Pelvic Health

Women’s Pelvic Health Physiotherapy

• 1 in 4 women have urinary incontinence 
• 1 in 7 women experience pelvic pain
• 1 in 4 women report painful intercourse (dyspareunia) in their lifetime
• Many women suffer with pelvic health issues following childbirth or general aging
   
• Research has shown that pelvic floor physiotherapy has a very high success rate for conservative management of these challenging conditions.
• Research shows that 30 Kegels daily for 3-4 months (when properly performed) will rebuild strength in 80% of women.
   
• Specially trained physiotherapists use internal and external “hands on” or manual techniques to assess your pelvis for any tightness or weakness of the associated muscles.
• Internal examination is important to evaluate your ability to properly contract and relax pelvic muscles and to determine the cause of pelvic pain or dysfunction.

Why do I need to have an internal exam?

Our pelvic floor muscles are internal. The unique challenge with these muscles is that we cannot see them because they are hidden inside the pelvis. Many of us do not even know that these muscles exist, much less how to keep them healthy and recruit them appropriately during our daily activities.

In the 1940’s, Dr. Arnold Kegel first taught women how to do pelvic floor muscle training by inserting a finger into the vagina and giving women feedback about how they were performing the exercises. Most therapists today teach women how to do Kegels without doing an internal exam to ensure proper contraction of these muscles. This has led to a poor success rate with Kegels as well as a great deal of frustration for people trying to use these exercises therapeutically. Assessing the pelvic floor without doing an internal exam would be like a surgeon trying to assess one’s ankle through socks and shoes, without seeing or feeling the joint.

It is important to remember that Kegels are not appropriate for everyone. If you have pelvic pain, urinary urgency, frequency, or hypertonicity (excessive tension) in your pelvic floor, Kegels may not be for you; in fact, they could make your symptoms worse. You must have your muscles assessed to see what the best treatment options are for you.

Although pelvic floor challenges are common, they are not normal or necessary. With the help of our pelvic physiotherapist, we can help you regain control, maximize your function and improve your well-being.

Consult our pelvic physiotherapist if you have:

• Vulvodynia or vaginismus                                 -scarring from c-section, tearing or episiotomy
• Stress urinary incontinence                                -leaking urine, gas or stool when you cough, sneeze or exercise 
• Painful bladder conditions                                 -problems getting to the washroom in time (urinary urgency or frequency)
• Chronic constipation                                          -difficulty emptying bladder or bowel completely or frequently
• Dyspareunia (pain with intercourse)                  -inability to wear a tampon, or pain when having a pap test done
• Endometriosis                                                    -bulging or tenting of your abdomen during exercise
• Chronic itching/irritation of the vulva  -ongoing pain in your vagina, rectum, pelvis, pubic bone, abdomen or low back
• Pudendal neuralgia                                             -pressure, heaviness or bulging in your vagina or rectum

Muscles of the Female Pelvic Floor:

Men’s Pelvic Health Physiotherapy

• Estimated that 1 in 9 men suffer from chronic pelvic pain.
• Myofascial trigger points in the internal and external pelvis can be responsible for many of these symptoms.
• Specially trained physiotherapists use internal and external “hands on” or manual techniques to assess your pelvis for any tightness or weakness of the associated muscles.
• Internal examination (with your consent) is important to evaluate your ability to properly contract and relax pelvic muscles and to determine the cause of pelvic pain or dysfunction.
• Pelvic pain and incontinence in the male population are two subjects that are often not well recognized, discussed, or treated appropriately. Urogenital health concerns in men need more support and recognition. 
• Although pelvic floor challenges are common, they are not normal. With the help of our pelvic physiotherapist, we can help you regain control, maximize your function and improve your well-being.

Consult our pelvic physiotherapist if you have:

• Frequent urination
• Urinary incontinence
• Pain in the testicles, penis, or prostate (Chronic Prostatitis)
• Post-ejaculatory pain
• Slow urine stream
• Hesitation
• Pudendal neuralgia
• Chronic groin and suprapubic pain
• Painful bladder conditions
• Difficulty emptying bladder or bowel completely or frequently
• Chronic constipation      
• Post-Prostatectomy Incontinence
• Erectile dysfunction
• Nocturia (frequent urination at night)
• Symptoms of retention which can often be associated with Benign Prostate Hyperplasia and/or a Tight Pelvic Floor

Muscles of the Male Pelvic Floor:

Pelvic Floor Physiotherapy Research:

• In 2010, the Cochrane Collaboration published: Pelvic Floor Muscle Training vs. No Treatment, or Inactive Control Treatments, for Urinary Incontinence in Women. This study looked at the big picture with regards to the effectiveness of pelvic floor physiotherapy for treating stress and urge incontinence.  
• The Cochrane Collaboration concluded that there is Level I/ Grade A evidence (the strongest level of evidence available) for pelvic floor strengthening for urge and stress incontinence.  Recommendations were made that pelvic floor strengthening (using internal palpation) should be the first line of defense for stress and urge incontinence. This means that all patients should be seen for some pelvic floor physiotherapy before they consider surgery. Only those patients who cannot adequately train their pelvic floors should be considered for a TVT or other type of surgical sling repair. Talk to your surgeon about trying pelvic floor physiotherapy before considering surgery. 
• Second, a Randomized Clinical Trial (strongest type of study) was published in the Journal of Urology in 2012 by Fitzgerald et al.  This study found that internal pelvic floor myofascial treatment in chronic bladder pain patients was effective in 59% of patients as compared to generalized massage therapy.
• Third, the Interstitial Cystitis Treatment Guidelines were issued by the American Urological Association in 2010, recommending diet modification and physiotherapy as the first line treatment in a patient with painful bladder syndrome.
• Pelvic floor physiotherapy should also be an integral part of pre- and post-partum care.  In France, every woman who has a vaginal delivery is assessed and treated by a pelvic physiotherapist as part of her recovery. This treatment can prevent much pain, discomfort, and limited function in the future.

Pelvic Health Screening Questionnaire for a Patient with Low Back Pain and/or Hip Pain:

• Do you urinate more than 8 times a day?
• Do you have difficulty initiating urination?
• Do you have burning with urination?
• Do you feel that your bladder is not emptied after you have urinated?
• Do you experience any urine loss (on the way to the bathroom or coughing/sneezing)?
• Do you feel pelvic pressure?
• Do you have less than one bowel movement every 3 days?
• Do you have to strain or facilitate to have a bowel movement?
• Is your stool lumpy/hard or does it have cracks in it?
• Do you have pain during or after a bowel movement?
• Do you experience pain during or after intercourse?
• Do you experience pelvic pain, i.e. vaginal, rectal, penile, testicular, perineal, or pelvic?
• Do you have pelvic pain with sitting?
• Have you ever been diagnosed with any of the conditions listed below?
  • Vulvodynia
  • Vestibulodynia
  • Vaginismus
  • Dyspareunia
  • Interstitial cystitis
  • Chronic prostatitis
  • Endometriosis
  • Pudendal neuralgia
  • Chronic pelvic pain
  • Levator ani syndrome
  • Piriformis syndrome
  • Coccydynia
  • Proctalgia fugax
  • Urethral syndrome
  • Bladder sphincter dysenergia

If you answered yes to any of the above questions, problems with your pelvic floor muscles, fascia, or nerves may be contributing to your symptoms/pain. You may be a candidate for an assessment from a physiotherapist with appropriate training to assess your pelvic floor through internal palpation (vaginal or rectal exam). Please speak to your treating health care provider for more details.