Everyone has a Pelvic Floor!
The pelvic floor is a bowl-shaped, broadband of muscles, ligaments and connective tissue located at the base of the pelvis. It functions to support the pelvic organs, maintain continence and support the core and low back. In addition, the pelvic floor also plays a role in maintaining sexual function and promoting circulation from the lower extremities.
It resists downward pressure created when straining, coughing or sneezing and prevents evacuation of digestive and urinary contents at inopportune times!
Weak or dysfunctional pelvic floor muscles can cause and contribute to a myriad of conditions including:
- Back pain
- Pain with intercourse
- Incontinence
- Repeated groin strains
Since the pelvic floor is the only stabilizing muscle that is oriented in the horizontal plane, it performs a critical role in spinal stability during all activities. Often chronic back, pelvic or groin pain that does not resolve with usual treatment is related to poor pelvic floor muscle function. Since the pelvic floor muscles along with the deep abdominal and back muscles work together to provide lumbar stability, and weakness in one can impact function in the other muscles, it is important to assess all of the deep stabilizers together.
Real-Time Ultrasound
At Coast Therapy we utilize Real-Time UltraSound (RTUS) to assist with pelvic floor and core muscle rehabilitation. The value of RTUS is that it allows for real-time study of these muscles as they contract and impact their associated fascial attachments. This allows both the patient and the therapist to view the contraction as it happens, leaving little room for supposition.
RTUS can be used as both an assessment tool, and maybe more importantly as a form of biofeedback, providing patients with knowledge of performance, in the early stages of motor relearning.
At Coast Therapy, Pelvic Physiotherapy Assessment & Treatment may include:
- A comprehensive history to identify issues specific to your pelvic floor concerns
- Real-time US assessment of pelvic floor and abdominal function
- Measurement of the DRA at rest and contracted. A distance of more than 2 cm. is considered worthy of concern.
- An internal pelvic examination to assess muscle tone, strength and ability to relax, as well as potential sign of prolapse of the uterus, bladder or rectum.
- Assessment of pelvic alignment, low back and hip movement
- Targeted pelvic floor and deep core exercises
- Use of Biofeedback to assist with specific muscle re-training programs
- Breathing re-training
- Manual Therapy
- Pain Management strategies
This assessment can be performed starting at 6 weeks post-partum. It is recommended before jumping back into an exercise program.
Any of the following can be treated with Pelvic Floor Rehabilitation
- Incontinence – Bowel or Bladder
- Chronic or repeated groin pull/strain
- Pelvic girdle pain including, coccydynia and/or SI joint dysfunction
- Perinatal and Postnatal Health
- Low back pain
- Pelvic Organ Prolapse
- Painful Intercourse
We are LGBTQ+ Friendly!
Coast Therapy welcomes LGBTQ+ patients. You are welcome to discuss your comfort, anatomy, goals and assessment preferences with your therapist. We can direct bill your benefits provider; contact the clinic for more information and to confirm your plan’s eligibility and any balance payable.
Pelvic Floor Physiotherapy for Men
Men’s pelvic-health concerns may include urinary leakage, urgency, pelvic or perineal pain, difficulty with bowel emptying and symptoms affecting sexual function. Pelvic-floor rehabilitation may also be part of care before or after prostate surgery when coordinated with the treating team. Symptoms have different possible causes; assessment should consider medical or urological review as well as muscle function.
Male pelvic floor physiotherapy is currently offered at our Burquitlam clinic.
Persistent hip, lower-back or sacroiliac-region pain can sometimes involve the pelvic floor. Physiotherapy can assess possible contributions without assuming that every pain problem starts there. A tight pelvic floor may need relaxation and coordination work before strengthening.
What Men Can Expect at the First Visit
The therapist asks about bladder and bowel habits, pain, sexual symptoms, previous procedures, medications, daily activity and goals. You can discuss sensitive symptoms privately and ask why each question or test is relevant.
Examination may include breathing, posture, hip and back movement, and external muscle assessment. If useful, an internal rectal examination may be offered to assess pelvic-floor tone and function. It is optional: the therapist explains the purpose, alternatives and risks, and asks for informed consent. You may decline or stop at any point and ask about having a support person present.
Your initial plan may include education, bladder or bowel habit strategies, relaxation, breathing, graded movement or strengthening when appropriate. Sexual difficulties can involve factors beyond the pelvic floor, so physiotherapy may form one part of care involving your doctor or another clinician.
Progress and Recovery
The timeline depends on the concern, how long it has been present, other medical factors and response to treatment. Progress may mean fewer leakage episodes, more comfortable sitting or activity, easier muscle relaxation or improved confidence. Rehabilitation often involves practice over weeks to months, with planned reviews. A fixed number of visits or a guaranteed result cannot be set before assessment.
Seek urgent medical care for sudden severe testicular pain, inability to pass urine, or pelvic pain with fever and feeling unwell. New bladder or bowel changes with saddle numbness or leg weakness require emergency assessment.
Frequently Asked Questions
At your first pelvic floor physiotherapy assessment, your therapist will assess for the tone and strength of your pelvic floor muscles and check for any signs of prolapse. Often (but not always) pelvic pain is related to increased tone or tension of pelvic floor muscles, which may or may not be accompanied by hypersensitivity or other nervous system involvement. Based on the results of your assessment, the therapist will employ a variety of treatment techniques which may include manual therapy, exercises to relax and/or strengthen your pelvic floor and education on how to self-manage your condition.
Hypertonicity of the pelvic floor can sometimes develop as a result of stress or anxiety, or following trauma. In some cases, it may be due to compensation for muscular weakness or a guarding response to pain in the pelvic floor or nearby regions (i.e. hips, low back). Oftentimes we don’t know exactly what caused the pelvic floor to become tight. Thankfully however, we can still implement techniques to address the dysfunction.
Not necessarily. Just because a muscle is tight does not mean it is strong. Muscles can be tight and weak, or tight and strong. As a general rule, we usually advise patients on how to relax a hypertonic pelvic floor before we begin strengthening. Each case is unique however which is why we recommend seeing a pelvic floor therapist for a thorough assessment and guidance before beginning a pelvic floor program at home.
Please fill out ALL the intake forms online before your appointment as that will assist your therapist in preparing for your appointment. Then follow the pre-appointment instructions which are as follows: void urine 1 hour before the appointment then do not void again until your appointment. In the hour leading up to your appointment please drink at least 16 ounces (2 cups) of water.
Yes.
You can absolutely begin pelvic floor physiotherapy during your pregnancy as a preventative measure, or to address pelvic floor symptoms arising during the pregnancy (note: internal examinations are not done during the first trimester). Research has shown that strengthening the pelvic floor is associated with a shorter second (pushing) stage of labour. In addition, learning to effectively strengthen and relax the pelvic floor muscles during pregnancy may give you an advantage in the recovery process postpartum.
If you are waiting until after giving birth to get started, we typically recommend booking your first visit 6-8 weeks postpartum.
Pain with intercourse can be related to several different components. We can assess if your pelvic floor muscles are tight and teach you how to relax them. We can also provide education regarding other factors that play a role in painful intercourse.
Not necessarily. In many cases, an overactive (rather than underactive) pelvic floor is the cause of pain and dysfunction. In these cases, strengthening the pelvic floor before learning to relax it properly first may be counter-productive. Your pelvic floor therapist will assess whether your pelvic floor is underactive or overactive, and develop a treatment plan focused on addressing any deficits.
Yes! Pregnancy and delivery can put a large amount of stress and stretch on your core and pelvic floor. Most people can benefit from learning how to safely and properly train their core and pelvic floor muscles after giving birth.
With your consent, your pelvic floor physiotherapist may perform an internal pelvic exam to assess the muscles of your pelvic floor. This may include evaluating muscle tone or tightness, strength and coordination, your ability to contract and relax the pelvic floor, and how the muscles respond to movement or pressure.
When appropriate, your physiotherapist may also assess for signs of pelvic organ prolapse. Your therapist will explain each part of the assessment beforehand, and you can ask questions, pause, or stop the examination at any time.
The therapist will take time before the examination to outline what the assessment will involve, what the goals of the assessment are, as well as any potential risks. The therapist will discuss alternative assessment options, and ensure they have your informed consent to proceed. The therapist will make every effort to describe what is about to happen or what may be felt during the assessment and treatment. As with any physical therapy assessment or treatment you may ask for clarification and ask the therapist to stop (withdraw your consent) at any time. The therapist will also describe the recommended treatment, any risks and any alternative treatments following the assessment.
It is up to you to determine the suitability and whether your child will be okay during your treatment session. From our experience, it is best to arrange childcare for the first visit as it is quite long and involves lots of education and explanation. You will feel more relaxed and likely gain more from your visit if you are able to attend without children present. Subsequent visits are generally shorter with less need for detailed discussions, and as such may be more suitable if you need to bring your child. Please feel free to discuss this with your therapist if needed.
Absolutely. We want you to feel comfortable and are happy to support you in any way we can to make your comfort a priority.
No. We use Ultrasound within the scope of Physical Therapy practice, which means that we cannot and do not provide diagnoses like MDs or Sonographers. We can certainly tell and show you, how your muscles work and give a detailed assessment of the function quality of your core, abdominal and pelvic floor muscles.
Separation of the abdominals occurs in all pregnancies that reach full term and are noticeable for at least 6-8 weeks after delivery. The degree of separation does not necessarily correlate to the degree of function &/or pain. Many people do not have persistent concerns about the separation and return to their previous activities without intervention. However, if you do have concerns about abdominal separation or your core stability/strength following the first 6-8 weeks after delivery, or have related pain, we can assess this and check the function of your muscles. We can teach you how to use your core properly during everyday activities (lifting, exercising, caring for a baby) and create a specific exercise program that will improve the function of your abdominal wall. We can also help to assess the condition and provide a valuable opinion to help your doctor or specialist determine whether further intervention is required or not.
Absolutely! In fact, research shows that weak and dysfunctional pelvic floor muscles are often present in chronic pain conditions. It may very well be the missing link that other rehab treatments are not addressing.
No, pelvic floor physio may help at any stage. While it is easier to retrain the pelvic floor muscles sooner rather than later, progress can be made at any age, whether you’ve had a baby or not!
Frequently Asked Questions About Male Pelvic Health
Expect a discussion of urinary, bowel, pain and sexual symptoms, relevant medical history and goals. Assessment may include movement and external muscle checks. An internal rectal assessment may be offered when useful, with explanation and consent; you can decline it.
It may help when muscle strength, coordination or habits contribute to leakage, including in some prostate-surgery rehabilitation pathways. A medical assessment may be needed to establish the cause. Your therapist develops a program suited to your findings and any surgical instructions.
Pelvic-floor treatment may form part of care when pain, muscle overactivity or coordination affects sexual function. Erectile or ejaculation difficulties can also involve medical, medication-related or psychological factors. Discuss symptoms with your doctor as well as your physiotherapist; treatment is not a guaranteed cure.
Some changes may be noticed early, while muscle retraining or persistent-pain rehabilitation can require weeks to months. The therapist should agree on measurable goals and review points. Lack of progress or changing symptoms may lead to reassessment or medical referral.
Contact your preferred Coast Therapy clinic and confirm a practitioner who assesses your specific concern, including male pelvic health when relevant. Check whether any preparation is needed and ask about current appointment options and benefits billing.