A Guide to Pelvic Physiotherapy – What Is It & What Should I Look For?

What is Pelvic Physiotherapy?

Pelvic physiotherapy is a specialized branch of physiotherapy, meaning that not all physiotherapists treat this area of the body. Currently in Canada, it is not part of the Masters of Physical Therapy curriculum, so pelvic physiotherapists must complete post-graduate certification courses. What makes these treatments so specialized is that it deals with the muscles found inside the pelvis (a.k.a. your pelvic floor). To determine how these muscles are functioning, a pelvic physiotherapist will do an internal digital examination (meaning, using a finger to examine vaginal, rectal or both areas depending on the patient’s complaints). The physiotherapist will also examine you as a whole — assessing your low back, core, hips, etc. — and discuss relevant information about your bladder and bowel habits. We are trained physiotherapists so we can look at all the areas of your body just like any other physiotherapist, but we have the added benefit of also being able to assess your pelvic floor.

Conditions Typically Treated by a Pelvic Physiotherapist

  • Urinary or fecal incontinence
  • Bladder and bowel urgency and frequency
  • Pre- and postpartum
  • Any pelvic pain conditions (including painful sex, vestibulodynia, vulvodynia, coccydynia or tailbone pain, painful bladder syndrome)
  • Endometriosis
  • Interstitial cystitis
  • Pelvic organ prolapse
  • Constipation
  • Pre- or post-pelvic surgeries (i.e. colorectal surgeries due to cancer, prolapse surgery)

Would I Benefit from Pelvic Physiotherapy?

In short, YES!  It is incredibly valuable for women to learn about this part of their bodies. All too often, pelvic physiotherapists see patients who have no idea what their pelvic floor is, how it functions, or what type of conditions arise when it isn’t functioning well. This unfamiliarity leads to so many women suffering with conditions that are completely fixable (incontinence, pelvic pain, prolapse, etc.). Unfortunately, the pelvis and its associated functions are still far too often treated as a taboo area in our society. Generally speaking, doctors don’t ask patients often enough if they are suffering with pelvic issues. As a consequence, women suffer alone with these conditions because of unnecessary embarrassment or the stigmas surrounding pelvic health.

Personally, my interest in pelvic health coincided with my first pregnancy. I have an undergraduate degree in kinesiology and a Master in Physical Therapy , so I was pretty confident in my overall knowledge about the human body. But the more I studied pelvic health; I couldn’t believe there was so much information about the pelvis that was not included in the six years of my education. Taking specialized pelvic courses felt like Anatomy 101. In so many ways, it was very enlightening, but also frustrating. Why had we never been taught about all these muscles and the important functions they serve?

At some point in their lives, many women will struggle with issues surrounding their pelvic floor. Between one-third and one-half of women who have vaginal births will have minor pelvic organ prolapse. Additionally, just as we age, 30 percent of women will experience urinary incontinence.

But with knowledge comes power! When women understand their bodies; know the state of their pelvic floor muscles; and know how to exercise them appropriately (over one-third of women who perform Kegel  exercises do so incorrectly), they can avoid most conditions pelvic physiotherapists treat.

Do I HAVE to Undergo the Internal Exam?

This is the most common question pelvic patients ask, and the answer is this: no.

But it is recommended.

It is perfectly normal to be anxious about a pelvic floor exam, but an internal digital exam is the gold standard when it comes to assessing pelvic conditions. Without it, we can get an idea of what’s happening, but not the full picture. It would be like trying to assess a sprained ankle without taking off your shoe.

Most patients are worried because they have so much pain and aren’t sure they can tolerate the assessment and treatment, and that’s natural! Having said that, all pelvic physiotherapists want is to minimize any anxiety or stress around coming to an appointment. So, if it is something you are worried about, talk to your therapist. As mentioned, the internal exam is the preferred option but there are other strategies to pursue if it’s not an option. Whether it’s breathing and visualization for relaxation of an overactive pelvic floor or verbal cueing with observation for proper contractions, alternative options exist.

A pelvic physiotherapist should always explain what we are doing every step of the way and will move very slowly to ensure we aren’t creating a lot of pain. Consent and tolerance are important pillars of our treatment plans.

How Can I Access This Sort of Care?

Anyone can see a physiotherapist, call and make an appointment for an initial assessment. However, if you are hoping for your treatment to be covered through extended health care benefits, check if your insurance policy requires a doctor referral. Most importantly, if you have benefits that cover physiotherapy then any pelvic physiotherapy sessions should also be covered.

What Should I Look for When Trying to Find a Pelvic Health Physiotherapist?

Trust is the most important factor. The pelvic floor is an intimate area of your body, and to treat it properly, a patient and physiotherapist must have a good connection and be able to ask and answer sensitive questions. Most clinics have team bios on their websites so you can check out credentials and specialties ahead of time and get in touch beforehand.

Another factor to keep in mind is to look for a pelvic physiotherapist who analyzes not just your pelvis, and not just your body, but you — as a whole person.

So many of the conditions pelvic physiotherapists see are multi-layered. Mental health could be playing a role, biomechanical dysfunctions of the back could be contributing, or overall habitual movement patterns could be exacerbating your problems. In many chronic pelvic pain cases, all of these areas need to be addressed to see the best results.

Having said that, as pelvic physiotherapists, we do not treat any potential mental health connections, but we can educate you on how they can play into your symptoms and recommend trusted individuals that do work in these areas.

Ultimately, a pelvic physiotherapist who asks the right questions and looks at the whole picture will be able to help you.

Image credit: Duvet Days

Courtney Steele

Physiotherapist, Clinic Director
Cornerstone Physiotherapy (North York Location)
Orthopaedics and Pelvic Health

Courtney Steele has been practicing as Physiotherapist since 2008. She works in orthopaedics and pelvic health physiotherapy. She is currently practicing and is the clinic director at Cornerstone Physiotherapy in North York. Courtney is a Credentialed McKenzie Therapist (MDT), a fellow of the Canadian Academy of Manipulative Physiotherapists (FCAMPT) and has numerous post-graduate pelvic health courses in a variety of subspecialties.

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