Pelvic Floor Physiotherapy
Pelvic floor physiotherapy is recommended for a wide range of pelvic floor disorders: urinary incontinence, pelvic pain, prolapse, diastasis recti, and more. Although common, such disorders are seldom discussed and often assumed to be something that you ‘just have to live with’.
Using clinically validated methods, a pelvic floor physiotherapist can help you reduce or eliminate pelvic dysfunction and improve the quality of your life.
Pelvic Floor Physiotherapy at Our Clinics:
- We offer 1-on-1 care in private rooms with an experienced pelvic floor physiotherapist.
- We treat both women and men for a wide range of disorders, from new mothers with pelvic trauma or muscle weakness to high performance athletes with muscle hypertonicity or imbalance.
- Our focus is manual therapy, targeted exercise interventions that you can do at home, and education. We also incorporate other tools and techniques into your care as necessary, including specialties such as orthopaedic physiotherapy, or physiotherapist-provided yoga or Pilates.
- A physician referral is not needed to attend our clinics, however, your pelvic floor physiotherapist can work closely with your family doctor, urogynecologist or other specialist.
- Our services are covered under most employee health care plans, and our receipts also qualify as a tax deductible medical expense on your tax return.
- We can also offer pelvic physiotherapy at home.
Learn about our resident pelvic floor physiotherapists: Jessica Metcalf, PT, Bridget Coley, PT, and Paula Zambonato, PT at our Danforth & Chester and Yonge & St. Clair locations. In addition to pelvic health training, all of our pelvic physiotherapists have post-graduate training in orthopedic manual therapy, and Paula is also a Certified Pilates Instructor.
Book at Our Danforth Clinic Book at Our Yonge St. Clinic
Learn more about how pelvic floor physiotherapy can help:
Pelvic Floor Physiotherapy for Urinary Incontinence
Do I suffer from urinary incontinence?
Urinary incontinence can take many forms. It may occur daily, or multiple times each day, or it might occur much more infrequently such as once a month. It may be just a few drops or a full bladder emptying, it may be fairly predictable (such as low-grade ‘stress incontinence’) or entirely unpredictable (such as ‘urge incontinence’), and it may only happen overnight.
Regardless of the severity of your condition, loss of urine control is not normal and you do not have to live with it. Addressing incontinence sooner rather than later can also help prevent a natural progression of symptoms.
It’s difficult to get a good estimate of the prevalence of urinary incontinence because many individuals are hesitant to discuss it, or assume that a little leakage is normal. But at least 1 in 4 women and 1 in 9 men currently suffer from it, and at least 50% of women will suffer from it at some point in their lives. The causes of urinary incontinence vary. It may result from pelvic floor damage or nerve damage during pregnancy and labour, or during a surgical procedure such as a hysterectomy, or it may arise from having a high body-mass, or simply be the result of muscle weakness. A variety of other factors also appear to play a role, such as diabetes and smoking.
How is urinary incontinence treated?
1. Pelvic Floor Physiotherapy (aka ‘Pelvic Health Physiotherapy’)
You have probably been told that doing Kegel exercises will help. Pelvic floor physiotherapy often includes Kegel exercises as part of a treatment program, but not always. If performed correctly, Kegel exercises can help treat incontinence arising from a weak pelvic floor in some men and women. Unfortunately, Kelgel exercises are often performed incorrectly, and they can also be counterproductive for cases of incontinence where excess muscle tone is a contributing factor (see: Do Kegels Work? Are Kegels Bad for You? It Depends).
Pelvic physiotherapy treats incontinence through lifestyle interventions, pelvic floor muscle training, and hands-on therapy.
Regardless of the underlying cause (weakness, trauma, injury or neuromuscular deficit), pelvic floor physiotherapy can improve or eliminate your symptoms by:
- Strengthening urethral closure.
- Supporting the pelvis and decreasing downward pressure on the neck of the bladder.
- Coordinating pelvic floor and other core muscles to effectively manage intraabdominal pressure during physical activity.
Treatment programs for urinary incontinence can be very effective, improve quality of life, and are usually very cost effective – the largest costs associated with urinary incontinence are actually the costs of diapers, pads and bedding rather than the cost of pelvic floor physiotherapy. Pelvic floor physiotherapy is routinely considered as a first-line treatment for urinary incontinence thanks to its high success rates and minimal risk. Cases that do not respond to conservative treatment are referred to specialists for various medical interventions.
2. Medical Interventions for Incontinence
For cases of urinary incontinence that don’t respond to pelvic floor rehabilitation, first line medical intervention may include drug treatment (typically drugs that block the neurotransmitter acetylcholine), and for more difficult cases a variety of minimally invasive or invasive surgical procedures exist depending on the underlying cause of incontinence.
3. Self-Help Methods
Supervised pelvic floor physiotherapy is the recommended first-line treatment for mild to moderate stress incontinence because it is safe and highly effective. A recent clinical review reported that women who participated in supervised pelvic floor training were eight times more likely to be cured of stress incontinence than women who did not (Dumoulin C., Cochrane Database Syst Rev. 2018. Oct 4;10).
With that said, many people find success improving their urinary incontinence symptoms with a few lifestyle interventions and pelvic floor training tools pulled directly from the toolbox of pelvic floor physiotherapists. Learn how to treat your stress incontinence symptoms (urine leakage caused by coughing, sneezing or other physical exertion): How to Stop Stress Incontinence – Self-Help Tips from a Physio and Mom.
What should I expect at my first appointment?
Our pelvic floor physiotherapist will review your health history including any specialist referral information and perform a physical examination to aid in determining the underlying source of your symptoms. They will then explain their findings to you and educate you on your treatment options and what a pelvic floor treatment program would look like for your particular case. For most people, this initial assessment will also include time for initial treatment.
In some cases, your physical assessment would benefit from including an internal examination. While such examinations are routinely performed by at our clinic, they are optional. A pelvic examination can be used to determine if there is any related pelvic organ prolapse, and if the patient can contract their pelvic floor muscles.
Pelvic Health and Pregnancy
Abdominal separation, ligament laxity, pelvic bone movement, and weight gain are natural physiological changes that occur during pregnancy. These changes can increase your susceptibility to injury and pelvic health disorders, both during pregnancy and after. Specialized physiotherapy can offer pelvic health solutions for common pregnancy-related concerns:
Common Concerns
1. During Pregnancy
Pelvic girdle pain is very common in the later stages of pregnancy (see: Patient Guide: Pelvis / Sacroiliac Instability and Low Back Pain During Pregnancy), and can be helped by physiotherapy including manual therapy and targeted strengthening.
2. After Pregnancy
While the physiological effects of pregnancy naturally resolve themselves postpartum, this recovery is not always complete. This can leave the door open to a range of conditions related to pelvic health dysfunction, in particular:
- Urinary incontinence (see: How to Stop Stress Incontinence – Self-Help Tips from a Physio and Mom)
- Prolapse
- Diastasis recti (see: Diastasis Recti and Pregnancy: ‘Closing the Gap’ Between Current Treatment Practices and Clinical Evidence)
- Pelvic pain and instability and low back pain (see: Patient Guide: Pelvis / Sacroiliac Instability and Low Back Pain During Pregnancy)
- Vaginal laxity (see: Vaginal Laxity and Childbirth: Is a “Loose Vagina” Common? Treatable?)
- Dyspareunia (pain with intercourse)
- Exercise intolerance – initiating a regular exercise program prematurely can promote pelvic floor issues (see: 5 Signs You’re Not Ready for Postpartum Exercise and 5 Steps to Know if You’re Ready for Postnatal Exercise)
Pelvic Floor Physiotherapy Can Help
Pelvic floor physiotherapy (aka “pelvic health physiotherapy’) is the recommended first treatment for various pelvic health disorders related to pregnancy. Treatment includes hands-on therapy, pelvic floor and abdominal home exercise programming, and lifestyle recommendations to prevent recurrence.
Pelvic floor physiotherapy is effective at treating pelvic health disorders common in pregnant and postpartum women. It can also be used preventatively.
Physiotherapy involving the targeted strengthening of pelvic muscles can help prevent common pelvic health disorders arising in pregnant and postpartum women. For example, pelvic floor training has been shown to help prevent pre- and postpartum incontinence, and may also decrease labor times.
What should I expect at my first appointment?
Your pelvic floor physiotherapist will review your health history, any specialist referral information, and perform a comprehensive physical examination. This examination may include an optional internal pelvic examination. Such examinations are routinely performed to help diagnose certain pelvic floor conditions.
After your assessment your pelvic floor physiotherapist will explain their findings to you, and educate you about all available treatment options. If pelvic floor physiotherapy is warranted, they will discuss with you a personalized pelvic health treatment program. For most people the initial assessment also includes time for an initial treatment.
Pelvic Floor Disorders in Athletes
Why would pelvic floor disorders occur in athletes or otherwise ‘fit’ individuals?
Pelvic floor disorders are typically associated with pelvic floor injury or weakness (such as after child birth, or in the elderly), so you may be surprised to learn that pelvic floor disorders are also common in very fit and athletic individuals as well, including elite athletes. In fact, some studies suggest that rates of pelvic floor disorder can be higher in some types of athletes than in the general population.
How can this be? There are a couple of explanations. The first explanation is the simplest: even though you may be very ‘fit’ and routinely incorporate abdominal and low back exercises into your training, your pelvic floor muscles may still be genuinely weak. Pelvic floor muscles are notoriously difficult to ‘feel’ and regular exercises including common ‘core’ exercises do not effectively target these muscles. The second possible explanation is that you may not suffer from classic weakness, but instead suffer from pelvic floor muscle overactivity, an ‘inner core’ muscle imbalance, or a sport-induced injury that can cause an otherwise strong pelvic floor to become ineffective.
What type of pelvic floor disorders are common in athletes?
- Urinary incontinence – likely the most common pelvic floor complaint in athletes, urinary incontinence occurs in athletic women and men, including those whose activity of choice involves a lot of core training. In fact, it’s even prevalent in fitness instructors, including Pilates teachers and yoga instructors. Learn about the top four causes of urinary incontinence in athletic women.
- Low back pain – that originates in the pelvic floor.
- Pelvic pain
- Deep glute or hamstring pain – this pain can originate in the pelvic floor as well (in this case, in the obturator internus muscle).
- Prolapse – which is the bladder or uterus falling out of its normal position.
- Dyspareunia – which is pain with intercourse.
If it’s common, does that mean it’s normal?
No. Even if your pelvic floor symptoms such as leakage only occur during extremely demanding physical activities rather than during day-to-day life, pelvic floor dysfunction is not ‘normal’ and does not need to be part of your life. Many high-performance athletes do not suffer from urinary incontinence or other pelvic floor dysfunctions.
You also shouldn’t need to avoid certain activities such as swimming, trampoline or CrossFit, which can be particularly challenging to the pelvic floor.
How are pelvic floor disorders treated in Athletes?
Pelvic floor physiotherapy is a recommended first-line treatment for a variety of pelvic floor disorders common in athletes and non-athletes alike. Treatment typically includes targeted strengthening, hands-on therapy, and education.
However, treatment of pelvic floor disorders in athletes can also differ than for non-athletes. This is because:
- The source of pelvic flood disorder in athletic individuals tends away from weakness and towards muscle imbalance, pelvic floor overactivity, or ineffective pelvic muscle recruitment during intensive exercise movements. An emphasis on learning proper muscle control and muscle relaxation techniques may be helpful, as may be incorporating alternative strengthening exercises such as so-called ‘reverse Kegels’.
- Pelvic floor demands during sport is typically much greater than for day-to-day activities. For example, learning proper abdominal pressure control may be necessary to allow for safe and effective pelvic floor function during high-intensity activities such as powerlifting or CrossFit.
- Athletic individuals want to regularly exercise and/or engage in their sport. This means that they may have greater body awareness and interest in strengthening exercises (which is great for rehab), but may also mean that they are more prone to overtraining, or resistant to suggestions for rest and cross-training (which is not great for rehab).
- Athletic individuals can suffer from additional orthopaedic injuries that may complicate diagnosis or recovery.
What should I expect at my first appointment?
Our pelvic floor physiotherapist will review your health history including any specialist referral information and perform a physical examination to aid her in determining the underlying source of your symptoms. They will then explain their findings to you and educate you on your treatment options and what a pelvic floor treatment program would look like for your case. For most people, this initial assessment will also include time for initial treatment.
In some cases, your physical assessment would benefit from including an internal examination. While such examinations are routinely performed by at our clinic, they are optional. A pelvic examination can be used to determine if there is any related pelvic organ prolapse, and if the patient can contract their pelvic floor muscles.
The Pelvic Floor, Menopause and Cancer
Vaginal and Urinary Symptoms of Menopause
The decline in estrogen levels during menopause can lead to the thinning and inflammation of vaginal walls. These changes manifest in vaginal symptoms that include dryness, irritation and pain with intercourse. Decline in estrogen can also precipitate symptoms of pelvic floor dysfunction including urinary incontinence and recurring urinary tract infections. Collectively, these changes are known as the Genitourinary Syndrome of Menopause.
Symptoms of Menopause in Cancer Patients
Chemotherapy and hormone therapy can induce early menopause in individuals treated for cancer, making these patients susceptible to experiencing vaginal and urinary symptoms of menopause at an earlier age. In addition, postmenopausal cancer patients treated with aromatase inhibitors (which strongly reduce estrogen levels), are twice as likely to suffer symptoms as compared to the general postmenopausal population.
Treatment for Symptoms of Menopause
If you are experiencing vaginal or urinary symptoms of menopause, see your family doctor. They can offer advice and education on medical and non-medical treatment options available to you including:
1. Pelvic Floor Physiotherapy (aka ‘Pelvic Health Physiotherapy’)
Your pelvic floor physiotherapist can offer methods to help alleviate the vaginal and urinary symptoms of menopause. These include:
- Pelvic floor physiotherapy to help treat urinary incontinence and pain during intercourse.
- Education on vaginal moisturizers, lubricants and other tools and approaches to help reduce pain and discomfort.
For more information and advice for cancer patients please see: Managing the Vaginal and Urinary Symptoms of Menopause in Breast Cancer Survivors.
2. Local Estrogen Therapy
The bulk of clinical evidence supports the safety and efficacy of local estrogen therapy for relieving the vaginal and urinary symptoms of menopause. Patients should discuss with their family doctor to decide if local estrogen therapy is right for them.
Estrogen therapy is generally not recommended for breast cancer patients due to fears of triggering estrogen-linked tumour growth. However, this is a very active area of ongoing clinical research, and some patients and their physicians are deciding to go ahead with low-dose forms of local estrogen therapy. For more information please see: Is Local Estrogen Therapy Safe for Breast Cancer Survivors?.
What should I expect at my first appointment?
This depends on the symptoms you are experiencing. Your pelvic floor physiotherapist will review your health history, any specialist referral information, and perform a physical examination to understand the issues underlying your symptoms.
Your pelvic floor physiotherapist will then explain their findings to you and educate you on your treatment options, and on what a pelvic floor treatment program would look like for your particular case. The initial assessment usually also includes some time for initial treatment.
In some cases a physical assessment will benefit from including an internal examination. While such internal examinations are routine, they are also optional. An internal examination can be beneficial for diagnosing the source of urinary incontinence, and for assess the pelvic floor muscles, which can help guide treatment.
Other Resources
Check out Katie’s talk on the impact of cancer treatment on bladder function and pelvic health: Impact of Cancer Treatment on Bladder and Pelvic Health
Other Pelvic Health Disorders
In addition to urinary incontinence, our pelvic floor physiotherapists have training and experience treating a variety of pelvic health dysfunctions. They can offer pelvic health solutions for:
- Chronic pelvic pain
- Prolapse
- Diastasis recti
- Sacroiliac joint dysfunction
- Dyspareunia (pain with intercourse)
- Vulvodynia
- Interstitial cystitis
- Vaginismus
- Chronic constipation
- Pudendal nerve irritation
- Low back pain
General symptoms of pelvic floor dysfunction include chronic pelvic pain, issues around urination (frequently needing to urinate, waking in the night frequently to urinate, urgency and incontinence), and constipation. If you experience any of these symptoms you should discuss them with your family physician.