Pelvic floor physiotherapy: What it is and why it could be a game-changer for you

Period cups, unexplained bleeding, menopause — these topics might make some people blush and others say “ick.” Yet, they’re issues that many women have questions about. One of our missions at The Honest Talk is to answer those questions (and banish the “ick”), and today, we’re diving into pelvic floor physiotherapy. Although you may have heard the term, not everyone knows what it is or how it can benefit them.

We were fortunate to speak with Wendy Miller, an Ottawa-based physiotherapist specializing in pelvic health and orthopedic injuries. Wendy believes in tailoring treatments to address the root causes of discomfort and promote long-term well-being. She’s here to help you understand what’s really involved in pelvic floor physiotherapy.

THT: How does pelvic floor physiotherapy differ from general physiotherapy?

WM: They’re both physiotherapy, however, pelvic floor physios get specialized training for the pelvic muscle group. In the pelvic area, just like everywhere else, there are ligaments, tendons, muscles, nerves, and bones. We’re looking at the structure, the function, the contraction, the relaxation. Can you activate the muscle the way it’s supposed to? Can you relax the muscle? When you realize it’s just a muscle group, that simplifies it.

THT: Who can benefit from this type of physiotherapy?

WM: People who are having pain in the pelvic area — pain between the sit bones or pain around the pelvic girdle. And women who are having trouble with urinary incontinence — so that would be urinary leaks. Urinary urgency, a feeling of having to go to the bathroom more than you should have to or having to void more frequently. And fecal incontinence, smears in your underwear, not being able to control when you have an urge to have a bowel movement. Difficulty controlling flatulence, gas.

Then pain with intercourse. Pain with vaginal exams. And women who are either about to give birth or have given birth and are rehabbing and recovering from that. All of those would be good indicators that pelvic floor physio would be helpful.

THT: What are some common misconceptions about pelvic floor health?

WM: I think the biggest thing is that feeling of it being very awkward, with someone up in your personal space. There are some people who think, I just couldn’t do that. I couldn’t talk to someone about that.

And most people at the end of an assessment say, “Well, that was not near as bad as I thought it was going to be,” or “You made that really comfortable.” Then they say, “I should have come years ago.”

THT: Could you describe what a typical assessment and treatment session might look like?

WM: When you come in for an assessment, a significant amount of time is spent talking. For a lot of people, some of these pelvic floor issues started with chronic constipation in childhood and now they’re in their 60s or 70s. So, it’s a lot of questions and answers and a lot of chatting about what they’ve experienced over the years, what they’ve tried, what’s worked, what’s not worked. And also getting a feel of their comfort level when they’re talking about these issues.

Once we get a good history and understand what their goals are with treatment — what are they hoping to get out of a session — then we can move on to a physical exam, and that can take on lots of different forms depending on someone’s comfort level. It could include an external exam of the abdomen, pelvic area, an internal vaginal palpation, and internal rectal palpation, but it might not include any of that. Sometimes the problem they come with is really just education and constipation or urgency issues which might not even require an internal exam.

THT: What impact can this therapy have on overall health and quality of life?

WM: I like to say that everything works well in balance. So, the right side in balance with the left side, the front balanced with the back, and muscles need to be able to contract but also need to be able to relax, and any muscle group that can’t do that will have an impact on the one beside it, which will then translate to the one beside it and beside it.

I’ve had folks whose primary problem would have been scarring in their abdomen (from an older surgery) that pulled their hip and their pelvis into positions that were causing their problems. I’ve had folks that have had hemorrhoids and they don’t think hemorrhoids would be responsible for their vaginal pelvic pain, but because they are holding so tight to protect against that feeling it’s changed how the whole pelvic floor functions.

Your pelvic floor is part of your core — to me the pelvic floor is the boss of the core — so if you’re thinking about anything that would benefit from core exercise, core stability, or if your sport or activity would benefit from a stronger core, then your pelvic floor is the boss of that zone.

I’ve had people say, “My shot got way stronger in soccer when I started doing this.” “I can run way faster.”

THT: What advice would you give someone hesitant about starting pelvic floor physiotherapy?

WM: Call and have a conversation. As an example, having my spine manipulated is something I’ve never been comfortable with, but I go to a chiropractor and I ask them not to do that. I’m very fine with someone booking an appointment and saying “I’m not comfortable with … whatever…. Can we just talk about stuff and see how things go?”

THT: I’m not sure if people understand that you can have a pelvic floor physiotherapy appointment and it not be internal.

WM: It depends on the person’s comfort level, but a significant amount of time we don’t get to the internal on the first day because there’s so much to talk about. Or I can tell someone’s a bit anxious and nervous and if you’re doing an assessment on someone who’s nervous, you’re not going to get accurate information, so we wait on that. Most of the time, after they’ve been in for an assessment, they’ve seen the clinic space, they understand how it would work, they say, “I’m up for this next time!”

Occasionally they say, “This makes me really uncomfortable.” And I say, “Well, let’s keep talking about what you can do and how you can gather information. And you can come with that information next time and it still doesn’t have to be internal.” We can do a heck of a lot with no touch. Just like if someone had a back injury or a chest injury and they didn’t want to expose that area.

THT: Can you share any final thoughts for us?

WM: Pelvic floor therapy doesn’t help everyone. There are people who are surgical candidates, and they really do need surgery. But it is an amazing conservative treatment that can change people’s lives. If someone is going to the bathroom 19 times a night — getting no sleep — or if they have an injury they’re not healing from and you can help them with that type of problem, it’s life-changing. And for someone who wants to travel and they’re having fecal incontinence, and they’re embarrassed, they’re not going to travel. If you can work on that and all of a sudden their retirement is travelling, then they’re over the moon. It’s worth a try.

Tips for a comfortable pelvic floor physiotherapy appointment

Get recommendations: Trusted sources like friends or your family doctor might be able to recommend a practitioner who would be a good fit, and they could also tell you more about their clinic space and approach.

Open communication: Don’t hesitate to reach out to your therapist before the appointment to explain any concerns or preferences you have, such as not wanting certain treatments.

Bring a companion: Consider bringing a partner, friend, or family member to your appointment if it helps you feel more at ease.

Voice your comfort level: By communicating your comfort level during the assessment and treatment, your therapist can adjust the session to avoid anything you’re not comfortable with.

Take your time: Remember, you don’t have to rush into any part of the treatment. It’s okay to have an initial session that doesn’t include an internal examination.