The Ultimate Guide to Pelvic Health Physiotherapy: Everything a woman needs to know about their pelvic floor and whether physio is for them
Do you wonder if you would benefit from pelvic health physio?
Have you been wondering if pelvic health physio could help you in preparing for pregnancy, recovering from birth (vaginal or cesarean), or years after birth?
Have you been told that pelvic floor physiotherapy can improve your symptoms of leaking, pelvic pain, back pain or pain with sex?
You could be wondering whether your pelvic health is affecting your athletic performance and whether you’re experiencing pelvic floor dysfunction.
You might also be wondering how to mitigate pelvic floor symptoms that come on while you’re running, lifting, jumping or with general activity.
This post is designed for you to get all the answers to these questions to be able to make tracks in addressing and correcting your pelvic health as well as figuring out if you should see a pelvic physio - and how to find one!
Things we’ll cover in this blog post:
What is the pelvic floor?
The pelvic floor is a group of muscles and connective tissue that span the underside of the pelvis and attach from your pubic bone to the tail bone and between your sit bones side to side.
What is the function of the pelvic floor?
There are 5 main functions of the pelvic floor muscles:
SUPPORT: They span the bottom of your pelvis acting like a hammock to support your internal organs - including supporting a baby when pregnant and provide support to prevent pelvic organ prolapse;
STABILITY: The pelvic floor muscles are an essential component of your deep core musculature; working alongside your deep abdominal and back muscles to ensure your body achieves stability and balance.
SEXUAL FUNCTION: A properly functioning pelvic floor contributes to sexual satisfaction free of pain or discomfort;
SUMP PUMP: The pelvic floor muscles impact circulation and the lymph system by working as a pump to move fluid out of the pelvis and back into the circulatory system;
SPHINCTER: The pelvic floor muscles play an important role in controlling the opening and closing of the urethra and anus thus impacting your ability to hold and expel urine, gas and feces (aka pee, toots and poop).
What is pelvic floor physiotherapy?
Pelvic floor physiotherapy is known by several other names such as; pelvic health physiotherapy, pelvic physio, women’s health physiotherapy prenatal or postpartum physiotherapy.
In the USA and some provinces in Canada it is also known as pelvic physical therapy - rather than physiotherapy.
Pelvic physiotherapy is focused on the deep core and pelvic floor musculature, specifically. Your core is much more than just your “abs” and is the foundation for all of your body movements, stability and function.
Every practitioner may have a slightly different approach as to addressing your pelvic health and how it affects the rest of your body functions and systems.
Personally, I take on a holistic, full-body approach that assesses not only the pelvic floor but your body in its entirety.
How is a pelvic physiotherapist different from any other physio?
In Ontario, you can find out if a practitioner is rostered to perform internal assessments alongside other controlled acts (such as acupuncture etc) on the College of Physiotherapists of Ontario site.
Pelvic health physiotherapists have specific post-graduate training which includes using internal and external hands-on techniques to evaluate how your pelvic floor muscles are working and coordinating with the rest of your body.
This allows your pelvic physio to assess your pelvic floor musculature internally by using one or two gloved fingers vaginally, or one finger rectally. Muscles are assessed on their own and how they relate to other parts of your body including:
organs
connective tissues
nervous system
and bony structures such as your tailbone, back and hips.
You are not required to have an internal assessment, however, it is the gold standard in getting to the bottom of assessing your strength, coordination, tension and function or dysfunction.
From there your physiotherapist will develop a treatment plan tailored to your specific needs and goals.
This could involve:
full body exercises
breath and body awareness
pelvic floor-specific exercises or strategies
movement recommendations and alterations to postures when doing your normal movement (running, lifting etc)
return to exercise plan
or hands-on treatment.
Pelvic health physiotherapy is a proven, effective method of successfully treating pelvic floor symptoms and conditions. It is widely acknowledged as an effective first line of treatment for improving pelvic and overall health.
How to find a pelvic physio provider near you
If you’re in Millbrook, Peterborough or surrounding area, you can find me at the HIVE pelvic health co. The pelvic health branch of Trail Physio in Millbrook, Ontario. If you’re somewhere else looking for a pelvic physio - there are some tips below.
When in doubt - Google it.
Simply type your city or town and “pelvic health” or “pelvic floor” physiotherapy and see what comes up. From there, if the practitioner’s clinics have websites, have a look through their bio to see if you think they’d be a good fit for you - or you could call the clinic if you have additional questions.
Some practices also have complimentary 15-minute discovery calls to see if you’d be a good fit for their practice.
You must trust and feel comfortable with who you choose to assess your pelvic health. It can feel extremely personal and vulnerable when addressing these types of issues and if you vibe well with your chosen pelvic physiotherapist, you’ll get so much more out of your sessions and likely have better results.
Who would benefit from pelvic health PT?
Everybody has a pelvic floor, so every BODY could reap the benefits of pelvic health physio.
This includes:
someone preparing for pregnancy
currently pregnant
anywhere in the postpartum period
Following either cesarean or vaginal birth
peri-menopause to menopause
and also folks who have never been pregnant
You don’t need to have experienced a pregnancy to benefit from pelvic health PT, just like you don’t need to have had shoulder surgery to benefit from shoulder physio.
If there’s pain, dysfunction or you’ve noticed a decline/plateau in your athletic performance, you could be a candidate for pelvic physio.
It’s worth noting that some practitioners don’t treat men, some don’t treat women and some don’t treat children. Just like any other medical practice, physiotherapists can have a specific focus.
What symptoms or conditions does a pelvic physio treat?
There are so many conditions and phases of life that a pelvic physio can address and make a treatment plan for. Here is a list of conditions and diagnoses commonly seen and treated by pelvic physios:
Leaking urine, gas or faeces with sneeze, cough or laugh
Leaking urine with orgasm
Bed wetting
Pain with sex or inserting a tampon
Pelvic pain
Anal pain or discomfort
Haemorrhoids
Sacroiliac joint pain
Tail bone pain
Hip or back pain
Preparing for pregnancy
During pregnancy to prep for birth
Postpartum at any point - up to years or decades post birth
Post vaginal birth
Post cesarean birth
Pelvic trauma
Abdominal surgery
Pelvic surgery
Before or after hysterectomy
Prolapse
Diastasis Recti or abdominal separation
Return to exercise, running, lifting
Improving athletic performance, strength or endurance
Pregnancy and the pelvic floor
Contrary to popular belief - impact on the body from pregnancy isn’t just from the birth itself. Pregnancy in itself has a huge affect on your abdominal muscles and the pelvic floor musculature. Carrying a baby for 9+ months is hard work!
Regardless of how baby is born - vaginal or cesarean birth (aka c-section) - both your deep core musculature and your pelvic floor will be affected. The degree of how much impact you see with your pregnancy and birth varies between people immensely.
A common condition pelvic physios treat postpartum is called Diastasis Recti or abdominal separation.
In pregnancy, the majority of people will have this condition - it’s a beautiful way for your body to adapt to your pregnancy. Having your abs move apart creates space for your growing baby.
Post birth, it takes time for these abs to move back to their original position and in some cases, there can be a residual gap that needs to be addressed.
A series of exercises and advice can help close this gap and get you safely back to activity. In rare cases, surgery is required to help close the Diastasis Recti if it is very extreme and not closing enough with conservative treatments.
What does a typical pelvic health physio session look like?
Pelvic health sessions differ between clinics and regions, generally, the first appointment will be longer than any follow-ups.
At the HIVE pelvic health co., I start with a comprehensive 70 min assessment (either in-clinic or virtual) that includes:
discussion of medical conditions and history including past surgeries, procedures, current medications, mental health
current symptoms
birth and pregnancy history (if applicable)
birth preferences
current pregnancy if pregnant
physical observation and tests to gauge your mobility, strength, flexibility and tension
Next we address any goals you have for movement or exercise
ex: returning to run/ training for a race or distance, return to lifting/ training for a lifting meet or working towards PRs) movement in pregnancy, injury recovery and prevention or ways to support an efficient postpartum recovery.
Based on your reported symptoms, a thorough external exam of your back, hips, abdominals, pelvis or other body parts is required to evaluate your movement patterns, strength, tension, coordination, function and flexibility.
After an external exam, or at subsequent appointments in person, an internal exam may be indicated to have a more comprehensive look into your specific pelvic health and can evaluate tension, strength and coordination of the pelvic floor musculature.
An internal exam is NEVER mandatory and you can stop the exam at any time for any reason.
You must provide consent before any step of the exam and you can withdraw consent at any time. Your physiotherapist will first explain why they believe an internal exam would be helpful along with other pros and cons of internal palpation. Once you agree, they will then guide you through the exam and provide feedback throughout.
During the internal portion of the pelvic floor exam, your physiotherapist will gently insert one or two gloved fingers into your vagina or one gloved finger into your rectum. This allows the therapist to palpate each muscle group and evaluate its tension and function. There is no speculum nor instruments inserted into the vagina or rectum.
Depending on the concerns presented and information that was gathered from your history and external exam, an internal exam may not be necessary. However, an internal exam is usually recommended as it is the gold standard for assessing pelvic floor muscles and associated structures.
If you choose not to proceed with an internal exam the physiotherapist will make recommendations for treatment from your subjective history and external exam to work towards your goals.
Your therapist will discuss the findings of your assessment, provide education, a home exercise management plan and recommend a treatment plan going forward - and discuss whether virtual or in-person appointments would be ideal.
A common question I get is :
Can I still come to my appointment if I’m on my period?
And the answer is a resounding - YES. Pelvic floor assessment and treatment can be provided even if you’re on your period. Pelvic organ position and muscle tone can be affected by hormonal changes and it can be helpful to assess this during this time.
If you’re not comfortable with an internal assessment or treatment when you’re menstruating, the session can be completed with external techniques or you can reschedule your appointment with at least 24 hours notice for a different time in your cycle.
How long are typical sessions for pelvic floor dysfunction?
The length of treatment sessions varies depending on what you’re treating and what the specific clinic and practitioner offer. Usually assessment sessions are a bit longer to allow for extensive history-taking and strategies to get you started in your recovery.
My current model allows for 70 minute intake assessments and usually 45 minute return treatment sessions but with the option of a 60 minute treatment session depending on what we are addressing.
If you are going to another clinic, they may have different lengths of appointments for various types of sessions.
What results can be expected from pelvic PT?
As with any kind of health care or physiotherapy, results depend on a lot of factors including client adherence to strategies and specific exercises given, severity of issue, specific goals and your specific healing patterns. Common results that I’ve seen often in practice include but are not limited to the following:
Reduce or eliminate pain in pregnancy
Recovery from vaginal birth
Recovery from cesarean birth
Return to lifting, running, exercise without pain or leaking
Improved strength, coordination and endurance of pelvic floor muscles
Reduced tension in pelvic floor
Improve mobility of scarring (cesarean, vaginal or abdominal)
Reduced frequency and urgency of peeing
Reduce or eliminate leaking pee, gas or stool
Reduce or eliminate haemorrhoids
Improve athletic performance
Pain free sex
Freedom from incontinence pads
Reduction and management of prolapse symptoms
Achieve understanding of the functions of the pelvic floor and core and how to optimize it’s function
Athletic performance and pelvic health
Let’s dig into how your pelvic health can affect your performance.
It all starts with the core. Our core is responsible for forming a good foundation of strength and stability in response to our big movements - and it’s so much more than just your 6 pack muscles or your rectis abdominus.
When we look a little deeper, we can see our “deep core” is compromised of our transverses abdominus or trans abs that wraps under our six-pack muscles and around to our spine, much like a corset. Those trans abs are bordered on the top by our diaphragm and the bottom by our pelvic floor. The whole system looks similar to a pop can and is often referred to as the “core canister”. These core muscle groups are extremely important for all movement both in athletics and life in general.
For example: if you were to lift your hand overhead to catch a ball, the initiation of that movement starts with your pelvic floor. Pretty cool eh?
If your core isn’t functioning optimally then we see overwork in other parts of your body - think arms and legs - and increased potential for injury.
Controlling the pressure in your core canister is paramount in providing core stability. We need to have both the ability to tense and increase intra-abdominal pressure for heavy lifts or forceful full-body movement but also have the control to modulate this pressure and adapt to dynamic movement whilst also providing the rest of our body with a supportive base.
We can change the pressure in our deep core by using our breath - and coordinating it with movements or a certain part of an exercise (ex. A heavy lift).
If the intra-abdominal pressure is too high, we can see pelvic floor dysfunction and a reduction in force that an athlete can provide or maintain.
Dysfunction may look like:
urinary, fecal, or gas leakage
pain in the perineum, vagina, anus, rectum, SI joint, hip, or low back
difficulty initiating or maintaining a flow of pee when emptying the bladder
difficulty pooping
pain with sex, orgasm; heaviness in the vagina or rectum
feeling as if there is a tampon in your vagina when there isn’t or physically feeling tissue coming out of your vagina
and unfortunately - any combo of the above and more.
Working with this idea of modulating pressure and developing that coordination can help reduce the strain put through your pelvic floor whilst also getting the most out of your body and your strength.
If you’re interested in improving your athletic performance and you’re not looking into your pelvic floor and core function, you’re missing a big piece of the puzzle.
What does pelvic PT cost? And is it covered by extended health benefits?
I am currently registered to practice physiotherapy in Ontario, Canada and Ireland though practicing exclusively in Canada - so keep in mind that other countries and regions may vary regarding price and benefit coverage if you do not reside in Ontario, Canada.
If you are attending pelvic physio in Canada:
If you have coverage for physiotherapy through extended health benefits, you will be covered for pelvic health physiotherapy. We will provide you with a receipt at the end of your session that you can submit for reimbursement or retain for tax purposes.
The price of pelvic physiotherapy can vary depending on the length of treatment and which clinic you attend. You can usually find individual clinic prices on their booking website or can enquire when you call to book. Often, pelvic physiotherapy can be more of an investment than typical physio as there is additional training required to practice, moreover, assessments and treatments are often longer than traditional orthopaedic physio sessions.
In Ontario, pelvic physiotherapy can be covered by OHIP if you meet certain OHIP criteria and if you visit an OHIP-approved physiotherapy clinic. These clinics must apply and be approved to provide OHIP-covered physiotherapy, however, most private physiotherapy clinics do not offer OHIP-covered physio. You will have to search online to see if an OHIP clinic exists in your area, speak to these clinics, ask if they provide OHIP-covered physiotherapy treatments and if you qualify for this coverage.
Where to learn more about pelvic health PT
It can be really hard to find legitimate sources for pelvic health resources. Here are a few I recommend that show a great grasp of current literature and best practices:
Also recommend checking out:
Anita Lambert @holistichealthphysio and her To Birth and Beyond Podcast with Jessie Mundell (you can find me on Episode #174: Pelvic Floor 101 with Laine Corp)
Other local practitioners I commonly work with in the Peterborough, Ontario and surrounding areas:
Chiropractors: Taylor Bonner & Shannon Kelly at Cavan Chiropractic (Millbrook), Sarah Campbell & Sarah Wild at Thrive Health (Peterborough)
Naturopaths: Susan Joyce and associates at Healthy Foundations
RMTs: Kelly Swift, Stacey Kempt, Haley Smith, Carron Concepcion, Adrienne Colby
More about Laine Wall
As the pelvic floor has so many functions, I believe that a holistic approach to treatment is the only way to address pelvic health. When one system invariably affects your daily life, your quality of life can be inversely affected by its dysfunctions.
Meeting people where they are is the first step to building a plan. In my office, there is never any judgment, assumption, or expectation. We start slow and intentionally to work towards what is most important to you.
I strive to keep my environment taboo and intimidation-free. Pelvic health can sometimes feel very helpless and embarrassing but it doesn’t have to.
You don’t need to have already started exercising before you come, you don’t need to know all of the anatomical structures before we talk.
you can cry
you can swear
you can say butthole.
This is a safe space.
I’m here to work through all of your issues with you - no matter how long they’ve been bothering you or how severely they are affecting your life. You don’t have to live with a body that isn’t at its best. You deserve to feel in control, strong and capable.
I don’t “fix” people. I am your guide. You’re the one doing all of the hard work, I’m here to support you in finding the best version of yourself whilst also crushing your goals into oblivion. Even if those goals are just to have confidence in your bladder when you’re watching Amy Schumer stand up.
Want to learn more about me? Here is my story.
If you were looking for a pelvic physio, I would love to help you on your pelvic health journey.
I work out of, and own, a pelvic physiotherapy clinic called The Hive Pelvic Health Co. in Millbrook, Ontario and also offer virtual appointments if you reside in Ontario, Canada.
The Hive Pelvic Health Co. is located in the township of Cavan-Monaghan, in Peterborough County; and is less than 20 minutes from the city of Peterborough and 30 minutes from Durham region.
Have more questions? I have answers! Get in touch.
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