Pelvic Floor Physiotherapy 101

Pelvic floor physiotherapy has gotten some buzz in the mom world as of late, however, we know that many of us don’t really understand what it is all about and why it might be an important part of our pregnancy and postpartum journey. We asked Chana Ross, the owner of Vital Physiotherapy & Wellness, a women’s health clinic in Midtown Toronto specializing in pelvic health to shed some light on the topic.

What is the Pelvic Floor?

The pelvic floor is made up of three layers of muscles that sit at the base of your pelvis. They provide a bowl of support for all of your important internal abdominal and pelvic organs including the bladder, bowel and the uterus. The pelvic floor muscles are integral to bowel, bladder and sexual function and serve as the base of the group of muscles referred to as the “core”.

pelvic floor physiotherapy

The pelvic floor has 5 Important function

  1. Supportive: These muscles support our organs against gravity and increased abdominal pressure such as when coughing or sneezing, during pregnancy and even when jumping.
  2. Maintaining Continence: The pelvic floor muscles control the opening and closing of the urethra and rectum, ensuring that stool and urine are held in when you want them to be and released when you are ready to “go”.
  3. Sexual Function: This muscle group plays a role in orgasm, sexual sensation and sexual satisfaction.
  4. Sump Pump/Circulatory Role: These muscles act as a ‘sump pump’ for our veins and lymph system, pumping the blood and lymph back to our heart with every muscular contraction.
  5. Stability: The pelvic floor muscles work with the deep abdominal muscles, deep back muscles and diaphragm to stabilize and support the spine and pelvis during daily movements.

What is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy is an internal hands-on physiotherapy technique to provide the gold standard level of pelvic floor muscle evaluation and treatment. Treatments are provided by pelvic health physiotherapists who are specially trained registered physiotherapists. Pelvic health physiotherapists focus on treating the pelvic floor muscles in people who are having issues with any of the 5 important functions performed by these muscles (see above!)

Strong research supports the importance of seeing a pelvic health physiotherapist. In fact, research shows that pelvic floor physiotherapy should be the first line of defence for incontinence (leaking urine) in women. This past fall (2018), The Society of Obstetricians and Gynaecologist of Canada released Pregnancy Fitness Guidelines and in it they suggested pelvic floor muscle training, such as Kegel exercises should be performed on a daily basis to reduce the risk of urinary incontinence. The guidelines go on to say that instruction on proper Kegel technique is recommended to obtain optimal benefits (ie. pelvic floor physiotherapy.)

How do you Know if Your Pelvic Floor is Working Well?

Do you ever pee when you laugh, jump or are on the way to the bathroom? Do you have pain when inserting a tampon, with a PAP test or with intercourse? Do you feel pelvic heaviness or even some bulging out of the vaginal opening? Or do you notice that your core feels “weaker” or your stomach looks different after giving birth?  If this sounds like you, then you may have pelvic floor dysfunction.

The chances of having these symptoms usually increases during and after pregnancy due to the increased pressure from the growing baby. These symptoms also around the time when your body goes into menopause. Your pelvic floor could even start to feel pain with daily movements such as walking, standing up from a chair and turning in bed.

We often just assume that leaking urine, low back pain, pain with sex and poor abdominal function are “just being part of the MOM package.”

This isn’t true.

You deserve more.

I strongly believe that anyone who has ever been pregnant should get assessed. Some pelvic health conditions are asymptomatic (meaning you have no systems), until you do and it is too late.

Be proactive about your health.

But, Aren’t you Just Going to Tell me to Kegel? Why do I Need to see a Physiotherapist for That?

The pelvic floor muscles are muscles like any other. Instructing women to “just do her Kegels” is not going to cut it when our goal is optimal pelvic health.

Here’s why

  1. Many women Kegel incorrectly which means that your muscles are NOT getting stronger. Stopping your flow of urine multiple times a day is not actually training your muscles to do what they have to do.
  2. Many women have pelvic floor muscles which are too tight and persistently clenched. If your muscles are clenched all the time, they are not available when you need them to perform. Instead they need to be trained to relax and not to contract. You won’t be able to tell if your pelvic muscles are too tight on your own.
  3. The pelvic floor doesn’t work in isolation. No muscle in the body works in isolation, and the pelvic floor muscles are no exception. They are part of your “anticipatory core” system and they work together with the three other inner core muscles to turn on BEFORE any other muscle starts to move.

With pelvic floor physiotherapy you’ll be trained so that your pelvic floor muscles are ready, available, flexible and coordinated enough to take on whatever it is you want to do, from exercise, to sex to sneezing!

What Can I Expect at an Appointment?

In your first visit, you will likely spend about half of the time talking. We go through a detailed history of your bladder and bowel function, gynaecological history and activity goals.  We want to hear YOUR story and ensure that we help resolve your symptoms and we understand why doing so is meaningful to you in your life.

Next you will have a physical assessment of your posture, breathing pattern and functional positions such as squatting or standing on one leg will be performed. Depending on your goals we may watch you run, skip or hop as well.

Lastly, with your consent, an internal exam is performed to determine how well your pelvic floor muscles are functioning. Your pelvic floor physiotherapists will conduct a (pain free) pelvic exam to determine what your muscles are actually doing. This pinpoints where the problem is and gives them the information they need to send you home with a unique care plan to tailored to address your body’s needs.

Many women are scared that the assessment may hurt or they feel embarrassed. Let me stop here and say:

IT IS THE JOB OF THE PELVIC FLOOR PHYSIOTHERAPIST TO ENSURE THAT YOU FEEL SAFE AND COMFORTABLE WITH THE PELVIC EXAM.

IT IS THE JOB OF THE PELVIC PHYSIOTHERAPIST TO HELP YOU GET RID OF YOUR PAIN AND NOT TO CAUSE MORE!

Your pelvic floor assessment should be empowering. It should lead you to a better understanding about how your body works and ensure you that there is hope!

How to Choose the Right Pelvic Floor Physiotherapist for me?

Is it really important to ensure that your physiotherapist makes you feel comfortable and that your concerns have been heard. If you do not want to have an internal pelvic exam, your physiotherapist will be understanding and respectful and, most importantly leave you feeling empowered by the experience.

When choosing a physiotherapist, ask your friends who they connected with. Finding someone who you have a good therapeutic relationship with is the most important part of your recovery along with doing your pelvic floor physiotherapy homework of course!

Seeing a pelvic floor physiotherapist was an important part of my prenatal preparation and my postpartum recovery. I became a pelvic physiotherapist because I needed pelvic floor physiotherapy.

It changed my life.

I know it will change yours too!

Have more questions? We would love to answer them!

Contact us at Vital Physiotherapy & Wellness, join our mailing list or follow us on Facebook or Instagram where we regularly answer questions about pelvic health!

League of Moms / 04/02/2019

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