Pelvic Floor Physical Therapy: The Ultimate Guide to determine if Pelvic Floor Physiotherapy is for you

Have you every been told that it was normal to pee when you cough, sneeze or laugh? Can’t comfortably play with your kids without pain or leaking? 

You had a baby or maybe you’re just aging so these issues are normal right? WRONG!

Just because something is common, doesn’t mean it’s normal!

Some of these issues are common because those with female anatomy have been neglected in terms of research and treatment. 

If you want to learn more about what pelvic floor dysfunction and pelvic floor physiotherapy is and if it is the right fit for you, you’re in the right place! Well, we will be answering these questions and more in the following blog post!

Here is what we will be covering: 

1. What makes a Physiotherapist a Pelvic Floor Physiotherapist?

2. What is Pelvic Floor Physiotherapy? 

3. What is the Pelvic Floor?

4. What is the Roll of the Pelvic Floor?

5. What does Pelvic Floor Physiotherapy Treat?

6. Who is Pelvic Floor PT for?

7. Pelvic Floor Screening tool - Do you have pelvic floor dysfunction?

8. What does a Pelvic Health Physiotherapy session look like?

What makes a Physiotherapist a Pelvic Floor Physiotherapist?

Not all physiotherapists are pelvic floor physiotherapists. After graduating from a Masters (Canada) or Doctorate program (USA) of physical therapy, a physiotherapist must then obtain further training in Pelvic Health. In Canada, Physiotherapists must complete a series of courses that incorporate practical learning and assessments that are recognized by their governing provincial body. Once courses are completed and passed, they must be approved by their provincial governing college to become a Registered Pelvic Health Physiotherapist. 

Yes… the learning is continuous even after graduation and I love it. That’s why you will always catch me taking updated courses or reading a research article. 

Now….

What is Pelvic Floor Physiotherapy? 

You may have heard a few terms for pelvic floor Physiotherapy such as pelvic floor PT, pelvic floor physical therapy, pelvic physio, women’s health, reproductive health etc. 

Pelvic Floor Physiotherapy focuses on symptoms affecting the region between the belly button and hips. It primarily focuses on the muscles of the pelvic floor found between the pubic bone, tailbone and your sit bones (i.e. iscial tuberocities). Your pelvic floor muscles also interact with your abdominal muscles, the multifidus muscle found in your lower back, and your diaphragm! There are 36 muscles attached to the pelvis! Therefore pelvic floor Physiotherapy requires a holistic approach focusing on your pelvic floor, the structures attaching to your pelvis and your nervous system. For a specific area of the body… it can be very complex.

What is the Pelvic Floor? 

So you now know that Physios require extra training to become a pelvic floor physiothertherapist. You may still be wondering what exactly is the pelvic floor? So let’s get into it! 

The pelvic floor is a collection of 14 muscles and connective tissues forming a sling at the bottom of your pelvis. It also forms the base of your core! (Yes, the pelvic floor muscles are a part of your core). The muscles stretch from the pubic bone to the tailbone (i.e. coccyx) and laterally extend to your sit bones (i.e. ischial tuberocities).

What is the Role of your Pelvic Floor?

There are 5 main roles of the pelvic floor are as follows: 

1. Support 

• Supports your internal organs against gravity and intra-abdominal pressure 

2. Sphincteric 

• The pelvic floor muscle create sphincters to help control the opening of the urethra, vagina and anus

3. Sexual 

• The pelvic floor muscles provide tone to the vaginal and rectal walls and aids in orgasim and blood flow

4. Stability 

• Provide stability to your pelvis, trunk, spine and hips

5. Sump-Pump 

• Aids in the movement of venous and lymphatic fluids 

Therefore, a healthy pelvic floor allows you to: 

• Run, sneeze, cough and laugh without leaking

• Have functional core/spinal stability 

• Have pain-free intercouse

• Enjoy life without pelvic pain 

• Optimize your breathing 

What does Pelvic Floor Physiotherapy Treat? 

The ultimate goal of pelvic floor physiotherapy is to address pelvic floor dysfunction. Dysfunction in the pelvic floor can contribute to hip and back pain as well as any of the following issues: 

• Urinary Incontinence Disorders 

• Stress urinary incontinence

• Urge urinary incontinence

• Mixed urinary incontinence

• Overactive bladder syndrome

• Nocturia (excessive nighttime urination)

• Bowel Dysfunction

• Fecal incontinence

• Constipation

• Bowel urgency

• Rectal pain or discomfort

• Incomplete emptying

• Pelvic Organ Prolapse 

• Uterine prolapse

• Cystocele (bladder prolapse)

• Rectocele (rectal prolapse)

• Enterocele (small bowel prolapse)

• Pregnancy and Postpartum 

• Diastasis recti (separation of the abdominal muscles)

• Pelvic girdle pain

• Pregnancy-related pelvic floor dysfunction

• Postpartum recovery and rehabilitation

• Pelvic Pain 

• Dyspareunia (painful intercourse)

• Vulvodynia (vulvar pain)

• Vaginismus (involuntary pelvic muscle spasm)

• Pelvic Floor dysfunction in Children 

• Bedwetting (enuresis)

• Daytime urinary incontinence (diurnal enuresis)

• Constipation and fecal incontinence

• Pediatric pelvic pain syndromes

Pelvic floor physiotherapists employ a variety of treatment techniques, including pelvic floor muscle exercises (Kegels), biofeedback, manual therapy, education, behavioral strategies, and lifestyle modifications to address these conditions and improve pelvic health and function. It's important to consult with a qualified pelvic floor physiotherapist for personalized assessment and treatment based on individual needs and goals.

Who is Pelvic Physiotherapy for? 

Pelvic floor physiotherapy is for everyone! Everybody has a pelvic floor. 

Leaking when running, coughing, sneezing or laughing? Pain with sex? Pregnant? Planning on getting pregnant? Want to learn more about optimizing labour and delivery? Are you experiencing any of the above conditions? If you answered yes to any of those questions pelvic floor physio would be a right fit for you!

You may also use the Cozean Pelvic Dysfunction Questionnaire, found down below, to see if Pelvic PT would be a fit for you!

Pelvic Floor Screening Tool - Do you have Pelvic Floor Dysfunction?

We ask specific questions in the clinic to see if you have pelvic floor dysfunction. A great tool you can use is the Cozen Screening Tool developed by Pelvic Health Physiotherapist, Nicole Cozean, the founder of Pelvic Sanity. Using this screening tool along with your medical history can help determine if a pelvic health physiotherapist would be appropriate.

What happens at my first Pelvic Health Physiotherapy Session? 

1. Fill out an intake form

   - This helps me gather specific information to help start off our session

2. Upon arrival I’ll ask you questions about your concerns 

3. Education: this is a major part of receiving consent during your appointment. I try to explain in detail what the assessment and treatment will look like. We will also discuss the anatomy of the pelvic floor. 

4. External Exam: depending on your concerns, I will assess lower back and hip movements and your breathing. Remember, your pelvic floor is a part of your core. 36 muscles attach to the pelvis and only 14 of those compose the pelvic floor. So assessing what is going on around your pelvis is also important. 

5. Internal Exam: Pelvic floor physiotherapists are trained in assessing the pelvic floor via a vaginal exam. We will examine muscle tension, tenderness, pain and your ability to contract your pelvic floor. Often people think they are performing kegels or connecting to the pelvic floor but you’d be surprised at how many people truly struggle with this. 

• An internal exam doesn’t have to be performed if you are not comfortable with it. Please keep that in mind. Consent is ongoing and you can change your mind at any time. 

6. Treatment: 

• After the exam, I will treat according to what was found during the assessment. Treatment can be a combination of any of the following: education, manual therapy, exercises, Dry Needling, acupuncture, exercises targeting the nervous system and eStim. 

7. Practice/Homework: 

• You will go home with a tailored program just for you. Please please perform the prescribed exercises. This is whats going to allow for changes to take place and stick.

I hope this blog post was able to answer some of your questions about pelvic floor physiotherapy. If you have any further questions, please don’t hesitate to ask!

If you are interested in treating pelvic floor dysfunction you can schedule an assessment via the button below or call/test 587-341-3637 to book an appointment.

Have a wonderful day!

Leila Awada, PT