Frequently Asked Questions
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.
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.
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)
4. What's involved with virtual physiotherapy appointments?
If you’re a new client or returning client who hasn't been seen in over 6 months, your first appointment would be a virtual assessment. One of the many benefits of having your physiotherapy assessment virtually is that we can discuss all of your symptoms and concerns prior to coming into the clinic, while physically distancing and from the comfort of your own home.
We use a private, secure online platform specially created for health professionals. All you need is a device with a webcam and access to the internet.
At your assessment we'll discuss if and when in-person follow ups would best (ie. for an internal pelvic floor exam) or which can be done virtually based on the findings of your assessment. A great deal of our initial assessment is spent talking and educating, which is more difficult to do with masks on.
Many clients have had full treatment plans virtually and others have had a combination of virtual and in-person sessions with great results of reaching their physiotherapy and pelvic floor goals since Covid precautions began.
During virtual assessment and treatment appointments, we also:
• discuss your specific pelvic floor, core or orthopaedic symptoms/concerns and put together a personalized plan for your goals
• evaluate your posture and movements patterns
• prescribe, observe and progress exercises specific to your goals
• provide labour and birth prep including pelvic floor considerations
• provide postpartum recovery guidance back to your goals including exercise, return to running, strength training, yoga and Pilates
Many insurance companies have coverage for virtual physiotherapy appointments due to COVID-19 precautions, however you are encouraged to contact your company directly to check.
5. What happens during an initial assessment?
Initial assessments are currently virtual which allows your pelvic health physiotherapist to assess your needs, concerns and begin addressing your physiotherapy goals. During your assessment, your physiotherapist will be able to discuss if an in-person appointment is recommended and if having an internal pelvic floor exam could help address your symptoms.
We review your past medical and birth history, discuss preferences for your upcoming birth as well as what types of treatments you may have already tried for your symptoms. Discussing your history will provide a good indication as to what assessment and treatment techniques may be helpful. Your physiotherapist will take a look at your posture (not just your pelvis), movements that are symptomatic and general movement strategies (this can be done virtually and in-person).
Your physiotherapist will discuss and show you on an anatomical pelvis model where your pelvic floor muscles are, how these muscles are assessed as well as any pros and cons with carrying out an internal exam in regards to your goals.
If an internal pelvic floor exam is recommended for your symptoms and you consent to the exam, at a follow up appointment we will talk you through the entire physical exam and have you provide us feedback during the assessment. You are able to withdraw your consent at any time.
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 the symptoms you are describing.
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.
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.
7. How do physiotherapists become trained in pelvic health and internal exams?
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.
8. How long are initial and follow up appointments?
Your initial assessment is a private one-on-one meeting with your physiotherapist and will be approximately70 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 but may be 30 or 60 minutes depending on the treatment plan discussed.
9. Can I bring my baby or children to my appointment?
Currently with COVID-19 precautions, we ask that you come to your appointment on your own, however babies in a car seat can attend. Once precautions have been lifted we will return to being able to have having babies out of car seats and other children or support persons at your appointment.
10. Do I need a doctor referral to come to physiotherapy?
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.
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 if you need a referral in order to receive reimbursement.
Many insurance companies now have coverage for virtual physiotherapy appointments due to COVID-19 precautions, however you are encouraged to contact your company directly to check this as well.
*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. You must provide 24 hours notice so another client can book the appointment spot. If the minimum of 24 hours notice is not provided, including a missed appointment, the full appointment fee will be charged. Please note that 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.
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!
15. Laine, how did you get into pelvic health physiotherapy?
Coming from a background of orthopaedics and neurological physiotherapy, my journey into pelvic health began as a personal one following the back to back pregnancies and births of my two sons.
It was hard for me to understand why during pregnancy you’re followed so regularly, but six weeks after you’ve given birth, you’re discharged. Additionally, I realized that a lot of what we’ve been told is a “normal” part of pregnancy, postpartum and aging is not normal at all and there are ways to have success in improving our pelvic health. I began taking extensive post-graduate courses in pelvic health, cognitive behavioural therapy, pain management and matwork pilates.
I believe that no injury is an island and take on a holistic full body approach to treatment by using a variety of methods, rooted in education and exercise, to balance tension with strength, improve overall function and return clients to an active lifestyle.