Our Mission at Markham Pelvic Health is to remove stigma, educate and provide leading treatment in pelvic floor physiotherapy. Over the years, we’ve had so many questions from our clients. We’ve done our best to assemble a guide to include everything from basic anatomy to frequently asked questions that may be on your mind before your first appointment!

1. What is Pelvic Floor Physiotherapy?
2. When is the best time to seek treatment?
3. What does treatment involve?
4. Is an internal assessment necessary?
5. What Conditions can be treated with Pelvic Floor Physio?

Pelvic floor physiotherapy (AKA Pelvic Health Physiotherapy) is a specialized form of physiotherapy focused on the pelvic floor muscles and all of the surrounding muscles around the pelvic bones. The pelvic floor supports your pelvic organs and are crucial in functions such as bladder & bowel control, sexual function, and after childbirth. When the pelvic floor muscles are not functioning correctly, it can often lead to symptoms such as urinary or fecal incontinence, sexual dysfunction and pelvic pain.

This is also known as pelvic floor dysfunction. Pelvic floor physiotherapy aims to evaluate, diagnose and treat these conditions through manual therapy, exercise and education.

Most people will come in for pelvic physio when they begin to experience symptoms of pelvic floor dysfunction. You should consider treatment for pelvic floor physiotherapy if you experience any of the below symptoms:

• Urinary Incontinence
• Pelvic Pain
• Painful Intercourse
• Diastasis recti (abdominal muscle separation)
• Pelvic Organ Prolapse (when one or more of your pelvic organs descend from their normal position)

If you are pregnant or a surgical candidate, It’s recommended that you take a proactive approach and start your pelvic floor physiotherapy program before symptoms begin. This helps ensure thorough preparation is provided to help you feel empowered for the big event, provides a baseline for rehab potential, and helps speed up recovery.

Pregnancy
We recommend starting pelvic floor physiotherapy in your second trimester. Through manual therapy, exercises and education, you will be able to better prepare for the physical demands of labour & delivery.

Starting in your second trimester will help minimize the physical trauma and symptoms you may experience through pregnancy and postpartum.

Surgical Candidates
Creating a plan for pre-operative preparation and recovery can help improve your outcomes for surgery. Did you know that starting pelvic floor physio early on can help improve post-surgical outcomes?

Older Adults
Contrary to popular belief, it is never too late to start pelvic floor physiotherapy! Many of the clients we see have been experiencing their issue for decades, and surprised to find that great improvements can be made quickly.

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All treatment programs start with a 60 minute assessment in a private room with your pelvic floor physio. The most accurate diagnosis of your condition will be provided based on your medical history and the internal assessment of your pelvic floor muscles.

Treatment goals are then defined by you and your pelvic floor physio, in a collaborative manner. A detailed plan of care will be created to map out how we will help you reach your goals.. This will often include a combination of manual therapy, exercise program and education.

An internal assessment of the pelvic floor provides the most accurate diagnosis of your condition. It provides a full picture of what is causing your issue and what needs to be done to address it. Treating the pelvic floor muscles over clothing is similar to treating a knee through a pair of jeans. It may likely still be effective, however, it may take longer to help you achieve your desired outcomes.

Some of the conditions below may seem common, but they are not normal and can oftentimes be treated with a non-surgical approach through pelvic floor physiotherapy.

• Incontinence
• Overactive Bladder (OAB)
• Pelvic Organ Prolapse
• Diastasis Recti Abdominis (Abdominal Separation)
• Vaginismus
• Chronic Pelvic Pain
• Painful Bladder Syndrome or Interstitial Cystitis
• Chronic Low Back Pain or Sacroiliac Joint Pain
• Vulvodynia or Vestibulodynia
• Constipation, hemorrhoids, and anal fissures
• Pudendal Neuralgia
• Dyspareunia

Incontinence
Unwanted urine, fecal and gas leakage. It is common in pregnancy and older adults. It often happens during activities such as running, laughing, coughing and jumping. It also makes you feel the need to rush to the bathroom in certain situations. Did you know there are actually two different kinds of Incontinence?

• Stress Incontinence occurs during the sudden increase in abdominal pressure that puts stress on your bladder
• Urge Incontinence refers to that feeling of needing to rush to the bathroom as soon as you get home.

Overactive Bladder (OAB)
Sometimes referred to as irritable bladder, this is the frequent and sudden urge to urinate that may or may not result in leakage. Normally, signals are sent to the brain that the bladder needs to empty itself as it slowly fills up with urine. The sensations being mild and get stronger as your bladder fills up. With Overactive Bladder, your bodies signalling process malfunctions as your bladder by only send strong and urgent signals.

Pelvic Organ Prolapse
A condition where one or more of the pelvic organs sits lower in the pelvic cavity. It occurs when the supportive muscles and tissues become loose and weak. It’s a condition that often occurs if you have given birth.

Diastasis Recti Abdominis (Abdominal Seperation)
A separation or stretching of the rectus abdominis muscle in your abdomen, which often occurs after having a baby. This is often related to core weakness, back pain, incontinence, and prolapse.

Vaginismus
Involuntary contraction and tensing of the vaginal muscles with attempted vaginal penetration including tampon insertion, sexual intercourse, and gynecological examinations. Usually involves pain, burning, and excessive tightness.

Chronic Pelvic Pain
Pain in the general pelvic region lasting longer than 6 months. This may occur with Irritable Bowel Syndrome, after a urinary tract or prostate infection, surgery for endometriosis, prolapse repair, or pelvic trauma (ie. slip and fall).

When your body is exposed to an injury, your body’s alarm system will activate and your nerves will become slightly more sensitive. As your injury begins to heal, your nerves will slowly return back to its resting level of sensitivity. With chronic pain, your body’s alarm system may remain heightened even if this injury is healed. Learning to retrain your body’s nervous system can help you overcome chronic pelvic pain.

Painful Bladder Syndrome or Interstitial Cystitis
Bladder pain that is usually experienced when the bladder fills and relieved when emptied. It can be associated with a thickened bladder wall, lesions in the bladder, and bladder inflammation.

Chronic Low Back Pain or Sacroiliac Joint Pain
Recurring or persistent back or pelvic pain? The pelvic floor is usually overlooked and may likely be the missing piece of the puzzle!

Vulvodynia or Vestibulodynia
Pain felt in the external female genitalia (vulva) or at the opening of the vagina.

Constipation, hemorrhoids, and anal fissures
Hard stools, excessive straining, and tearing or protrusion of the anal tissues can be related to pelvic floor tension or coordination difficulties.

Pudendal Neuralgia
Irritation or compression of this nerve often results in pain with sitting, voiding, and with sexual function.

Dyspareunia
A general term that describes painful intercourse. It affects both males and females and may be related to a menopause, muscular tension, scar tissue dysfunction, or an underlying medical condition.