Pelvic floor physiotherapists are orthopedic physiotherapist's who have specialized training in assessing and treating conditions resulting in the dysfunction of the pelvic floor muscles for both males and females.

Some of the pelvic floor disorders that are treated with pelvic floor physiotherapy are:

• Urinary incontinence, fecal incontinence, urge incontinence
• Urinary urgency, retention, hesitation, frequency
• Pain with bowel movements or urination
• Pelvic organ prolapse
• Constipation
• Painful Intercourse (Dyspareunia)
• Pain in areas of the vagina (Vestibulodynia, Vulvodynia or Clitorodynia)
• Interstitial cystitis
• Painful Bladder Syndrome
• Endometriosis
• Chronic Pelvic pain
• Pudendal Neuralgia
• Low back pain
• Hip pain
• Prenatal care
• Postpartum care

Initially, when you call to make your appointment the administrative staff will send you an intake package that will help the physiotherapist learn more about your symptoms and your condition. This comprehensive intake package is typically completed prior to your assessment and your therapist will review it prior to seeing you.

Most assessments last anywhere between 45 minutes to 1 hour. Your therapist will take the time to go through your history, as many individuals have undergone multiple tests, seen many practitioners and suffered with pelvic pain or incontinence before consulting a physiotherapist.

The next component of the assessment is the physical exam which includes an external and the, often dreaded, internal examination. Commonly, for females this includes both a vaginal and rectal exam and for men, a rectal exam. Most people are hesitant and nervous about this portion of the assessment, but your physiotherapist will walk you through every step of the process so that you feel comfortable and in control of the situation. Think about it this way, if you had a knee injury, you would expect your physiotherapist to examine the injury. Pelvic floor problems are no different, they require a detailed assessment so that treatment is targeted and effective.

Now, there are some caveats to this , some people have a great deal of pelvic pain or discomfort, in these circumstances we do not have to do a full internal exam. There are some other options such as assessing the external genitalia/vulvar region (outside the opening of the vagina/rectum), assessing the pelvic girdle which includes the hips, low back and pelvis and their associated muscles. Often these areas can give us clues about what is happening and can be an area to work on while we ease into the internal (if needed).

Treatments range from 30-45 minutes in duration and the therapist will recommend a detailed treatment plan based on your condition. Usually each treatment will involve an internal component. In its most simplistic form the therapists are either strengthening weak or lengthened (hypotonic) muscles, or reducing spasm in tight and shortened (hypertonic) muscles.

Often pelvic floor dysfunction can arise from various systems in the body including the nervous system, musculoskeletal and visceral (organs) structures. For these reasons think of your pelvic floor physiotherapist as your case manager helping you put together all the pieces that may be contributing to your symptoms.

Pelvic Floor Rehabilitation Is Directed At:

• The Pelvic floor
• Hips
• Lumbar spine
• Abdominal region
• Sacro- iliac joints and pubic symphysis
• Central Nervous System

young woman performing a pelvic bridge exercise with feet on a yoga ball supervised by a physiotherapist

Pelvic Floor Physiotherapy Treatments May Include:

• education on pain systems/diet
• stress management
• relaxation strategies
• cognitive behavioral therapy
• manual therapy - internal and external
• acupuncture
• biofeedback
• electrical stimulation/TENS
• stretching and strengthening exercises
• bladder/fibre diaries

Pelvic floor treatment is the first line of defense for stress and urinary incontinence. In France, the government covers the cost of 6 postnatal pelvic PT appointments to prevent or treat pelvic floor dysfunction. In Britain, women undergo pelvic floor muscle training before surgical procedures are even considered.

Prior to the evolution of pelvic floor physiotherapy individuals were often prescribed kegels for the treatment and prevention of pelvic floor dysfunctions. It is important to note that kegels may not be appropriate for every individual and verbal instructions for kegels are not adequate. In 2008 clinical guidelines were established in Canada that recommended that "proper performance of Kegel exercises should be confirmed by digital vaginal examination or biofeedback". This is a crucial part of recovery as more than 30% of women cannot contract their pelvic floor muscles effectively.

Often postnatal and older adults are prescribed pelvic floor physiotherapy but what about our pre-partum individuals? Research shows that women who did pelvic floor muscle training between 20-36 weeks of pregnancy had a lower rate of prolonged second stage labour, less pregnancy related low back pain and pelvic pain and were less likely to have urinary incontinence than those who did no training. This is an essential time to evaluate your pelvic floor, learn best practices for labour and delivery and set oneself up for optimal postpartum recovery.

Last but not least - chronic pelvic pain. To truly treat an individual with pelvic pain we must understand the complexities of their condition. Although there are many pain syndromes that have a myofascial origin we must not solely place the blame on the pelvic floor muscles but look at the pain as a result of many factors. In order to heal and manage your pelvic pain it is important to align yourself with a physiotherapist who understands the interaction between pelvic pain, the central nervous system, and the relationship of biological, psychological and social factors.