Pelvic health physiotherapy is a branch of orthopaedic physiotherapy that focusses on issues around the pelvic floor, pelvic girdle, tailbone and genitalia. Pelvic health physiotherapists have specialized training to evaluate your history as it relates to your pelvic area, and the pelvic floor muscles, connective tissue and nervous system directly with a vaginal or rectal exam. A pelvic health evaluation is often the missing link in pelvic pain, low back or hip pain, or persistent core dysfunction.
This is a common myth. Kegels are the general term for pelvic floor muscle contractions and gained favour in the past as the cure-all for incontinence, sexual pain, and many woes of the pelvis. Problems arose when Kegels were prescribed broadly and over-zealously to women and men without assessing if the pelvic floor was truly weak. Dr. Kegel himself individualized his prescription after an internal exam. As we know better, we do better. We now understand that pelvic dysfunction can occur because the muscles are too short, or too tight, or the timing and synergy are off, or the connective tissue is adhered or the brain map of the area is disrupted, just like any other region in the body. We wouldn’t give shoulder exercises without directly assessing how the shoulder moves, or how strong and coordinated the muscles, nerves and connective tissue are, and the same is true for the pelvic floor.
Many conditions of the pelvic region can influence the state of the pelvic floor, and conversely pelvic floor dysfunction can mimic symptoms of a variety of medical conditions. Often when a medically diagnosed condition exists we tend to attribute the majority of symptoms to that diagnosis and miss the opportunity to explore other causes of pain and dysfunction. The pelvic region is particularly susceptible to this phenomenon as our general knowledge of the area is low and fear and embarrassment are often high. A few of the more common conditions that both men and women seek care for are listed below.
Stress or Urge Urinary Incontinence
Fecal incontinence or Constipation
Pregnancy and Post-Natal Wellness and Recovery (vaginal or caesarean births)
Pelvic Pain – male or female
Pelvic Organ Prolapse
Vaginissmus, Vulvadynia or Vestibulodynia
Low back, SI Joint or Hip pain not responding to other multi-modal care
Pelvic post-surgical or post cancer care
Sexual Pain or Dysfunction
Sexual or other Physical Traumas of the pelvis
Persistent Core Dysfunction
Interstitial Cystitis or Bladder Pain Syndrome
Persistent Genital Arousal Disorder (PGAD)
Paediatric persistent Bed Wetting
Pro Function Pelvic Health Physiotherapists are well rounded and will assess your whole person in the context of your life when exploring any issues related to pelvic health. A detailed history will be taken to understand the depths of what might be driving your pelvic concerns. We will ensure you are comfortable with the process and understand if and why a pelvic exam is indicated. Initially an orthopedic scan will be done to get a broader picture of factors that are influencing the pelvis and then a vaginal (no speculum) or rectal exam will be conducted to assess the state of the muscles, nervous system and connective tissue within the pelvis as well as the strength, length and coordination of the pelvic floor muscles.
Treatment is highly individualized and your plan of care will be discussed and jointly decided upon after your initial assessment. Pregnant clients that have a normal risk pregnancy are asked to wait until after the first 12 weeks before considering a pelvic floor examination, and should allow at least 6 weeks of healing following the birth regardless of whether it was a vaginal or caesarean birth. Clients with higher risk pregnancies such as those with placenta previa, incompetent cervix, pre-eclampsia or multiples should seek the advice and clearance of your primary care provider, midwife or OB GYN before choosing a pelvic floor exam. Children and sexually inactive teens will be assessed with an external exam only.
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