Pelvic Floor Physiotherapy

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. 

Meet our Therapist

Joanne Ukposidolo

Registered & Certified Pelvic Health Specialist

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First Time Visitors

FAQ

What conditions are treated/improved with pelvic floor physiotherapy?

Stress Urinary Incontinence: The involuntary loss of urine with an increase in intra-abdominal pressure. You may leak when you laugh, cough, sneeze, or with physical activity (jumping, running, walking).

Urge Urinary Incontinence: The involuntary loss of urine following a strong urge to urinate that cannot be controlled.

Mixed Urinary Incontinence: A combination of stress incontinence and urge incontinence. It is very common to have mixed incontinence as opposed to pure stress or pure urge incontinence. 

Overactive Bladder: Frequent urination, more than 5-8 times per day.

Urinary Hesitancy/Dyssynergia: Difficulty initiating either urine stream or bowel movement. This can be a result of poor pelvic floor muscle coordination.

Constipation: When bowel movements are infrequent or challenging to pass. Symptoms may include bloating or abdominal pain and the inability to completely empty the bowels. 

Endometriosis: A condition in which endometrial tissue appears outside of the uterus. This appearance can be associated with pelvic pain, heavy and painful periods, pain during sexual intercourse, as well as urinary and bowel dysfunction.

Pudendal Neuralgia: The pudendal nerve supplies sensory, motor, and autonomic function to the external genitalia, bladder, and rectal muscles. With pudendal neuralgia, the nerve is mechanically compressed, entrapped, or irritated causing pain and dysfunction in the pelvic region. Prolonged sitting, difficult childbirth, and cycling are common causes of pudendal neuralgia. 

Interstitial Cystitis: A condition affecting the bladder involving unpleasant sensations and symptoms such as pain, pressure, burning, urinary frequency, and urgency. With this condition there can be identifiable bladder disease (such as Hunner’s lesions).

Levator Ani Syndrome: The levator ani muscles are the deep muscles of the pelvic floor. These muscles can go into spasm resulting in pain within the perineum, rectum, or tailbone. 

Dyspareunia: Pain experienced with sexual intercourse. Pelvic pain can occur before, during and after sexual intercourse. Symptoms can be experienced superficially at the opening, with deep penetration or with orgasms. 

Coccydynia: Pain experienced within the tailbone or coccyx. Symptoms increase with prolonged sitting.

Vulvodynia: A nonspecific, unprovoked, generalized pain around the opening of your vagina (vulva) with no identifiable physical findings.

Vaginismus: An involuntary clenching of the pelvic floor muscles to prevent vaginal penetration. This may limit gynecological exams, tampon insertion, or sexual intercourse.

Pelvic Organ Prolapse: Occurs when one or more pelvic organs (uterus, bladder, rectum) protrudes into the vaginal canal. This is due to the weakening of pelvic floor muscles and connective tissues that function to provide support for the pelvic organs. Common contributing factors for weakness within the pelvic floor include:

  • Pregnancy
  • Vaginal delivery
  • Constipation
  • Being overweight
  • Chronic coughing
  • Hormonal changes that occur with menopause 

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 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

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 

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 Sport Medicine 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 to visit the naturopath for pelvic floor physiotherapy at the Sport Medicine Clinic?

You do not need a referral for pelvic floor physiotherapy. Some select insurance companies require a referral note from a family physician before a physiotherapy claim can be honoured. Please contact your insurance company to gain a comprehensive understanding of your full benefits and coverage package.

Is the Sport Medicine Clinic accepting new patients for pelvic floor physiotherapy?

Yes! Please call 416-865-0903 or email us today to book your appointment.

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