Services: Pelvic Floor Physiotherapy

Pelvic floor physiotherapy treatment room

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 Clinic:

  1. We offer 1-on-1 care in private rooms with an experienced pelvic floor physiotherapist.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. We can also offer pelvic physiotherapy at home.

Learn about our resident pelvic floor physiotherapists: Katie Hauck, PT at our Danforth & Chester location, and Robyn Rubinger, PT at our Yonge & St. Clair location. In addition to pelvic health training, Katie and Robyn have post-graduate training in orthopedic manual therapy.

Have a question about how we can help, or just looking for some advice? Feel free to email Katie directly at [email protected]. You can also email to book a free phone consultation to help you decide if our services are right for you.

Book at Our Danforth Clinic Book at Our Yonge St. Clinic

 

Learn more about how pelvic floor physiotherapy can help:

Urinary Incontinence Pelvic Disorders in Pregnancy Pelvic Disorders in Athletes Menopause & Cancer Other Pelvic Floor Disorders

 


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.

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, but these exercises are actually counterproductive for cases of incontinence where excess muscle tone is a contributing factor.

Pelvic physiotherapy treats incontinence through lifestyle interventions, pelvic floor muscle training, and hands-on therapy.

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 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.

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.
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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:

  1. Urinary incontinence
  2. Prolapse
  3. Diastasis recti (see: “Diastasis Recti and Pregnancy: ‘Closing the Gap’ Between Current Treatment Practices and Clinical Evidence”)
  4. Pelvic pain and instability and low back pain (see: “Patient Guide: Pelvis / Sacroiliac Instability and Low Back Pain During Pregnancy”)
  5. Vaginal laxity (see: “Vaginal Laxity and Childbirth: Is a “Loose Vagina” Common? Treatable?
  6. Dyspareunia (pain with intercourse)
  7. 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. Choosing the right time and type of regular exercise program and other physical activities can encourage sufficient postpartum recovery and prevent injury.

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.

If you have any questions about your specific condition, or need some advice, please email Katie at [email protected]. She is happy to help.
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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?

  1. 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. Click here to learn more about the four main causes of urinary incontinence in athletic women.
  2. Low back pain – that originates in the pelvic floor.
  3. Pelvic pain
  4. Deep glute or hamstring pain – this pain can originate in the pelvic floor as well (in this case, in the obturator internus muscle).
  5. Prolapse – which is the bladder or uterus falling out of its normal position.
  6. 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. Our own pelvic floor physiotherapist Katie Hauck is an avid CrossFit competitor herself.

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:

  1. 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’.
  2. 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.
  3. 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).
  4. 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.
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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:

  1. Pelvic floor physiotherapy to help treat urinary incontinence and pain during intercourse.
  2. 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
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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:

  1. Chronic pelvic pain
  2. Prolapse
  3. Diastasis recti
  4. Sacroiliac joint dysfunction
  5. Dyspareunia (pain with intercourse)
  6. Vulvodynia
  7. Interstitial cystitis
  8. Vaginismus
  9. Chronic constipation
  10. Pudendal nerve irritation
  11. 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.
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If you want to learn more about pelvic health physiotherapy, have any questions about your specific condition, or need some advice, please email Katie at [email protected]. She is happy to help.