What is a pelvic floor physiotherapist?

A Pelvic Floor Physiotherapist is specially trained to treat various conditions, which involve the pelvic floor muscles. The pelvic floor muscles are the muscles commonly known to stop the flow of urine, control flatulence or perform a Kegle. They also provide support to the organs within the pelvis including the bladder, bowel and uterus. If these muscles aren’t working properly, whether they’re too tight, weak or simply uncoordinated, they can have an effect on these systems. 

Who should seek out pelvic floor physiotherapy?

There are several symptoms that are very common but are NOT normal and could lead you in the direction of a pelvic floor physiotherapist. These include:

  • Bowel or bladder leakage or incontinence (involuntary loss of urine or stool)
  • A feeling of incomplete emptying after urinating or having a bowel movement
  • A feeling of heaviness in the vagina
  • A sense of a bulge in the vagina, like something is “falling out”
  • Strong urgency for bowel or bladder (having a hard time making it to the toilet in time!)
  • High frequency of urinating (more then every couple hours) or waking at night to urinate
  • Constipation or difficulty passing stool
  • Pain with intercourse at any stage of life

Pelvic floor physiotherapy can also be sought out for educational and preventative purposes in order to learn about themselves and how to stay as mobile, strong and in-tune with their own bodies as possible. Other specific groups of people that would greatly benefit from a pelvic floor assessment would be pre and post-natal women (even if they are having or have had a C-section!) and women going through the changes of menopause.

Some clients may be referred directly from their family doctor or their obstetrician, gynecologist or urologist but a referral is not always necessary unless your insurance requires it. Diagnoses that may be made by doctors for a referral to pelvic floor physiotherapy could be:

  • Stress incontinence
  • Urgency or urge incontinence
  • Overactive Bladder
  • Chronic Constipation
  • Pelvic pain
  • Pelvic Organ Prolapse (POP), which could also be termed: rectocele, cystocele, uterine prolapse or urethrocele depending on which organ is involved
  • Dyspareunia, Vulvodynia, vestibulodynia or vaginismus
  • Post-partum Diastasis Recti
  • Coccydynia (or tailbone pain)

What to expect on the first visit:

A pelvic floor physiotherapy assessment would involve a detailed subjective examination asking various questions regarding past medical history, urinary, bowel and sexual function. An objective assessment would follow including observing posture, low back and pelvic movement, core and hip strength as well as an external and internal vaginal and/or anal-rectal examination.

Once everything has been assessed, education will be provided on the examination findings and a treatment plan will be discussed. Treatment is dependent on the assessment but may involve pelvic floor strengthening exercises, relaxation exercises, manual therapy techniques for the muscles or joints, breathing techniques, low back and hip mobility and strengthening, behavioral modification techniques including filling out a bladder diary or optimizing bowel routine.

The initial assessment is one hour long and follow up sessions are typically 30minutes although the physiotherapist may suggest a 45minute or one hour follow up session depending on the assessment.

It is important to note that consent must be achieved before beginning the assessment and if at any point you are uncomfortable or have questions regarding part of the assessment or treatment it is vital that you share this with the physiotherapist and adjustments will be made accordingly.