Proactive Pelvic Floor Physiotherapy
Women have unique physical therapy and health needs that can shift and change over time. Women’s Physical Therapy, also known as Pelvic Physical Therapy, has grown exponentially as women empower themselves and advocate for their health and wellbeing.
Growing bodies of research support and recommend physical therapy as a first line of treatment for a variety of conditions that were previously only addressed with medications and/or surgery.
Women’s health physio is centered around the belief that being a woman involves unique challenges that need to be addressed as a whole instead of in parts.
Our physiotherapists Krystal Mangan and Natalie Barraclough are specially trained to work with women of all ages to treat the following conditions:
- Leaking when you cough, laugh or jump… or not getting to the bathroom in times (also known as stress or urge incontinence). This may be associated with pregnancy, sports activities, menopause or hormonal changes.
- Pregnancy-related aches and pains (prenatal and postnatal)
- Diastasis Rectus Abdominis (DRA) aka mummy tummy.
- Prolapse of the uterus, bladder or rectum painful bladder syndrome (interstitial cystitis) urinary frequency.
- Painful intercourse pain associated with endometriosis and/or dysmennorrhea persistent pelvic pain, generalized and local vulvar pain (vulvodynia) hip, low back and/or sacroiliac pain that has not responded to traditional care.
Although most of these conditions are quite common, they are not normal and can often be improved with physical therapy!
Schedule an Appointment With Our Pelvic Floor Specialists
What To Expect At Your First Appointment
Pelvic floor issues may be common but the stigma about discussing some of these issues remains. Working up the courage to see someone about your pelvic issues can be hard, but knowing what to expect at your first appointment can help dissipate some of the worries you may have.
Physiotherapists who treat pelvic floor conditions understand that these symptoms can be embarrassing and difficult to talk about. They are accustomed to discussing these issues and will try to put you at ease.
All discussions you have with your physiotherapist will remain confidential and will be carried out in a private area so there’s no fear of being overheard. In some cases, your physio may need to communicate with other health professionals, including your GP – but they will ask your permission first.
Here are answers to some of the commonly asked questions we get asked about women's health physio.
All initial appointments are one hour and follow-up appointments will be approximately 45 minutes.
Your physio will ask you a number of questions to fully understand your problem. Some of the questions may include:
- What is the problem that is bothering you the most?
- Some questions about your bladder function, including how often you go to the toilet during the day and night, if you leak urine (and if so, how much and how often), if you feel you have to rush to get to the toilet on time, and the kinds of symptoms you have when urinating, including any pain or feelings of incomplete emptying.
- About your bowel function, including how often you empty the bowel, whether you find this difficult or painful, the consistency of your bowel motions, any loss of control from the bowel or any sense of having to rush to get to the toilet on time.
- Questions about your childbirth history, including how many children you’ve had, the types of deliveries and the weight of the babies.
- If you have any symptoms of prolapse, including a feeling of something dropping internally or a heaviness, lump or bulging inside the vagina or rectum.
- Questions about sexual intercourse, including whether you find this painful or if you have any difficulties or concerns.
- About your medical history, including current medical problems, the medications you are taking and any past operations.
- What you do for work and in your leisure time, so they can understand how your problem may be impacting on your daily life.
When seeing a physio for pelvic health, it is likely that at some stage they will need to examine your pelvic floor muscles. This will commonly occur at the first appointment, but not always.
Your physio will always ask you for permission before performing any examination, and you have the right to say no. However, this may mean they cannot diagnose and treat your problem to their best ability, and they can discuss that with you.
A typical examination may include:
- An examination of your posture and functional activities such as a squat
- An examination of the external genital area. While this may be uncomfortable for some, it is important for your physio to check the skin for signs of infection, age-related changes and prolapse.
- When performing an external examination, your physio may also ask you to try to contract the pelvic floor muscles, so they can see what happens from the outside in the vulva and your abdomen when you do this.
- An internal vaginal examination may be performed. This is the gold standard for assessing and understanding how the pelvic floor is functioning. Your physio will use one or two gloved fingers to check the pelvic floor muscles internally. They can also check for prolapse and any tender or tight areas internally. They will ask you to contract and relax the muscles several times. This will usually be done lying down, but sometimes your physio may ask to check these muscles while you stand or sit.
Your assessment and treatment program will be specific to you, your needs and your comfort level. These are delicate personal issues and your rehabilitation is respected as a sacred and highly personal process.
We will always proceed within the realm of what you are ready for and capable of. The physiotherapist treating you is a highly trained, sensitive professional who will discuss any issues with you before carrying out any treatment. An open dialogue of how you are finding the treatment and any difficulties you are having emotionally or physically will be ongoing and will help guide your care.
In many European counties, internal examination and treatment of the pelvic floor has been the norm for years. In some countries, pelvic floor physiotherapy is even covered by government health care after childbirth, and always the first option before pelvic surgeries are considered. When the pelvic floor muscles are assessed internally, the research has shown that the treatments carried out by a physiotherapist for pelvic floor problems are highly successful for both pelvic pain and incontinence.
Assessing the pelvic floor without doing an internal exam is like an orthopaedic surgeon or a physiotherapist doing a knee exam through a pair of jeans. Treating any other part of the body without touching the affected body part to see which muscles are tight, or weak, and how the joints move and glide would be completely unacceptable. Internal palpation is an integral part of treating the pelvic floor and is the Gold Standard for pelvic floor care. If you are uncomfortable or have questions please talk to your physiotherapist.
NO, an internal exam is not mandatory. It is the gold star assessment when it comes to pelvic dysfunction.
We liken it to going to the dermatologist for a rash and not removing the clothing covering the rash. However we can often get a pretty good idea of what is happening through our history and evaluation. We will gather as much information as we can to adequately treat you. It may require a few additional visits, but your overall comfort and compliance with treatment is our biggest concern.
Remember you may give or remove consent at any time. If you are concerned with having an internal, speak to your physiotherapist, together you can decide when the best time would be, if at all. We have treated many women whose pain conditions have required starting with external treatment.
If you have an infant, you are welcome to bring them with you; however, coming to sessions solo is preferred so we can concentrate on you. Please be aware that if you bring your baby, it is possible we may have to curtail the amount of work we can do within the session if you need to tend to baby and pause treatment.
Patients are often scheduled back to back and sessions will need to end on time in order to honour the time of the next patient. Please remember you are responsible for the safety of your baby while on the premises.
Our therapists are able to assess and treat the pelvic floor even if you currently have your period. It you feel uncomfortable having your assessment during your period or it is really heavy, 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.
No. You do not need a doctor’s prescription to access our services; however, some insurance companies may need a referral for reimbursement. Please contact your insurance company to determine if you need a doctor’s referral to access your physiotherapy benefits.