Frequently Asked Questions
1. Why should I see a pelvic floor physiotherapist?
Every woman can benefit from working with a pelvic health physiotherapist whether you're trying to become pregnant, are expecting, have children or don't have children. My goal is to guide you in preventing, managing, reducing and resolving resolving common pelvic floor conditions that women are often told is a normal part of being pregnant, being a mother or just a part of life. 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, I'm a pelvic health and orthopaedic physiotherapist which means I assess how your pelvic floor muscles work together with the rest of your body and not just as a set of isolated muscles. Pelvic health physiotherapists work together with other health professionals as we all have different skills that together, can help you reach your health goals.
2. What is pelvic floor physiotherapy and what conditions does a pelvic health physiotherapist treat?
It is physiotherapy for the pelvic floor and core muscles but at Holistic Health Physiotherapy, I take the entire body into account, not just the pelvic floor. 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. The pelvic floor muscles attach from your pubic bone to the tail bone (front to back) and sitz bones (side to side). They act as a trampoline and have many jobs including supporting your bladder/uterus/rectum (and your baby when pregnant), stabilizing your low back/pelvis, and closing the openings where urine and stools come out. In my opinion, they are one of the most important sets of muscles our body has. I assess your ability to contract and relax these muscles, how they work with the other core muscles and how they are supporting and working with the rest of your body. The conditions that a pelvic health physiotherapist often treat and help prevent include:
incontinence (leaking urine/stool/gas when you cough, laugh, exercise or don’t make it to the washroom)
diastasis (ab separation)
urinary frequency & urinary urgency
pelvic organ prolapse
low back/pelvic girdle/SIJ/public symphysis pain/ tailbone pain
internal pelvic pain (including vaginisimus, endometriosis, interstitial cystitis, and pain during intercourse)
guidance with exercise and sport during pregnancy and postpartum recovery including years after birth
orthopaedic conidtions/injuries/pains - neck, shoulder, knee, ankle , etc
3. Do I have to have an internal pelvic floor exam and what is involved?
Before an internal pelvic exam is considered, your physiotherapist will listen to why you have come for an assessment including your goals, and what your symptoms are. We review our past medical and birth history or about your 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 of what assessment and treatment techniques may be helpful. Next, your physiotherapist will take a look at your posture (not just your pelvis) , movements that are symptomatic or that you're concerned with.
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. However, your physiotherapist will first 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. Your physiotherapist will talk you through the entire physical exam with you providing feedback during the assessment. There are various conditions that can be successfully treated with many 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 in order to access the front and back portions of the pelvic floor muscles. They are assessing your pelvic floor strength, tone, laxity, coordination and connective tissue. 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.
4. How do physiotherapists become trained in pelvic health physiotherapy and internal exams?
All Ontario pelvic health physiotherapists have completed post graduate training including in person exams to provide internal assessment and treatment physiotherapy services. The College of Physiotherapists of Ontario requires physiotherapists to be rostered (found here) in order to perform internal assessments and treatments.
5. How long are initial and follow up appointments?
Your initial assessment is one-on-one in a private treatment room and will be 70 minutes with your pelvic health physiotherapist. Follow up visit length will be discussed during your assessment, as they are tailored to your particular needs. Depending on the treatment plan discussed, they will be either 30, 40 or 60 minute sessions.
6. Can I bring my baby or children to my appointment?
You're welcome to bring your baby or children to your appointment. It's recommended that you bring items/toys to occupy your little one(s) or you're welcome to have a friend or family member attend to watch your little one(s) either in the treatment room or in the studio sitting area while you're in your appointment. I completely understand if you need to attend to your baby during your physiotherapy session however your understanding is appreciated that unfortunately the time allotted for the session can't be extended due to other scheduled clients.
7. Do I need a doctor or midwife referral?
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 session, I recommend you contact your insurance company to find out if you need a referral in order to receive reimbursement. Pelvic floor physiotherapy is under physiotherapy in your health benefits. If your company requires a referral, this will need to be done by your physician often before your first physiotherapy assessment.
8. How do I pay? Does extended health insurance cover pelvic health physiotherapy?
Clients may pay by cash, etransfer, cheque 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 coverage for physiotherapy, then pelvic floor physiotherapy will be included. I recommend that you follow up with your insurance provider to check your coverage. Some insurance plans require a doctor's prescription in order to be reimbursed for physiotherapy services, even though you do not need a referral to see a Physiotherapist. *Please note we are unable to bill OHIP or under MVA (motor vehicle accident) or WSIB (workman’s compensation).
9. I'm on my period - should I still attend my appointment?
I'm able to still assess and treat the pelvic floor internally even while on your period. For some people tt can be helpful to assess while you're menstruating as the pelvic floor muscles and pelvic organ position can be affected by the hormonal changes, especially if you notice a change in symptoms during this time of the month. If you prefer not to have an internal assessment or treatment during your period, I can either provide the assessment or treatment externally 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.
10. What if I need to reschedule or cancel my appointment?
If you need to reschedule your session, please provide 24 hours’ notice so another client can book the appointment spot. If 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 or late cancelled appointments.
11. 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 a normal 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 provided me the opportunity to help hundreds who are pregnant or during postpartum recovery including years after giving birth with returning to exercise and sport. Since then I've never looked back!