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/Post-partum Health
- Low back pain
- Pelvic Organ Prolapse
- Painful Intercourse
We are LGBTQ+ Friendly!
We can direct bill your Benefits Provider – Call us for more information.
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 women can benefit from learning how to safely and properly train their core and pelvic floor muscles postpartum.
With your consent, the therapist will do an internal pelvic exam to assess the tone or tightness of your muscles, your strength and control of the pelvic floor and your ability to relax the pelvic floor muscles. Often a prolapse assessment is also performed.
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 women 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!