• Pelvic Floor Physiotherapy

Everyone has a Pelvic Floor!

 

The pelvic floor is a bowl shaped, broad band of muscles, ligaments and connective tissue located at the base of the pelvis. It functions to support the pelvic organs, maintain continence and support the core and low back. In addition, the pelvic floor also plays a role in maintaining sexual function and promoting circulation from the lower extremities. It resists downward pressure created when straining, coughing or sneezing and prevents evacuation of digestive and urinary contents at inopportune times!

Weak or dysfunctional pelvic floor muscles can cause and contribute to a myriad of conditions, including back pain, pain with intercourse, incontinence, and repeated groin strains (just to name a few). Since the pelvic floor is the only stabilizing muscle that is oriented in the horizontal plane, it performs a critical role in spinal stability during all activities. Often chronic back, pelvic or groin pain that does not resolve with usual treatment is related poor pelvic floor muscle function. Since the pelvic floor muscles along with the deep abdominal and back muscles work together to provide lumbar stability, and weakness in one can impact function in the other muscles, it is important to assess all of the deep stabilizers together.

 

What happens to the pelvic floor during pregnancy and delivery

 

During pregnancy, there is an increased demand on the pelvic floor as it works to support the weight of the uterus as the baby grows inside the womb. Over the course of the pregnancy, the muscles and ligaments comprising the pelvic floor can become lengthened and weak due to this sustained increase in load. During labour, these tissues are stretched further, and in some cases may undergo additional trauma due to tearing, cutting (episiotomy) or use of forceps/suction during delivery. Changes in the strength, tone and contractility of the pelvic floor following pregnancy and delivery is often why some women experience symptoms of incontinence (leakage), pelvic pain or prolapse post-partum.

How can pelvic floor physiotherapy help with these issues?

 

There is strong evidence to support pelvic floor physiotherapy for the treatment of incontinence, prolapse and pelvic pain among other conditions. Depending on your symptoms, and the therapist’s assessment, treatment may include strengthening of the pelvic floor, learning to relax the pelvic floor, education on self-management strategies and/or manual therapy. Following your initial assessment, the therapist will discuss which treatments are indicated in the treatment of your condition, and work with you to develop an individualized treatment plan.

Real Time Ultrasound

 

We utilize Real-Time UltraSound(RTUS) to assist with pelvic floor and core muscles rehabilitation. The value of RTUS is that it allows for real time study of these muscles as they contract and impact their associated fascial attachments. This allows both the patient and the therapist to view the contraction as it happens, leaving little room for supposition. Consequently RTUS can be used as both an assessment tool, and maybe more importantly as a form of biofeedback, providing patients with knowledge of performance, in the early stages of motor relearning.

We use state of art, Alpion E-Cube 7 Diagnostic Ultrasound machine. Those type of machines are usually reserved for hospitals and Doctor offices. It allows to produce high quality image that are easy to inetrpret not only by the therapist, but also by the patient. Large, 19″ screen helps as well!

 

At Coast Therapy, Pelvic Physiotherapy Assessment can include:

  • A comprehensive history to identify issues specific to your post partum journey
  • Assessment of pelvic alignment
  • Real-time US assessment of pelvic floor, abdominal and back muscle function
  • Measurement of the DRA at rest and contracted. A distance of more than 2 cm. is considered worthy of concern.
  • An internal pelvic examination evaluates whether there is prolapse of bowel, bladder or rectum.  
  • Use of Biofeedback to assist with specific muscle re-training programs

This assessment can be performed starting at 6 weeks post-partum. It is recommended before jumping back into an exercise program.

Any of the following can be treated with Pelvic Floor Rehabilitation

  • Incontinence – Bowel or Bladder
  • Chronic or repeated groin pull/strain
  • Pelvic girdle pain including, coccydynia and/or SI joint dysfunction
  • Perinatal/Post-partum Health
  • Low back pain
  • Pelvic Organ Prolapse
  • Painful Intercourse

 

FAQ

What should I do before my first appointment?

Please fill out the intake form online before your appointment as that will assist your therapist in preparing for your appointment. Then follow the pre-appointment instructions which are as follows: void urine 1 hour before the appointment then do not void again until your appointment. In the hour leading up to your appointment please drink at least 16 ounces (2 cups) of water.

Can I come if I have my period?

Yes.

I am currently pregnant, should I wait until after I give birth to see a pelvic floor physiotherapist?

You can absolutely begin pelvic floor physiotherapy during your pregnancy as a preventative measure, or to address pelvic floor symptoms arising during the pregnancy (note: internal examinations are not done during the first trimester). Research has shown that strengthening the pelvic floor is associated with a shorter second (pushing) stage of labour. In addition, learning to effectively strengthen and relax the pelvic floor muscles during pregnancy may give you an advantage in the recovery process postpartum.

How soon after delivery can I come?

If you are waiting until after giving birth to get started, we typically recommend booking your first visit 6-8 weeks postpartum.

I have pain with intercourse. How can you help me?

Pain with intercourse can be related to several different components. We can assess if your pelvic floor muscles are tight and teach you how to relax them. We can also provide education regarding other factors that play a role in painful intercourse.

I think I may have pelvic floor dysfunction, does this mean my Pelvic floor is weak?

Not necessarily. In many cases an overactive (rather than underactive) pelvic floor is the cause of pain and dysfunction. In these cases, strengthening the pelvic floor before learning to relax it properly first may be counter-productive. Your pelvic floor therapist will assess whether your pelvic floor is underactive or overactive, and develop a treatment plan focused on addressing any deficits.

I delivered my child 2 month ago. I have no pain or incontinence. Is is worthwhile to make an appointment regardless to check it out?

Yes! Pregnancy and delivery can put a large stress and stretch on your core and pelvic floor. Most women can benefit from learning how to safely and properly train their core and pelvic floor muscles.

What happens during a pelvic exam?

The therapist will do an internal pelvic exam and assess the tone or tightness of your muscles as well as the strength of your pelvic floor muscles.

Is the treatment painful?

The therapist will take time before the examination to outline what the assessment will involve, what the goals of the assessment are, if there are any risks to the assessment, if there are any alternative methods to assess and ask for your consent to proceed. The therapist will also describe the recommended treatment, any risks and any alternative treatments following the assessment. The therapist will make every effort to describe what is about to happen or what may be felt during the assessment and treatment. As with any physical therapy assessment or treatment you may ask for clarification and ask the therapist to stop (withdraw your consent) at any time.

Can I bring my kids/newborn?

Yes. Our room is large and we have some toys at the clinic. Unfortunately, being a busy health clinic, we cannot watch your children for you. It is up to you to determine the suitability and whether your child will be okay during your treatment session. From our experience, it is best to arrange childcare for the first visit as it is quite long and involves lots of education and explanation. You will feel more relaxed and likely gain more from your visit if you are able to attend without children present.  Subsequent visits are generally shorter with less need for detailed discussions, and as such may be more suitable if you need to bring your child. Please feel free to discuss this with your therapist if needed.

Can I bring somebody else to be present during my visit?

Absolutely. We want you to feel comfortable and are happy to support you in any way we can to make your comfort a priority.

I know you are using Real-Time UltraSound. Can you tell me anything about my fetus, pregnancy or other medical conditions (hernia, kidney stones etc)?

No. We use Ultrasound within the scope of Physical Therapy practice, which means that we cannot and do not provide diagnosis like MDs or Sonographers. We can certainly tell and show you, how your muscles work and give a detailed assessment of function quality of your core, abdominal, back and pelvic floor muscles.

After my pregnancy I have a Diastasis Rectis (abdominal separation). Can you fix this?

Separation of the abdominals occurs in all pregnancies that reach full term and are noticeable for at least 6-8 weeks after delivery.  The degree of separation does not necessarily correlate to the degree of function &/or pain.  Many women do not have persistent concerns about the separation and return to their previous activities without intervention.  However, if you do have concerns about abdominal separation or your core stability/strength following the first 6-8 weeks after delivery, or have related pain, we can assess this and check the function of your muscles. We can teach you how to use your core properly during every day activities (lifting, exercising, caring for baby) and create a specific exercise program that will improve the function and aesthetic appearance of your abdominal wall.  We can also help to assess the condition and provide valuable opinion to help your doctor or specialist determine whether further intervention is required or not.

I am a male who has a recurrent hip/low back/SIJ pain. Can I benefit from Pelvic Floor Physio?

Absolutely! In fact, research shows that weak and dysfunctional pelvic floor muscles are often present in chronic pain conditions. It may very well be the missing link that other rehab treatments are not addressing. Using RTUS we can easily tell if there is some dysfunction involving your core or pelvic floor. Most importantly, we can teach you using RTUS how to use those muscles correctly.

Is pelvic floor therapy only effective for new moms?

No, pelvic floor physio may help at any stage.  While it is easier to retrain the pelvic floor muscles sooner rather than later, progress can be made at any age, whether you’ve had a baby or not!

We can direct bill your Benefits Provider – Call us for more information. Our Coquitlam clinic is conveniently situated to offer Pelvic Floor Rehabilitation services to patients in Coquitlam, Port Coquitlam Port Moody, Burnaby, New Westminster and surrounding communities.

 


Coast Therapy is an award-winning provider of Massage Therapy & Physiotherapy services to Port Coquitlam, Port Moody, Pitt Meadows, Maple Ridge and Coquitlam residents for over 16 years.

We offer extensive experience in manual therapy and active care for complex sport & injury rehabilitation, prenatal & post-partum care, medical conditions, chronic pain, and general wellness concerns. Our therapists are experts in helping you achieve long-lasting pain relief and functional improvement.

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