Pelvic Health FAQs
Read our pelvic health FAQs to learn about the conditions that can affect this area of the body, and what to expect from pelvic physiotherapy at Nepean Sports Medicine & Physiotherapy Centre.
Pelvic Floor Physiotherapy FAQs
What is the pelvic floor?
The pelvic floor is the muscular base of the abdomen, and is attached to the pelvis, It is made up of muscles, ligaments, nerves and connective tissue, and plays an important role in the body by providing support for the bladder, genitals, uterus and anus.
What are some common conditions of the pelvic floor?
- Urgency: an strong physical urge to urinate or defecate that can be difficult to control.
- Nocturia: waking up at night with unusual frequency to urinate.
- Constipation: irregular and difficult passage of hard stools.
- Frequency: the need to urinate with a frequently that disrupts your normal routine.
- Incontinence: leakage of urine or feces that cannot be controlled.
- Chronic pelvic pain: pain in or around the pelvic region present for three or more months with no physical diagnosis or medical explanation.
What are some common treatments for pelvic floor complaints?
Depending on the variety and severity of your condition, your Pelvic Physiotherapist may employ different combinations of the following treatments:
Manual Therapy: Manual therapy is a range of hands-on techniques such as: soft tissue massage, mobilization, stretching, facilitation, as well as various trigger point release techniques.
Exercise & Stretching: An personalized exercise program will be designed for you by your physiotherapist. It will include a combination of strengthening exercises, stretches, good posture and breathing techniques, all of which are essential for good pelvic health.
Hypopressive Exercise: Hypopressive Exercises are specific breathing and posture techniques that decrease pressure to the abdomino-pelvic area, recruiting the pelvic floor muscles. These types of exercises can help prevent and treat urinary incontinence, prolapse conditions, and general posture.
Electrical Muscle Stimulation: EMS uses electrical pulses to stimulate pelvic floor muscle contractions, to improve their strength, and to treat issues like urgency and pelvic pain.
Nerve Stimulation: Percutaneous Tibial Nerve Stimulation (PTNS) uses neuromodulation to stimulates the posterior tibial nerve at the ankle via a fine acupuncture needle connected to a hand held machine that emits electrical impulses. Nerve stimulation has been shown to be effective in treating overactive bladder and incontinence.
Education: Understanding how various aspects of your lifestyle, diet, and urinary and bowl hygiene can affect your pelvic floor health, is important in maintaining it!
Is the internal examination really necessary?
An internal exam is the gold standard for assessment and treatment of pelvic floor conditions. Without feeling the muscles, your pelvic floor physiotherapist will be unable to identify if you have trigger points, or if you can contract your pelvic floor effectively.
That being said, there are many parts of the assessment and treatment that can be done without an internal exam. Some patients have been treated successfully without ever doing an exam.
Though the most benefit will be derived if your pelvic floor physiotherapist completes an internal exam, you will still benefit from pelvic physiotherapy if you are uncomfortable with or unable to have an internal exam.
How many sessions are required?
This will depend on the type of condition you have, and its complexity. In general, for simple incontinence or prolapse (without any exacerbating factors), you will require 6-12 treatments. If you have a complex pain issue, this will likely take longer.
Is there homework to do between sessions?
Yes, there will be work for you to complete between sessions. Some examples of homework you may have include stretches, strengthening exercises or tracking things like bladder or bowel habits, diet, and fluid intake.
What if I already tried doing kegels and they didn’t work?
Pelvic floor physiotherapy involves much more than just kegels (pelvic floor muscle training). If you have tried doing kegels in the past but have not noticed any improvement, there could be many reasons, and you may need a different type of therapy or treatment.
Up to 30% of women are unable to do a kegel when asked. Many women instead contract their abdominals, glutes, or adductors. Or they bear down (push). If this is the issue, you may have been attempting to do kegels, but you have actually been strengthening the wrong muscles. A pelvic floor physiotherapist will check vaginally or rectally so they can actually feel your kegel, and teach you how to locate and contract your pelvic floor.
If you have been doing kegels with no effect, the problem may be that your pelvic floor is actually too tight, or has trigger points. For a muscle to be effective, it needs to have strength, but it also needs to be able to relax. For instance, if you can’t open your fist, strengthening your hand is not going to help. So in some cases, doing kegels may actually make your symptoms worse. Instead, your physiotherapist will release the tension or trigger points in your pelvic floor muscles, and give you stretches or other exercises to do at home. Your physiotherapist will also help you determine what other factors may be contributing to the tension or trigger points in your pelvic floor.
What if I have my period? Should I cancel my appointment?
Your therapist can still assess and treat the pelvic floor if you have your period. It can actually be beneficial, as the pelvic floor muscles and pelvic organs can be affected by the hormonal fluctuations, especially if you notice a cyclical relationship to your problem. If you don't want to have your assessment during your period, the therapist can either proceed with the assessment or treatment externally or you can reschedule your appointment, provided you give 1 business day’s notice.
Is my physiotherapist specially trained to do an internal exam?
Yes. Our pelvic physiotherapist has undergone and continues to seek post graduate training to provide internal assessment and treatment services. The College of Physiotherapists of Ontario requires physiotherapists to be listed on the roster in order to perform internal assessments and treatments.
How should I prepare for my first appointment?
As the patient coordinator, I will send you some forms to collect relevant personal information about you and your medical history. Along with this, please bring any reports from special investigations or testing such as urodynamic or MRI reports. Don’t worry if you don’t have them, we can always request them from your MD at a later time.
You may bring a change of clothes to be most comfortable. There isn’t much to prepare for the internal assessment, you will be asked to undress from the waist down, we have gowns for you to change into, and you will always be draped to your comfort level.
How long is the assessment and subsequent treatment sessions?
Your initial assessment is one on one in a private room. It will be approximately 60 minutes with your Pelvic Floor Physiotherapist. Follow up visits will be determined during your assessment, as they are catered to your particular needs but generally between 30 to 45 minutes per session. We highly recommend booking your appointments ahead to ensure your preferred time.
Can I bring my baby with me?
Yes. Your physiotherapist and our team welcome you to bring your baby with you for your appointment; you can even nurse during certain treatment techniques.
Will my extended health insurance cover pelvic floor physiotherapy?
Pelvic floor physiotherapy falls under the domain of physiotherapy, regardless of the area being treated. If you have insurance coverage for physiotherapy then pelvic floor physiotherapy will be included. But we encourage you to follow up with your insurance provider to confirm coverage. Please note that some insurance plans require a physician prescription in order to be reimbursed for physiotherapy services, even though you do not need a referral to see the Physiotherapist.
If I am pregnant, should I avoid an internal examination?
No, it is not necessary to avoid an internal examination when pregnant. If your doctor or midwife has not told you to avoid intercourse during pregnancy, an internal exam should be safe. If unsure, speak with your doctor or midwife directly prior to having an internal exam.
How long should I wait to have an internal exam after giving birth?
You should wait approximately 6-8 weeks after delivery before having an internal pelvic floor exam. This is true for vaginal deliveries and C-Section births. It is important to allow your body time to heal. During this time, you will also see spontaneous healing of a rectus diastasis, which should be checked at your follow-up appointment 6-8 weeks post-partum.
When is it unsafe to have an internal examination?
Internal examinations and treatments should be avoided if you have:
- Active hemorrhoids or infections
- Rectal bleeding
- Seed implants
- Radiation injuries less than 6-12 weeks old
- Undergone pelvic surgery less than 6 weeks ago
- Undergone prolapse repair surgery less than 12 weeks ago
- Been told by your doctor or midwife that you must abstain from intercourse or internal examinations during pregnancy
Is the internal exam similar to a gynecological exam?
Not really. Pelvic health physiotherapy is very different than an exam done by your physician or gynaecologist. We have much more time to do the assessment, and we do not use any big equipment (no speculum here!). Your physiotherapist will walk you through what they are doing every step of the way to make sure you are comfortable at all times.
Are there any risks to this treatment?
We create a private and sterile environment during assessment and treatment. We use a private treatment room, non-latex gloves and hypoallergenic gel, and wash or dispose of equipment properly. Your dignity and comfort is our highest priority.
There is a risk that you might feel some mild discomfort in the pelvic area after a treatment, particularly if it has involved stretching or trigger point massage to tight or tender muscles. Not all physiotherapists are certified to treat Pelvic Floor dysfunction. In order to perform internal examinations, your Physiotherapist has taken specific training, has written a certificate exam.
Ready to improve your mobility and get active?
Contact Nepean Sports Medicine & Physiotherapy Centre today.