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Pelvic Health

Pelvic floor muscles work with muscles in the low back and hip region to enable proper support of the lower back, pelvis, bladder and bowel.  The muscles in the pelvic floor play a key role in core stability, breathing, posture, and support of the pelvic organs.  When pelvic floor muscles are weak, or hypotonic, this can lead to supportive disorders such as incontinence and prolapse.  When pelvic floor muscles are shortened, tight, or hypertonic, this can lead to significant and persistent pelvic pain, frequent or urgent voiding, or constipation and retention issues. 

Pelvic floor physiotherapists are specially trained and regulated by the College of Physiotherapist in Ontario to treat pelvic pain and dysfunction.  This includes assessment of overall posture and function, closer analysis of pelvic pain patterns and bladder and bowel function as indicated. 

During assessment and treatment, the physiotherapist uses both internal and external techniques to properly assess and treat these pelvic floor muscles and associated structures.  Julie McDonald, GPC Pelvic Health’s physiotherapist uses manual techniques, specialized exercises, and lifestyle modifications to treat pelvic pain and dysfunction. 

Many women do not realize:

  • It is not normal to leak when you laugh, cough or sneeze.
  • It is not normal to have pain with intercourse.
  • It is not normal to feel pressure or heaviness in your pelvic region.
  • It is not normal to feel pain in the pelvic region.

Pelvic physiotherapists will complete a detailed evaluation to determine how they can best assist you with these types of difficulties. 

Pelvic physiotherapy is fast being established as the number one treatment choice for pelvic dysfunction including pain and incontinence.  If you experience low back, chronic hip pain or pelvic dysfunction you may benefit form pelvic physiotherapy. 

Some of the conditions pelvic physiotherapists address include:

1. Pelvic pain including pain in the lumbar, hip, genital area, and rectum.

  • Pudendal Neuralgia (genital nerve pain)
  • Interstitial Cystitis/Painful Bladder Syndrome
  • Urinary Tract Infections
  • Post Abdominal Surgeries
  • Chronic/persistent low back/ Si joint/tailbone pain
  • Vulvodynia (generalized vulvar pain)
  • Vestibulodynia (inner labia pain)
  • Vaginismus (painful penetration)
  • Clitorodynia (pain over/around the clitoris)

2. Incontinence (leakage), urinary frequency, urinary urgency

Research shows that before a surgical consultation for incontinence, patients should see a Pelvic Health Physiotherapist (who uses internal examination to assess the pelvic floor and teach appropriate exercises). In Britain, clients with these issues will not even be considered for surgery until they have tried 6 weeks of Pelvic Physiotherapy. Ontario, and most of Canada, has not yet adopted this practice. Talk to your doctor about pelvic floor Physiotherapy before considering surgery.

3. Prolapse (Pelvic heaviness)

Pelvic Physiotherapy is recommended as the first line of defence before surgery for pelvic organ prolapse.  Prolapse is a condition caused by weak or damaged pelvic floor muscles or support system. Some factors that may contribute to prolapse include: vaginal childbirth, menopause, chronic constipation and heavy lifting, and previous abdominal surgeries. Pelvic Health Physiotherapists do an internal exam to accurately evaluate the strength of the pelvic floor and assess for other contributing factors. Specific exercises are then prescribed to address specific assessment findings. 

4. Bowel dysfunction including constipation, straining or pain

Good bowel function is an essential part of our health and well being.  Constipation and Irritable Bowel Syndrome (IBS) are common pelvic disorders with many different causes.  Pelvic physiotherapists are trained to assess the muscles and structures surrounding the bowel.  These muscles play an important role in bowel function.  When addressing pelvic health the physiotherapist will look at your diet, bathroom habits, medications, stress levels, and health history in a detailed assessment.  Treatments are directed to each individuals needs based on these assessment findings. 

5. Dyspareunia (painful intercourse)

Some women can experience pain with intercourse. Pelvic pain can be experienced during sex, initial or deep penetration and orgasm. This is a common problem with many different causes. Treatments focus on the underlying cause, and can help eliminate or reduce symptoms.

6. Dysmennorhea (painful periods)

There are many contributing factors to dysmenorrhea (painful periods), including vascular congestion, stress/anxiety, uterine fibroids, and endometriosis. Pelvic Health Physiotherapy can help restore function and blood circulation to organs important to reducing pain.

7. Pregnancy Related Pelvic Concerns

Pelvic floor physiotherapy can be an important part of pre- and post- partum care. In France, it is recommended that all women who give birth vaginally see a physiotherapist as part of their post-natal care. If you are experiencing Diastasis Recti Abdominus (DRA = abdominal separation), pelvic/back pain, urinary leaking, heaviness, or just want to prepare for birth, Pelvic Physiotherapy can be an important part of your treatment plan.

What can I expect at my first appointment?

Pelvic physiotherapy is an extension of orthopaedic physiotherapy.  Physiotherapists trained in pelvic physiotherapy are trained to look the entire body.  At your initial visit your pelvic health physiotherapist will take your full medical history and discuss any concerns and difficulties you are experiencing.  She will ask questions about your pelvic pain history, surgical history, eating, drinking, voiding, and pain experienced with intercourse as they relate to your symptoms.  She will look at your posture, breathing, and muscles which may be contributing to weakness, tightness, or strain in the pelvic region.  This may include an external as well as an internal exam to determine pelvic floor muscle health.

After the assessment, your Pelvic Health Physiotherapist will work with you to develop a plan of care specific to your goals, symptoms, and needs.  Follow-up visits will be scheduled as needed usually within 1-2 weeks of the initial visit.

Please wear comfortable clothing to each session. 

What does treatment look like? 

Your Pelvic Health Physiotherapist will work with you to develop a plan of care specific to your needs. This may include:

  • Education and lifestyle modifications to help normalize bowel and bladder habits
  • Exercises to help improve pelvic floor muscle function
  • Exercises to help improve core strength
  • Relaxation techniques to help relax pelvic floor muscles
  • Manual techniques to assist with normalizing pelvic floor muscle tone and strength
  • Manual techniques to restore normal low back, pelvic, and hip joint mechanics

What To Expect

Assessment involves looking at the big picture and identifying contributing factors. Often these challenges are multi-faceted and require a holistic approach to rehabilitation. In addition to a thorough subjective history, assessment may involve orthopedic and movement screening, connective tissue evaluation for tension and mobility, and internal palpation, if indicated, to assess pelvic muscle function. Treatment of these conditions may include specific stretches and exercises, manual therapy, lifestyle modification and problem-solving strategies. You can expect open communication and teamwork to help you reach your goals.

Scheduling an Appointment

If you would like to schedule an appointment with our Pelvic Health physiotherapist, Julie McDonald please call 519-357-1383. You can contact Julie directly by emailing her at