Pelvic Health… pelvic floor and so much more
Kegels… Well yes, but it’s more than that. Pelvic health physiotherapy is an umbrella term that encompasses all things pelvic related in the physiotherapy world. Part of it involves the pelvic floor which is comprised of muscles, bones, ligament, organs, and connective tissue. The pelvic floor has many important daily functions that include: urinary and bowel function, support and strength and sexual function and satisfaction to name a few. The relationship the pelvic floor has with the rest of the body is important to understand to optimize your pelvic floor function, which in turn optimizes your quality of life.
The Canadian Physiotherapy Association and provincial college regulators require all physiotherapists practicing pelvic health to have additional certifications. This area of practice is considered a specialty and therefore requires specialized post graduate certification that teach specific techniques, evaluation and education for pelvic floor related conditions. Part of that skill set includes internal examination of the pelvic floor. This is performed with a gloved finger (sometimes two) and lubrication. There is no speculum or stirrups used. The client is covered with a sheet from the waist down. Each exam process is based on the client’s consent and comfort level of having an internal exam done. The client may or may not wish to have this part performed right away, which is perfectly acceptable. Internal (digital) assessment is considered the gold standard but is only one part of the entire assessment and treatment in pelvic health physiotherapy. It is safe to be seen if you are pregnant, but it is advised to seek approval from your doctor beforehand.
A large portion of clients are mothers (at any stage) that need a qualified health care provider to examine and guide them on their journey of pregnancy, birthing and beyond. Many are told to wait 6 – 8 weeks after having a baby before “resuming their original programming” for exercise. Pelvic health physiotherapy is an evidence-based resource to help you make informed decisions as to what is in your best interest on movement, exercise and all that parenthood demands. Another population that seeks pelvic physiotherapy is peri or post menopausal women. This special population also may benefit from pelvic health physiotherapy. Many other individuals have their own personal reasons to seek help with these services as well.
Reasons to seek pelvic health care with your physiotherapist may include but are not limited to:
- Incontinence (leakage in bowel or bladder, constipation)
- Urge issues (frequent urination)
- Nocturia (getting up at night to pee)
- Pelvic pain (including pelvic gridle pain, sacro-illiac joint dysfunction, pubis symphysis pain etc.)
- Vulvodynia (painful vulvar area)
- Vaginismus (painful insertion)
- Low back pain
- Pre natal and Post natal mamas
- Return to exercise after baby
- Diastasis Rectus Abdominis
- Dyspareunia (painful intercourse)
- Pelvic Organ Prolapse
- Scar assessment for vaginal or c-section deliveries
- Peri-menopause issues
- Pelvic floor dysfunction
- Poor core strategies (bracing, breath holding, bearing down)
These conditions listed above are seen in our culture as common and have been known to come across as “normal”. This is a common misconception and physiotherapy is the first line of defence in treatment and prevention. More and more research is coming out on this topic which will be revolutionary in the management of these conditions.
Each session is in a private treatment room with one-on-one care for one hour. This allows for a comprehensive and supportive environment to work together on the issues at hand. No rush, no pressure and complete individual attention. There is complete confidentiality with all information shared either on paper, electronically or in person.
What to Wear
Ideally you should bring a sports top you feel comfortable wearing (in private room only) and shorts of some kind. The reason behind this is the more that is visible, the better the assessment. You can think of it like trying to get a knee treated and examined while you are wearing snow pants and how much better the experience is with having shorts on instead.
What to Expect
Initially you will be asked your history and concerns. There is no right or wrong way to go about this. Together during the appointment, you will come up with goals to work towards. There will be forms sent to you that you may wish to fill out ahead of time and sent back prior to your day of appointment or if you’d rather, they can be discussed initially on the first day of assessment. Discussion on day one is a main part of the getting to know process and foundational for success in the long run.
Next there will be the physical assessment. This looks slightly different for everyone as it is tailored to the individual and their needs. Functions like walking, standing, squatting, forward bending or lifting are some examples of part of the physical assessment. Checking breathing and postures and movement are another. This may look more like what you’d see in the typical physiotherapy clinic exams.
The other portion of the exam may or may not take place if needed and based on the individual’s level of comfort. Pelvic floor examination can be partly done with clothes on and on the outside of the body, but most of the pelvic floor information is on the inside of the body. Which means that the physiotherapist will ask permission to insert one or two fingers into the vagina or rectum and assess the structures that make up the pelvic floor. This portion is done only at the consent of the individual. The client is always in the driver’s seat and can ask to stop the process at anytime they wish. For this reason, all exams are performed in a private and quiet room with the physiotherapist and client present. If you wish to have someone accompany you or if you need to bring your child, they are most welcome.
There will be ongoing discussion and explanation of what will happen and what is happening as Devan conducts any portion of the physical exam. Not every session will involve all these components as proper attention and evaluation in some areas more than others may be needed for successful treatment. At the start of each session you and Devan will decide together a general plan for that day (with some flexibility in mind).
It takes a village
Pelvic Health physiotherapy is one of many resources in the overall health picture. At the individual’s request only, Devan is more than happy to speak with your doctor, midwife, naturopath, psychologist, or any other health care provider about your current situation and physiotherapy goals. She is also there to help refer you to any healthcare providers that you may need.
We want you to succeed with physiotherapy. We want to empower you. Pelvic floor physiotherapy will most likely involve some work to do outside of the clinic in hopes it will enhance your life. There will be a mutual agreement between the individual and therapist for all homework given. This sets the stage for feeling more confident and increases the likelihood that progress will be made.
Pelvic Health physiotherapy is non discriminatory and is open for all genders.