As a mother of two young children, one birthed by unplanned C-section, the other at home, I know firsthand some of the changes a body can experience, especially in the pelvic region. I also take to heart what my menopausal friends share about their frequent bathroom trips or “little leaks” while jogging, laughing, or sneezing. Surprise pees, painful sex, organs on a downward migration—they’re nobody’s favorite topic of conversation, but they’re a reality for many women.
That’s where physiotherapists specializing in pelvic health come in. They not only bring relief for concerns ranging from sore sex to backaches; they also give hope and bolster confidence.
Pelvic physiotherapy, a branch of physio that specializes in strengthening and repairing the pelvic floor, treats a range of pelvic woes. Esteemed in Europe and growing in popularity in North America, pelvic physio offers significant physical and emotional benefits. It assesses and helps symptoms and conditions in what’s called the “abdominopelvic” area.
Lindsey Tasker, MPT, BSc Kinesiology, specializes in pelvic floor rehabilitation. She says physiotherapists with this expertise “take a look at how your core, diaphragm, back, and pelvic floor work dynamically together.”
What exactly is the pelvic floor?
Tasker describes the pelvic floor as a “sling of muscles.” This sling runs from the pubic bone at the front of the pelvis to the tailbone in the back and from sitting bone to sitting bone. The pelvic floor includes “the nerves, fascia, and ligaments, which provide support to the bladder, reproductive organs, rectum, and genitals.”
According to Angelique Montano-Bresolin, registered physiotherapist (pelvic health specialty) and clinic director of Proactive Pelvic Health Center in Toronto, Canada, the pelvic floor comprises “three layers of muscles and other soft tissue structures that form the bottom portion of our bony pelvis.”
As for what the pelvic floor does, Montano-Bresolin explains that it “works in coordination with the diaphragm and deep muscles of the abdomen and back for optimal posture, plays a vital role in sexual function and nutrient flow within the pelvic region, and helps maintain continence of the bladder and bowel.”
Who’s having pelvic floor problems?
Dysfunction of the pelvic floor is common. Between one-third and one-half of women experience incontinence—difficulty holding one’s bladder or bowels—and 50 percent of women over the age of 50 experience symptoms related to prolapsing—a slipping down or falling—of pelvic organs.
Montano-Bresolin points out that “women, men, and children of all ages can benefit from pelvic physiotherapy. It’s not so much a specific population but rather whether one is struggling with a pelvic floor dysfunction. Having said this, women during pregnancy and into the postpartum period tend to be at higher risk for developing pelvic floor issues, so this is a population that may especially benefit from pelvic physiotherapy.”
What can I expect at a pelvic physio session?
Montano-Bresolin says a pelvic physio journey generally begins with an “hour-long assessment that starts with a subjective history-taking followed by an objective physical examination that often (but not always) includes an internal and external assessment of the pelvis and surrounding soft tissues, including the back, hips, abdomen, and torso.”
This first session helps to “guide an appropriate treatment plan tailored specifically for the client. Length, frequency, and number of subsequent sessions will vary depending on symptoms, goals, and dysfunction. However, it’s not uncommon for positive changes to be experienced within the first four to six treatments.”
How do I find a physiotherapist trained in pelvic health?
To find an appropriate and registered physiotherapist, Tasker recommends turning to word-of-mouth suggestions from friends or family or getting a referral from your family doctor or OB/GYN. The American Physical Therapy Association also compiles directories of physiotherapists who have special pelvic physiotherapy certification at pt.womenshealthapta.org and womenshealthapta.org/capp.
“Once you’re able to connect with a pelvic health physiotherapist, it’s crucial to find the right one for you,” says Montano-Bresolin. “Consider asking about the education and training the physiotherapist has received and how often they have treated your condition or symptoms. Asking if their practice is evidence-based and sensing that you can trust and feel safe with your therapist are critical factors.”
It’s worth the hunt. “Pelvic floor physiotherapy is an amazing service now gaining awareness as we talk more openly,” says Tasker. “Pelvic health is an important part of our overall health.”
Could pelvic physiotherapy help you?
Lindsey Tasker, MPT, BSc Kinesiology, notes that pelvic physiotherapy can help with
- prenatal preparation for delivery
- postpartum rehabilitation
- bladder incontinence (stress, urge, mixed)
- weak or hypertonic (tight) muscles
- prostatitis (swelling of the prostate gland)
- nocturia (incontinence at night)
- dyspareunia (pain with intercourse)
- pelvic pain
- dysmenorrhea (menstrual cramps)
- interstitial cystitis (painful bladder)
- vaginismus (vaginal muscle spasms)
- vulvodynia (chronic pain of the vulva)
- pelvic organ prolapse
- pudendal nerve irritation (which causes pain or numbness in the pelvis)
- sacroiliac joint irritation (located where the spine and pelvis connect)
- diastasis recti (abdominal separation)
Strengthen your pelvic floor at home!
Observe how your breath and pelvic floor work together.
- Breathe in through your mouth and out through your nose. Notice how your pelvic floor feels as you do this.
- Do you feel it move with your breath? Do you feel any tightness or resistance with the breath?
– Lindsey Tasker, MPT, BSc Kinesiology
Do a dynamic cat/cow exercise.
- Position yourself on your hands and knees.
- To relax the pelvic floor, inhale and extend your neck as you look up toward the sky and arch your back while visualizing your two sitting bones spreading apart.
- Recoil in the opposite direction. Exhale as you curl your neck down (chin toward your chest) and curve your back up toward the sky while imagining your sitting bones coming together. This will activate the pelvic floor.
- Repeat this sequence in a slow and controlled manner five to 10 times.
– Angelique Montano-Bresolin, registered physiotherapist