1. What is the pelvic floor?

 

The pelvic floor is a group of muscles that span the underside of the pelvis and attach from your pubic bone to the tail bone and between your sit bones. The purpose of these muscles is to act as a trampoline and support your internal organs - including supporting a baby when pregnant. These muscles play a part in supporting your pelvis, hips and lower back; have a roll in sexual function; and impact your ability to hold and expel urine, gas and stool. The pelvic floor is an extremely important set of muscles in our body, and in our opinion, one of the most important.

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2. Why should I see a pelvic floor physiotherapist?

 

Whether you're trying to become pregnant, are expecting, have children or not, every woman can benefit from working with a pelvic health physiotherapist. Our goal is to guide you in preventing, managing, reducing and resolving common pelvic floor conditions. Often, we are told that these types of issues are just a part of being pregnant, postpartum and being a woman, though this is not the case.

 

Pelvic health physiotherapists are trained to assess and treat the pelvic floor as well as the rest of the body similar to general physiotherapy. At Holistic Health Physiotherapy, we are physiotherapists trained in both pelvic health and orthopaedics. This means we assess how your pelvic floor muscles work together with the rest of your body and not just as a set of isolated muscles.

 

Additionally, pelvic health physiotherapists work together with other health professionals as we value an approach utilizing diverse skills and together, we can help you reach your health goals.

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3. What is pelvic floor physiotherapy and what conditions are treated?

 

Pelvic floor physiotherapy is focused on the deep core and pelvic floor musculature, specifically. At Holistic Health Physiotherapy, we take on a full body approach that assesses not only the pelvic floor but your body in its entirety. 

 

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. 

 

A pelvic health physiotherapist can help you prevent, manage or resolve many conditions including: 

• incontinence or leaking of urine, stool or gas when you cough, laugh or exercise

• urinary urgency and frequency

• difficulty initiating urination or passing stool

• internal pelvic pain such as: endometriosis, vaginismus or pain during intercourse, interstitial cystitis, pain with menstruation

• pain around the clitoris, vagina, rectum or perineum 

• pelvic organ prolapse

• heaviness or pressure in the pelvis

• pain associated with the low back, pelvic girdle, sacroiliac joint (SIJ), pubic symphysis or tailbone

• Cesarean birth recovery

• diastasis recti (abdominal separation)

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4. What's involved with an initial physiotherapy assessment appointment?

 

If you’re a new client — or returning after more than 1 year — your first appointment can be in person or virtual.

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Virtual assessments are a great way to start from the comfort of your own home or workplace. We use a private, secure online platform specifically for healthcare appointments. You’ll only need a device with a webcam and internet access.

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Virtual sessions are highly effective for getting started on your goals and often lead to positive changes in pain, pelvic floor symptoms, and movement before any in-person follow-up is needed.

In-person sessions may include a pelvic floor exam or manual therapy if appropriate and aligned with your goals.

Whether your assessment is virtual or in person, it may include:

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• • Discussing your specific pelvic floor, core, or orthopedic symptoms and concerns

  • Reviewing medical and pelvic health history

  • Discussing birth history and/or preferences (if pregnant or postpartum)

  • Pelvic floor and core education

  • Evaluating posture and movement patterns

  • Prescribing and observing exercises specific to your goals

  • Guidance for labour and birth preparation, including pelvic floor considerations

  • Postpartum recovery planning and progression toward your goals (returning to exercise, running, strength training, yoga, or Pilates)

  • Creating a personalized treatment plan based on your goals and symptoms

  • Option for an internal exam (for in-person assessments only). Internal pelvic floor exams are always discussed first and are never required.

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5. What happens during follow up appointments? 

 

There isn’t a one-size-fits-all approach to pelvic health physiotherapy. Each person’s goals and symptoms will guide the number and frequency of sessions recommended.

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Booking a few follow-up appointments in advance is encouraged due to the full schedule (details are available on the booking page).

 

During your assessment, your physiotherapist will discuss a personalized treatment plan with you, and appointments can always be adjusted based on your goals and symptoms.

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During follow-up appointments — in person or virtual — your physiotherapist will recommend the next step toward your goals, which may include:

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• Pelvic floor treatment that may involve internal or external techniques to help you understand how to best connect with these muscles; however, an internal exam is never required. Your treatment plan is always guided by your comfort, goals, and consent.

• Individualized exercise programming that integrates pelvic floor and core strategies into strength training, yoga, Pilates-based movement, or your favourite forms of exercise.

• Manual therapy and myofascial release to address muscles, fascia, and joints throughout the body to improve mobility, balance, and comfort.

• Acupuncture to support tissue healing, reduce pain, and promote relaxation.

• Education and ongoing support to help you feel confident moving in daily life and in the activities and sports you love.

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All clients receive access to their home exercise program through Embodia, an online platform that allows you to view and track your exercises on any device.

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6.  Is an internal pelvic floor exam required?

 

An internal pelvic exam is not mandatory but is the gold standard to assess how your pelvic floor muscles and connective tissue within the pelvis are working. An internal exam may be recommended to further investigate your symptoms.

 

There are various conditions that can be successfully treated with external treatment options if you don't wish to complete an internal exam. You will always be asked to provide consent before any assessment or treatment is provided and you are welcome to remove your consent at any time.

 

Prior to an internal exam, your physiotherapist will explain what is involved with an internal pelvic floor exam, using the clinic pelvic floor anatomy model. For the internal assessment, your physiotherapist will leave the room for you to under dress from the waist down and have you lie on the treatment table (similar to at your doctor's office) and drape/cover yourself with a sheet provided. Your physiotherapist will use a clean technique, using non-latex gloves for the internal exam. They will first observe your pelvic floor externally. The internal portion involves your physiotherapist inserting one or two gloved fingers into the vaginal canal, or one finger is inserted into the rectum. This allows access to the front and back portions of the pelvic floor muscles as well as the multiple layers of muscle. Pelvic floor strength, tone, laxity, coordination and connective tissue are assessed this way. Your physiotherapist will explain and ask for consent prior to each step of the assessment. You are always able to remove consent at any time.

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7. How do physiotherapists become trained in pelvic health and internal exams?

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All Ontario pelvic health physiotherapists have completed post graduate training, including practical exams, to provide internal assessment and treatments. The College of Physiotherapists of Ontario requires physiotherapists to be rostered (found here) in order to perform internal assessments and treatments.

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8. How long are initial and follow up appointments?

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Your initial assessment is a private one-on-one meeting with your physiotherapist (in person or virtually) and will be approximately 70 minutes.

 

Follow up visit length will be discussed during your assessment, as they are tailored to your particular needs. Typically follow up appointments are 45 minutes. 60 minute follow up appointments are recommended for partner labour prep sessions if you're pregnant.

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9. Can I bring my baby or children to my appointment?

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Yes babies and children are welcome to attend your appointments.

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10. Do I need a doctor referral to come to physiotherapy?

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You don't require a referral to see a pelvic health physiotherapist or any general orthopaedic physiotherapist in Ontario. However, if you plan to use your extended health insurance for the session, it’s recommended you contact your insurance company to find out if you need a referral in order to receive reimbursement. If your insurance company requires a referral, this will need to be done by your physician often before your first physiotherapy assessment.

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11. How do I pay? Does extended health insurance cover pelvic health physiotherapy?

 

Clients may pay by e-transfer or credit card at the end of each session (extended health insurance companies are not billed directly). Receipts will be provided for reimbursement for you to submit to your extended health insurance company or for tax purposes.

 

If you have insurance coverage for physiotherapy services, you’re covered for pelvic health physiotherapy. However, if you plan to use your extended health insurance for the session, it’s recommended you contact your insurance company to find out how much your particular benefits cover and if you need a referral in order to receive reimbursement.

 

Many insurance companies have coverage for virtual physiotherapy appointments since March 2020, however you are encouraged to contact your company directly to check this as well.

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70 minute Initial assessment - $180

45 minute Follow up appointments - $140

60 minutes Follow up appointments - $180 (recommended for partner labour prep sessions or if a longer session is needed for treatment) 

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*HST is not applied to physiotherapy services in Ontario

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*Please note we are unable to bill OHIP, ODSP or disability, MVA (motor vehicle accident) or WSIB (workman’s compensation).*

 

12. I'm on my period - should I still attend my in-person appointment?

 

You can still have an internal pelvic floor assessment or treatment while on your period. It can actually be helpful to assess while you're menstruating as the pelvic floor muscles and pelvic organ position can be affected by hormonal changes, especially if you notice a change in symptoms depending on where you are in your cycle.

 

If you prefer not to have an internal assessment or treatment during your period, we can provide an external assessment/treatment or we can change to a virtual appointment or you can reschedule your appointment (provided you give 24 hours notice). If less than 24 hours notice is given, the full appointment fee will be charged as a late cancellation.

 

13. What if I need to reschedule or cancel my appointment?

 

If you need to reschedule your session, please use the online scheduling system you used to book your initial appointments. 24 hours notice is required for any cancellations or changes to your appointment. Clients who provide less than 24 hours notice, or miss their appointment, may be charged a cancellation fee equal to the price of their appointment. Extended health insurance does not cover missed appointments or late cancellation fees.

 

14. Anita, how did you get into pelvic health physiotherapy with a focus on prenatal and postpartum care?

 

Early in my physiotherapy career, I began working with women incorporating physiotherapy techniques and Pilates mat and reformer exercise to resolve various conditions that society tells us are just a part of pregnancy and postpartum.

 

It didn't make sense to me that while our body is strong enough to grow a human being, we are expected to feel weak and suffer through pregnancy and childbirth, not to mention the expectation of getting 'our bodies back' in a matter of weeks after birth. I began taking post-graduate courses in internal pelvic health physiotherapy and doula training specifically for physiotherapists. This focus gave me the opportunity to help hundreds of pregnant and postpartum clients including returning to exercise, sport or dance. Since then I've never looked back!