In Praise of Pelvic Physiotherapy

Treating an important part of our overall health

In Praise of Pelvic Physiotherapy

Talking about pelvic health can feel uncomfortable. But without safe and honest conversations about our health “down there,” many suffer in silence. Learn about pelvic physiotherapy and how it treats incontinence, painful sex, and more …

As a mother of two young children, one birthed by unplanned C-section, the other at home, I know first-hand some of the changes our bodies experience.

I also take to heart what my menopausal friends share about their frequent bathroom trips or “little leaks” while jogging, laughing, or sneezing. From sore sex to back aches, our pelvis lies at our literal core. Pelvic physiotherapists not only bring relief, but they also foster hope and empower confidence.

Pelvic physiotherapy, a branch of physio that specializes in strengthening and repairing the pelvic floor, treats the full range of pelvic woes. Esteemed in Europe, and growing in popularity here in Canada, pelvic physio can bring about significant physical, and emotional, benefits.

To learn more about what pelvic physiotherapists do, how they help, and who they treat, I turned to Lindsey Tasker, MPT, BSc Kinesiology, of Armstrong’s Physiotherapy Clinic in Saskatoon, and Angelique Montano-Bresolin, registered physiotherapist (pelvic health specialty) and clinic director of Proactive Pelvic Health Centre in Toronto.

A pelvic physiotherapy primer

Pelvic physiotherapy is a dedicated branch of physical therapy that assesses and helps a wide range of symptoms and conditions in what’s called the abdomino-pelvic area. As Tasker explains, a physiotherapist with expertise in “pelvic floor rehabilitation takes a look at how your core, diaphragm, back, and pelvic floor work dynamically together.”

Finding the pelvic floor

In terms of where, Tasker describes the pelvic floor as “the sling of muscles going from the pubic bone all the way to the coccyx and sacrum, including the nerves, fascia, and ligaments, which provide support to the bladder, reproductive organs, rectum, and genitals. It comprises, according to Montano-Bresolin, “three layers of muscles and other soft tissue structures that form the bottom portion of our bony pelvis.”

As for what the pelvic floor does, Montano-Bresolin explains that it “works in coordination with the diaphragm and deep muscles of the abdomen and back for optimal posture, plays a vital role in sexual function and nutrient flow within the pelvic region, and helps maintain continence of the bladder and bowel.”

Widespread woes

Dysfunction of the pelvic floor is common. Between one-third to one-half of women experience incontinence—difficulty in holding one’s bladder or bowels—and 50 percent of women over the age of 50 experience symptoms related to prolapsing—a slipping down or falling—of pelvic organs.

It’s important to note, as Montano-Bresolin points out, that “women, men, and children of all ages can benefit from pelvic physiotherapy. It’s not so much a specific population but rather whether one is struggling with a pelvic floor dysfunction.

“Having said this, women during pregnancy and into the postpartum period tend to be at higher risk for developing pelvic floor issues, so this is a population that may especially benefit from pelvic physiotherapy.”

Potential patients

Tasker notes that pelvic health physiotherapy can help with

  • prenatal preparation for delivery
  • postpartum rehabilitation
  • bladder incontinence (stress, urge, mixed)
  • weak or hypertonic (tight) muscles
  • constipation
  • prostatitis
  • nocturia (incontinence at night)
  • dyspareunia (pain with intercourse)
  • pelvic pain
  • dysmenorrhea
  • interstitial cystitis (painful bladder)
  • vaginismus
  • vulvodynia
  • pelvic organ prolapse
  • pudendal nerve irritation
  • sacroiliac joint irritation
  • rectus diastasis

Preliminaries

Montano-Bresolin says that starting a pelvic physio journey generally begins with “an initial hour-long assessment that starts with a subjective history-taking followed by an objective physical examination that often (but not always) includes an internal and external assessment of the pelvis and surrounding soft tissues, including the back, hips, abdomen, and torso.”

This first session helps to “guide an appropriate treatment plan tailored specifically for the client. Length, frequency, and number of subsequent sessions will vary depending on symptoms, goals, and dysfunction. However, it’s not uncommon for positive changes to be experienced within the first four to six treatments.”

Pondering pelvic physio

To find an appropriate and registered physiotherapist, Tasker recommends turning to word-of-mouth suggestions from friends or family, or from your family doctor or OB/GYN.

Montano-Bresolin suggests “visiting the appropriate regulating body or college for physiotherapists in your province,” emphasizing that “once you’re able to connect with a pelvic health physiotherapist, it’s crucial to find the right one for you.

“Consider asking about the education and training the physiotherapist has received and how often they have treated your condition or symptoms. Asking if their practice is evidence-based and sensing that you can trust and feel safe with your therapist are critical factors.”

Professional pathways

I asked Tasker how someone becomes a pelvic physiotherapist. She explains that “postgraduate training in pelvic floor rehabilitation is done after completing either a bachelor’s or master’s degree in physical therapy,” and that practitioners continue to deepen their skills by pursuing the “many courses available in a wide range of pelvic health-related disorders.”

Pelvic health proponents

Montano-Bresolin says that “Canada is only now getting on par with other countries in the world, regarding pelvic health care.”

Tasker echoes this, adding that “pelvic floor physiotherapy is an amazing service, now gaining awareness as we talk more openly. Pelvic health is an important part of our overall health.” As Montano-Bresolin makes clear, pelvic health is fundamentally about “quality of life.”

 

Pelvic health practices

Can we do exercises at home to help strengthen our own pelvic floor? I asked our experts for suggestions that readers can practise at home.

Lindsey Tasker, MPT, BSc Kinesiology, Armstrong’s Physiotherapy Clinic in Saskatoon
  • Breathe in through the mouth and out through the nose, and notice how your pelvic floor feels as you do this.
  • Do you feel it move with your breath?
  • Do you feel any tightness or resistance with the breath?
  • Taking note of how your breath and pelvic floor work together dynamically is a good practice to begin with.
Angelique Montano-Bresolin, registered physiotherapist (pelvic health specialty) and clinic director of Proactive Pelvic Health Centre in Toronto
  • For a dynamic cat/cow exercise, begin by positioning yourself on your hands and knees.
  • To help facilitate pelvic floor relaxation, inhale and extend your neck as you look up toward the sky and arch your back, while visualizing your two sitting bones spreading apart.
  • Follow this by recoiling in the opposite direction and exhale as you curl your neck down (chin toward your chest) and curve your back up toward the sky while imagining your sitting bones coming together. This will help facilitate pelvic floor activation.
  • Repeat this sequence in a slow and controlled manner with intention approximately five to 10 times.

From endometriosis to vulvar pain, and menstrual cycle myths to learning more about the pelvic floor, Montano-Bresolin invites alive readers to peruse the Proactive Pelvic Health Centre’s online resources at proactiveph.com.

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