A pelvic physiotherapist is a physiotherapist that underwent post graduate specialized training in pelvic health, often including courses on pelvic anatomy, dysfunctions, and specific treatment techniques to treat specific conditions.

They can help:

• Anyone with pelvic floor issues, regardless of age, gender, body type, or physical ability
• People experiencing symptoms related to bladder or bowel control, or sexual functions.

Pelvic floor physiotherapy is a treatment for problems related to the pelvic floor muscles and bony elements of the pelvis. This specialized therapy includes the evaluation of the pelvis, treatment techniques and exercises that can help relieve symptoms like pain, discomfort, and disruptions to your quality of life.

Every person has a pelvic floor. The pelvic floor is made up of the muscles that support the urinary, bowel and reproductive tracts. Therefore, this group of muscles controls your bladder and bowels and play a significant role in sexual function.

In women, the pelvic floor helps to keep your bladder in place in the front and the vagina and rectum in the back. Your uterus is held in place at the top of the pelvic floor by muscles, tendons, ligaments, and connective tissue. In men, the pelvic floor helps keep the bladder, bowels, urethra, and rectum in place.

The pelvic floor muscles attach to your pubic bone in the front and the sacrum and tail bone at the back. If the muscles in the pelvic floor are weak (hypotonic) or short and tight (hypertonic), they do not work as they should, and this may lead to pelvic pain and dysfunction.

When your pelvic muscles cannot relax or work together the way they should, you may have pelvic floor dysfunction. If these muscles cannot relax, and only remains tight, you may have:

Bowel or bladder problems:

• Having to urinate frequently (unable to hold longer than 2 hours)
• Incomplete bladder or rectal emptying
• Having to push or strain to urinate or when having to pass stool
• Painful bladder
• Recurrent bladder infections
• Constipation
• Pain when passing stool
• Bladder or bowel leaking, or unable to control flatulence

Sexual problems:

• Pain or discomfort with penetration
• Unable to insert a tampon
• Poor erectile function
• Unable to reach an orgasm

Other symptoms relating to pelvic dysfunction

• A heavy, dragging feeling in the pelvis (pelvic organ prolapse)
• Pain in the pelvis, pelvic floor, or lower abdomen
• Pain in the pelvis or lower back during pregancy
• Pain over the tailbone (coccyx) when sitting
• Pain over the episiotomy or C-section scar longer than 6 weeks after delivery

• Pelvic surgery
• Aging
• Pregnancy and childbirth
• Being overweight
• Overuse of the pelvic muscles, straining too
• Serious injuries to the pelvic area
• Stress and Anxiety

• Urinary incontinence
• Fecal incontinence
• Pelvic organ prolapse
• Constipation
• Painful intercourse (vaginismus, vulvodynia, vestibulodynia)
• Pain in the vagina
• Interstitial cystits
• Painful bladder syndrome
• Endometriosis
• Chronic pelvic pain
• Antenatal and postnatal conditions and care
• Pre- and post-prostatectomy care and rehabilitation
• Lower back pain
• Sacro-iliac pain and dysfunction

• We will listen to you without judgement.
• We will ask you questions about your history and symptoms. Sometimes these questions may seem add or embarrassing you, but they are all relevant to your pelvic health. Trust us, we have heard it all!
• We will assess all non-pelvic floor contributors to your symptoms, like breathing, posture or other joints and muscles.
• We will explain what we are doing and more importantly why we are doing it along the way.
• If an internal exam is appropriate for you, we will go over it with you in details and get your consent before proceeding. If you are not comfortable having an internal exam, we can discuss alternatives.
• The internal pelvic floor exam will have you comfortably lying on your back with your knees bent, your feet flat on the table and you will be covered with a towel. A gloved finger with lubrication will be used to your pelvic floor muscles vaginally, and in men rectally.
• We will assess how tense or relaxed the muscles are, and also assess the strength, coordination, and reflexes of the pelvic floor muscles.
• If indicated, assess for prolpse vaginally and/or rectally will be done.
• Following the internal exam, we will go over our findings, how it might contribute to your symptoms, provide specific recommendations, and together we will produce a plan to achieve your goals.

The treatment might include:

• Either strengthening weak or lengthened (hypotonic) muscles or reducing spasm in tight and shorterned (hypertonic) muscles.
• Education on pain and dysfunction
• Stress management
• Relation strategies
• Stretching and strengthening exercises
• Bladder retraining
• Correcting techniques to empty the bladder and bowel