Pelvic Floor Physiotherapy
Pelvic Health Physiotherapy may be the answer for a problem you thought had no solution!
Pelvic Physiotherapy at GRSM
- Your appointments are held in a private room
Assessment and treatment involves both external and internal techniques, based on your symptoms and comfort level
You will work one-on-one with a physiotherapist to meet your individual goals, whether that means:
- Being able to exercise without leaking, not having to stop the car every hour to use the bathroom
- Being able to have pain free intercourse
- Being able to sit without tailbone pain
What does Pelvic Health Treatment involve?
- Manual (hands on) therapy internally to the pelvic muscles and joints, as well as externally to the back, hips, and abdomen
- Stretching and strengthening exercises
- Relaxation and breathing
- Education about bowel and bladder function
- Brain retraining/connection/proprioception
Our Pelvic Floor Physiotherapists
What is Pelvic Health Physiotherapy?
Our pelvic floor physiotherapists in Kitchener and Cambridge have specialized training in treating the pelvic floor. This is a group of muscles, joints, and nerves that contribute to bowel and bladder function, sexual function and stability of the pelvis, hips and back. Assessment and treatment of the pelvic floor is done externally as well as internally (vaginally and/or rectally), as many of these muscles cannot be felt from the outside.
Just like muscles elsewhere in the body, these muscles can be tight, weak, over-worked, under-worked, not coordinated well, disconnected from your brain and awareness, or upregulated by the nervous system. All these things can contribute to pelvic floor dysfunction and/or pain. Physiotherapy helps to identify which variables are contributing to the dysfunction and helps you get everything back on track and working together again.
Who Can Benefit From Pelvic Health Physiotherapy?
Women of all ages have seen great success with pelvic health physiotherapy. Do you ever experience leakage? It could happen with an action (cough, sneeze, jump), or as you’re rushing to get to the bathroom. Do you have pain or discomfort sitting for periods of time? Is intercourse painful? Do you have persistent back or hip pain that just doesn’t seem to get better with everything else you have tried? Are you pregnant or given birth? These are just a few examples of people who likely have pelvic floor dysfunction and will benefit from seeing a pelvic physiotherapist.
Can I just do Kegel Exercises instead?
Kegels are not for everyone and in some cases can cause more discomfort. Your pelvic dysfunction could be because your pelvic floor is already too tight and doing Kegels may worsen your symptoms. If pelvic floor weakness is the problem, Kegels may be an important part of your treatment. The only way to know when and how to properly perform a Kegel is to have a pelvic floor physiotherapist do an internal assessment.
Pre and Post-Partum Care
During pregnancy, those who see a pelvic floor physiotherapist have been reported to have less pelvic and low back pain and a lower risk of incontinence during their pregnancy and post-partum. Common complaints post-partum include incontinence, painful intercourse, and C-section and episiotomy scar pain; all of which can be addressed with pelvic physiotherapy. In Europe, pelvic floor physiotherapy is more widespread and well known. In France, every woman is allotted a number of visits with a pelvic floor physiotherapist as part of her post-partum care.
What To Know About a Pessary
What is a Pessary?
A pessary is a medical device inserted into the vagina to support pelvic organs. Our pelvic floor therapists in our Kitchener and Cambridge clinics may recommend one to help in the management of pelvic organ prolapse (POP). It helps to reposition the organs and prevent them from bulging into the vaginal canal, alleviating symptoms such as pelvic pressure, urinary incontinence, and vaginal bulging. Pessaries come in various shapes and sizes, with the most common types being ring pessaries, Gellhorn pessaries, and cube pessaries.
Who Would Benefit from a Pessary?
Pessaries are commonly recommended for individuals experiencing:
Pelvic Organ Prolapse (POP): Prolapse of the bladder, uterus, or rectum into the vaginal canal. Symptoms can include vaginal bulging, pelvic pressure, urinary incontinence, or difficulty with bowel movements.
Urinary Incontinence: Especially when linked to pelvic organ prolapse, pessaries can help by reducing the pressure on the bladder and improving urinary symptoms.
Pre- or Post-Surgical Care: Pessaries may be used as a temporary measure for patients awaiting or recovering from pelvic surgery, including prolapse surgery, as a non-invasive option to manage symptoms.
Women Who Cannot or Prefer Not to Undergo Surgery: For patients who wish to avoid or are not suitable candidates for surgery, pessaries offer a non-surgical alternative to manage prolapse symptoms.
When Should a Pessary be Considered?
- Persistent symptoms of pelvic organ prolapse that do not respond to conservative treatments (e.g., pelvic floor exercises).
- Pre-surgery or post-surgery management, when surgery isn’t an immediate option.
- For patients with moderate to severe prolapse symptoms who do not want surgery.
- Patients with medical conditions that make surgery riskier or contraindicated.
- Patients who may still be on their reproductive journey and require support before any definitive surgical decisions should be made.
How Do Pessaries Help?
- Supportive Function: Pessaries physically support the prolapsed organs, preventing them from bulging into the vaginal canal. This can allow for optimal function of the pelvic floor muscles.
- Symptom Relief: By reducing pelvic pressure, pessaries alleviate symptoms such as urinary urgency, incontinence, and vaginal bulging.
- Non-Surgical Option: Pessaries provide a non-invasive, reversible option for managing prolapse without the need for surgery
The Role of Family Medicine in Pessary Fittings:
- Diagnosis of a Prolapse: Under the current regulations outlined in Ontario, pelvic floor physiotherapists are unable to diagnose a pelvic organ prolapse (ie. communicate a degree, etc.). However, we can work in collaboration with a doctor or nurse practitioner in determining a diagnosis of a pelvic organ prolapse.
Referral for a Pessary: A doctor or nurse practitioner is required to make the specific referral for a pessary that the physiotherapist can then complete the fitting for.
Benefits of Physiotherapist-Fitted Pessaries:
- Improved Comfort and Effectiveness: With a proper referral, trained pelvic floor physiotherapists have the specialized knowledge to find the right size and type of pessary, ensuring it fits well and provides maximum relief. They are also able to provide education on the proper instructions on the care and maintenance of the pessary.
- Non-Surgical Option: For patients who are not ready for or cannot undergo surgery (ie. still have reproductive years) , physiotherapists offer an alternative that is both effective and non-invasive.
- Holistic Care Approach: Alongside fitting, physiotherapists may also offer pelvic floor exercises and other conservative treatments that complement pessary use.
Pessaries GRSM Offers:
Cube
Ring with Knob
Ring with Support
Pessaries are a valuable option for patients suffering from pelvic organ prolapse and associated symptoms. They provide non-surgical relief and are a safe, effective treatment for many individuals. Physiotherapists play a key role in the fitting process, offering expert guidance and ongoing support to ensure optimal use. As a doctor, you can confidently refer suitable patients to physiotherapists trained in pessary fitting to enhance their care.
If you have any questions or would like more information, you can reach out to our Kitchener physiotherapists by calling (519) 571-7111.
Misconceptions of Pelvic Health
Wrong! Incontinence is very common, with 1 in 3 women experiencing it. However it is NOT normal, there are things you can do for it!
Wrong! Most women, in fact 84% of women who are experiencing pelvic floor issues have muscles that are TOO TIGHT, not too weak. Kegels may not be the answer!
Wrong! The pelvic floor is an important part of our inner unit or core, and is related to your spine, pelvis and hip movement, strength and function. If something isn’t getting better, it may because there is a pelvic floor component.
Wrong! So much of pelvic floor training is actually brain training and being more aware of how you are moving. It doesn’t matter how long ago you had babies, your body still changed and therefore has the potential to learn how to move better.
Wrong! Anyone, regardless of childrearing, who is experiencing problems in the pelvic region, pain or ineffective urination, defecation, pain with intercourse, difficulties using a tampon, persistent back, hip, groin or tailbone pain, history of constipation, may benefit from pelvic floor physiotherapy.
Wrong! Leakage of any kind, at ANY age is common but NOT normal. Physiotherapy can help address this.
Wrong! Most people are hypertonic (or too tight) and therefore need to work on relaxation of tissues before strengthening occurs.
Wrong! We can address a number of pelvic issues, see below for a more comprehensive list.
Wrong! The prevalence and impact on quality of life is so high, it is crucial that we as health care professionals make discussions around these issues comfortable and normalized.
COMMON PELVIC FLOOR CONDITIONS WE TREAT
- Incontinence
- Urinary Urgency/Frequency
- Pelvic Organ Prolapse
- Pelvic Pain/Pressure
- Painful Intercourse/Tampon Insertion
- Hip Labral Tears
- Low Back/SI Joint Pain
- Tailbone Pain
- Constipation
- Vulvodynia, Vestibulodynia, Vaginismus
- Endometriosis
- Pudendal Neuralgia
- Dyspareunia, Dysmenorrhea
- Genitourinary Syndrome of Menopause (GSM)
- Interstitial Cystitis (IC) /Bladder Pain Syndrome (BPS)
- Diastasis Recti, Pre- and Post-partum
For more information, please contact by email at pelvichealth@grsm.ca or by phone at our Cambridge or Kitchener clinics.
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