribute to fecal incontinence. If you are noticing streaks in your underwear, inability to control flatulance, or sudden urges to go number 2 but not quite able to make it to the toilet, then a pelvic floor physiotherapist is who you need to see. 

Check out this post (and read the caption) to learn more about incontinence for men by the Cheerful Pelvis:

4. Dyspareunia

This is a medical term for pain with intercourse. This can happen with both women and men. There can be many reasons for this including endometriosis, psychological triggers, prostatitis, and pelvic floor dysfunction. Whatever the cause, pelvic floor physiotherapists work with you and the medical team to help restore sexual function and find strategies to help restore the ability to enjoy sexual activities without pain.

5. Diastasis Recti (DRA)

Feeling a gap on your belly that wasn’t there before pregnancy? A diastasis is a separation between the muscle belly of the rectus abdominal muscle. Most of the time this separation is just an over-stretch of the strong connective tissue that lays between the muscle. Most DRA return to normal within 6 months to 1 year postpartum.

How do you know if your gap is too big? It depends on the function and your symptoms. Your pelvic health physiotherapist will assess how wide the gap is, how well you can control the tension at the abdominal muscles, if there is “doming” or herniation present, and if there are any pain symptoms associated with the separation. 

6. Persistent Pelvic Pain

Pelvic girdle pain can refer to pain not just at the pelvic floor but also at the hips and back. In fact, there is a strong connection with low back pain and having pelvic floor dysfunction. Unfortunately, sometimes persistent pain may not go away completely but that does not mean that you have to suffer with this pain.

The Cheerful Pelvis describes in their post how pelvic floor physiotherapists can help you live well despite having pain

What Is Pelvic Floor Physiotherapy?

what is pelvic floor physiotherapy​

Pelvic floor physiotherapy improves tension, strength, coordination, and function of the pelvic floor. A physiotherapist with this training will help you better understand your symptoms, how it relates to these muscles, and how your movements and exercises can help restore your function. 

Over 50 years ago everyone was just told to kegel or slated for just surgery or medications. Now, based on research, we know we can help people even more with a proper evaluation, education, treatment, and an individualized plan including exercises and behaviour modifications to get from where you are to where you need to be.

Just like when someone sprains an ankle and needs rehabilitation, a pelvic floor physiotherapists helps you become more aware of your pelvic floor through specific interventions and exercises to rehabilitate the muscles to better do their job. 

MOOV Physiotherapy helps explain how a pelvic floor functions. If you have symptoms of pelvic floor dysfunction then pelvic floor physiotherapy is for you!

Don’t know if you will benefit from Pelvic Floor Physiotherapy or not? Watch this quick video to learn what a strong pelvic floor looks like (courtesy of MOOV Physiotherapy):

What Does a Pelvic Floor Physiotherapist Do?

A pelvic floor physiotherapist is trained to assess, educate, treat, and prescribe exercise and behaviour modifications to alleviate symptoms of pelvic floor dysfunction. 

An assessment starts with a thorough history of your concerns, questions of bowel, bladder, birth and pregnancy history, menstrual or menopause history, prolapse symptoms, trauma history, dietary or digestion concerns, and sexual function.

A physical assessment involves looking at posture, abdomen, breathing mechanics, movement and strength of the back and hips, as well as an external and internal assessment of the pelvic floor. The internal assessment involves assessing vaginally (for those with a vagina) and rectally. Your physiotherapist will take the time to explain what to expect in the assessment and which parts of the assessments would be helpful based on your specific concerns. 

Then from the assessment your pelvic floor physiotherapist will come up with a plan for how to manage your condition. This may include treatment of manual therapy and modalities, exercises to help improve pelvic floor muscle awareness, tension, strength, and coordination, recommendation of potential tools or other resources to help, and a home management plan. 

Your pelvic health physiotherapist will coach you through each session and help you throughout to reach your goals of restoring function, returning to exercise and intimacy without pain or discomfort and improvement in symptoms. 

Check out the video to learn great tips for low back issues for pregnancy courtesy of Donald Physiotherapy

 

What Are the Benefits of Pelvic Floor Physiotherapy?

Simply, to get back to the life you want to live! 

No one needs to suffer with their symptoms. Whether it is pain with intercourse, urinary or bowel incontinence, back or hip pain, prolapse, or other pelvic floor dysfunctions you can experience relief. 

You will feel encouraged, more aware, stronger, and confident are ways pelvic floor patients describe their experience with pelvic floor physiotherapy. 

5 Things to Look for In a Pelvic Floor Physiotherapist

Finding a physiotherapist for the pelvic floor can be challenging. As not every physiotherapist has this training, you want to make sure wherever you can access this care is the best care for you. However, not matter what, these are the top 5 things to look for in a Pelvic Floor Physiotherapist. 

1. Assesses and Treats the Whole Person

If all they talk about is kegels, which we will talk about in a bit, this is not the provider for you. Pelvic floor physiotherapists assess the whole person. For example, your knee hurts, keeping you from being active and potentially causing more constipation, the knee needs to be addressed as well as pelvic floor specific interventions. Your physiotherapist will help identify areas in your life where maybe other healthcare providers may be helpful to work as a team towards your goals!

2. Takes a Biopsychosocial Approach to Your Care

Have you ever felt like you were not heard, like your care provider only glanced at your issues without taking the time to listen to better understand your condition. A physiotherapist who practices the biopsychocial approach knows that symptoms and pain are not just due to structure. That stress, environment, beliefs, societal stressors, etc can all play a part in the presentation of persistent symptoms. That is why they take the time to listen, understand, get to know you and how your symptoms interact with your world. 

3. Orthopaedics and Exercise Foundations

Because movement is so important to how we experience the world then it is essential your physiotherapist is including movement strategies in into your care plan. That is why a pelvic floor physiotherapist assesses movements beyond that pelvic floor. They want to see balance, functional movements like squats, lifting, and walking or running. A skilled clinician will not just prescribe a “cookie cutter” approach to exercise, they will make sure that your exercises are specific to your needs and lifestyle. 

4. Is Trauma-Aware

Trauma con be described as any distressing or disturbing experience and is typically unexpected. Your pelvic floor physiotherapist should be sensitive and aware that many of those who seek out pelvic floor physiotherapy have not just experienced physical trauma but mental and emotional trauma can be very involved too. 

That is why a your pelvic floor physiotherapist should be taking the time to explain what the assessment and treatment involve, give space for questions and clarification, check in often with how you feel with any intervention that is provided, and offer a safe and inviting space for you to be heard. 

5. Offers First-Time Phone Calls

Its normal to feel nervous before booking a pelvic floor physiotherapy appointment. A good pelvic floor physiotherapist will understand your uncertainty and be able to accommodate a first meeting phone call to help bridge the gap and help you feel more comfortable. 

Look for a clinician that gives this as an option if you are feeling nervous about seeing help through pelvic floor physiotherapy. 

5 Steps to Improve Your Pelvic Floor Right Now

Much of pelvic floor physiotherapy begins with simply getting in touch with these parts of your body. Most of this is internal, and the muscles are not obvious like a leg or shoulder muscle. Posture and breathing play a large role in pelvic health physiotherapy.

Here’s a 5-step breathing process you can start using right now to begin to become more aware, or ‘find’, your pelvic floor muscles.

Step 1

Sit down, lay down, or find a child’s pose position

Step 2

Breathe in deeply, focusing on filling your lungs full and allowing the belly to rise/expand. Notice the slight movement or relaxation of the pelvic floor.

Step 3

Breath out. As your belly returns to neutral feel your pelvic floor muscles lift or contract slightly.

Step 4

Repeat step 1-3 for a total of 10 times

Step 5

Do this 5-10 times per day to help you reconnect to your pelvic floor and decrease the habitual tension and stress that can occur throughout the day. 

Pelvic Exercises for Women

Here are five exercise (from easiest to hardest) you can start using today to strengthen your pelvic floor muscle group:

1. Cat/Camel

On your hands and knees on the floor or bed, if this is too difficult then try seated on a chair. 

Deep breath in, letting your pelvic floor relax, as you curve your back. Imaging reaching your tailbone and crown of your head to the sky while your belly drops and moves towards the ground. 

Then, breathe out as you gradually contract the pelvic floor all while arching your back, dropping your head down and imagine tucking your tailbone between your legs. 

Read the caption on this post to learn more about Kegels, courtesy of The Cheerful Pelvis:

2. Kegels

A proper kegel should be done without clenching your bum muscles or holding your breath. If you were to do kegels while having wine night with the girls, no one should be able to notice you are doing them! 

Deep breath in to prepare and relax the pelvic floor. Lift and contract the pelvic floor on a breath out focusing mainly in the centre of the muscles. Sometimes it helps to imaging that you are picking up a blueberry with you urethra or vagina, or trying to stop the flow of urine. 

These can be held for 1 minute or work towards endurance where you hold for 5-10 seconds. Make sure to always relax the pelvic floor fully before doing the next contraction and this exercise should never be done while sitting on the toilet!

3. Quick contractions

This is the olympic level for pelvic floor coordination. Quick contraction are needed for functions like being able to hold back pee from a coughing fit or being able to achieve an orgasm. 

The goal is to be able to contract and relax the pelvic floor fully 10 repetitions in 10 seconds. 

Take a quick look at this post by Durham Pelvic Health and read the caption for more tips on how to do bridges effectively:

4. Bridges

Because we don’t live our life completely still we need to bring that strength and awareness to the pelvic floor with other movements. This is why starting to train pelvic floor exercises in with simple hip exercise can be helpful. 

Lay on your back with your knees bent and feet on the floor. Breathe in to prepare and relax the pelvic floor. Then, as you breathe out, slightly contract the lower abdomen muscles, lift the hips off of the floor, all while contracting the pelvic floor. Be able to coordinate all 3 throughout the whole movement. Lower the hips down to the floor on a breath in again while everything relaxes. 

5. Squats

This will truly put your pelvic floor muscle strength to the test, especially if you have experienced incontinence or prolapse. Make sure if this exercise is done you should not experience any pain, heaviness, pressure, or incontinence – if you do please do not continue this exercise. 

A squat is performed starting with your feet hip width apart. Breathe in, hips start to hinge or move back and down towards the ground (like sitting back into a chair), then bending the knees allowing the knees to track in line with the toes. Then, once at the lowest comfortable position in your squat, breathe out as you contract the pelvic floor, straightening both hips and knees at the same time.

Up for a challenge? Adding weight to this movement can further strengthen not just your legs and hips but your core and pelvic floor as well. 

Watch this IG Reel from Strive Health and Performance and try the Squat Mobility Exercise:

 

Pelvic Exercises for Men

Though there are certain pelvic floor disorders unique to men and women, the amazing thing is that the basic exercises are the same. See below where @the.cheerful.pelvis explains male specific kegel ‘cuing’ to help train those pelvic floor muscles.

The same five exercises listed above for women work just as well for men too.

If you’ve had a prostatectomy and are now suffering incontinence, or if you have erectile dysfunction, pelvic pain, chronic constipation, or frequent urination at night, you probably have a pelvic floor problem.

Try to make yourself a plan to do the five exercises listed above for a couple months and see if you notice any improvements. If it doesn’t seem to resolve the problem, look for a pelvic floor physiotherapist using the 5 criteria listed earlier.

Checkout this post from The Cheerful Pelvis

Conditions Successfully Treated with Pelvic Floor Physiotherapy

Frequently Asked Questions

It depends! If you have tight muscles that have a difficult time relaxing then Kegels are NOT the thing for you. If its more of a weakness or poor coordination then Kegels (when done properly) can be very helpful.

Sure can! Painful intercourse can stem from a number of issues. Vaginal dryness, tense pelvic floor muscles, scar tension, nerve entrapment, chronic conditions like endometriosis, etc can contribute to painful intercourse. A pelvic floor physiotherapist will ensure to evaluate the best strategies and intervention for your specific concerns.

No, you don’t and there are tons of techniques we can use to help you externally. There is lots of things to work on without doing any hand-son assessment. However, having an internal exam from a trained pelvic floor physiotherapist will provide the most information about your specific pelvic issue allowing a more complete understanding to move forward with a treatment plan of action. Discuss with your pelvic health physiotherapist your concerns and they will work with you to be sure to plan the assessment and interventions best suited for your needs.

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