Frequently Asked Questions
Pelvic Floor Physiotherapy FAQs
Your Pelvic Physiotherapist will start off by collecting a detailed history of your symptoms. She will then ask about many other potential symptoms that often go with pelvic floor dysfunction. These include questions about sexual function, bladder, bowel, low back, hip and tailbone symptoms. These questions may seem very personal and unrelated, but if there are problems in any of these areas, it is important to tell your therapist as they are often related to pelvic floor dysfunction. Your Pelvic Physiotherapist may ask you to fill out further questionnaires which will give her a better idea of what is contributing to your specific symptoms.
Once your Pelvic Physiotherapist has gathered information about your condition, she will begin a physical assessment. These may vary depending on your symptoms, and may not all be completed on the first visit. The physical assessment may include assessment of your low back, SI joints, connective tissue of the abdomen and thighs, and a pelvic floor assessment. Typically, a pelvic floor assessment involves an internal exam looking for trigger points in the pelvic floor, and assessing the strength of the pelvic floor. If you are uncomfortable with an internal exam treatment can absolutely still be provided. We welcome you to bring a support person to your appointment if this would make you feel more comfortable. Your support person can be in the room during the internal examination if you wish.
Once your Pelvic Physiotherapist has completed her examination, she will explain her findings to you. She will give you exercises or other homework to do, and explain how often you should return for treatment. She will explain what changes you should expect to see, and how long you should expect your treatment to take. She will give you time to ask questions.
An internal examination is not required, but please read on to find out why an internal exam may be suggested.
There are three main reasons that we assess and treat the pelvic floor muscles internally, either rectally or vaginally. The first is that these muscles cannot be palpated or reached externally, The second is that we are unable to ensure that your prescribed exercises are being completed properly. Lastly, and most importantly, we are assessing to see whether these muscles are lengthened and weak, or tightened and weak. This determination will dictate the course of your treatment. If we look at the research, there is clear evidence to suggest that giving written or verbal cues for pelvic floor muscle training does not constitute adequate training. Additionally, there are guidelines that recommend that pelvic floor muscle training be completed using an internal approach or biofeedback. We welcome you to bring a support person with you to your appointment if it makes you feel more comfortable. Your support person may be in the room during an internal examination if you wish. Like any course of treatment, on rare occasions patients can experience the following adverse reactions: NAUSEA OR LIGHTHEADEDNESS, PAIN OR DISCOMFORT, SKIN IRRITATION OR REACTION TO LUBRICANT GEL, ANXIETY OR EMOTIONAL DISTRESS, BLEEDING DURING OR AFTER TREATMENT UNRELATED TO MENSES. Please inform your physiotherapist should any of these reactions occur. We cannot perform internal treatment on patients under the following circumstances. If any of these apply to you, or if this information changes in the future, please inform your physiotherapist: ACTIVE INFECTION, RADIATION INJURY LESS THAN 12 WEEKS, POST-OPERATIVE LESS THAN 6 WEEKS (12 WEEKS FOR PROLAPSE REPAIR), ACTIVE RECTAL BLEEDING, SEED IMPLANTS OF RADIOACTIVE MATERIALS, IF YOU ARE PREGNANT AND HAVE BEEN ADVISED BY YOUR DOCTOR TO ABSTAIN FROM INTERCOURSE. Potential benefits of treatment may include: DECREASED SYMPTOMS, IMPROVED STRENGTH, AWARENESS AND FLEXIBILITY, IMPROVED BLADDER/BOWEL CONTROL, DECREASED PAIN AND DISCOMFORT, IMPROVED ABILITY TO PERFORM DAILY ACTIVITIES, IMPROVED KNOWLEDGE AB OUT MANAGING AND TREATING YOUR CONDITION.
If you do not wish to undergo the internal assessment and treatment of your pelvic floor you can absolutely continue with treatment, the physiotherapist will discuss alternatives with you.
This will depend on your condition and its complexity. In general, for simple incontinence or prolapse (without any exacerbating factors), you will require 6-12 treatments. If you have a complex pain issue, this will likely take longer.
Yes, there is homework. Some examples of homework you may have include stretches, strengthening exercises or tracking things like bladder or bowel habits, diet, and fluid intake.
Pelvic floor physiotherapy is so much more than just Kegels (pelvic floor muscle training). If you have tried doing Kegels in the past but have not noticed any improvement, there could be many reasons.
Firstly, up to 30% of women are unable to do a Kegel when asked. Many women instead contract their abdominals, glutes, or adductors. Or they bear down (push). If this is the issue, you may have been attempting to do Kegels, but you have actually been strengthening the wrong muscles. A pelvic floor physiotherapist will check vaginally or rectally so they can actually feel your Kegel, and teach you how to locate and contract your pelvic floor.
If you have been doing Kegels with no effect, the problem could be that your pelvic floor is actually too tight, or has trigger points. For a muscle to be effective, it needs to have strength, but it also needs to be able to relax. For instance, if you can’t open your fist, strengthening your hand is not going to help. In this case, doing Kegels may have actually made your symptoms worse. Instead, your pelvic floor physiotherapist will release the tension or trigger points in your pelvic floor muscles, and give you stretches or other exercises to do at home. Your pelvic floor physiotherapist will also help you determine what other factors may be contributing to the tension or trigger points in your pelvic floor.
EMSELLA FAQs
This is by far the number one question that we are asked multiple times every single day. They answer is yes! It’s ok to be skeptical, we were at first as well. But as we researched this new technology, read all the available studies, and peppered BTL (the developer and manufacturer of EMSELLA) it became clear that we had to make this technology available to our patients. We have used EMSELLA ourselves and the results have been amazing.
EMSELLA is an US FDA and Health Canada approved medical device. The technology uses a non-ionizing electromagnetic energy to stimulate the contraction of muscle cells. This technology does not have a thermal effect on the body.
The second most common question that we are asked is, “what does it feel like?” This is a little bit more difficult to answer because the sensation is very new and different. It doesn’t hurt and it’s neither pleasant or unpleasant, it’s just very different. If we had to describe it we would say that it feels like a strong buzzing in your perineum with occasional slower deep pelvic floor muscle contractions. The feeling is the most intense during the first visit when it’s new and you’re not sure what to expect. By visit number six, it’s comfortable and familiar.
Yes, EMSELLA benefits men and male pelvic floor anatomy. Men who are experiencing urinary leaks, feelings of urgency, excessive frequency and waking at night can expect to see an improvement with EMSELLA. EMSELLA has also been shown to help men with erectile dysfunction related to pelvic floor dysfunction. Men also report improvements in sexual satisfaction such as more pleasurable orgasms and improved volume of ejaculate.
Yes, EMSELLA benefits women and female pelvic floor anatomy. Women who are experiencing urinay leaks, feelings of urgency, excessive frequency and waking at night can expect to see an improvement with EMSELLA. Women may notice increases in sexual pleasure, confidence, lubrication, intensity of orgasms and overall sexual satisfaction after EMSELLA treatments.
Not at all! This is one of the benefits of EMSELLA technology. You sit down in the clothes you wore to your appointment and in 28 minutes you’re ready to go. Treatment is completely non-invasive.
The sound! No one is expecting the sound. EMSELLA uses a powerful electromagnetic force to depolarize the muscle cells of your pelvic floor and trigger them to contract. If you’ve ever had an MRI you know that a powerful electromagnet doesn’t work silently. You can expect to hear some tapping and buzzing during your EMSELLA treatment. It’s much quieter than an MRI, but it’s still louder than anyone expects.
Each EMSELLA treatment sessions last 28-minutes. Allowing a few minutes to remove your jewelry and get comfortable, you can expect to be in and out in 35-minutes. There is no downtime and you can return to all your normal activities immediately. A course of EMSELLA treatment consists of six visits, or two visits per week for three weeks.
This varies from person to person but it is not uncommon for patients to report that they begin to notice improvements after their first visit.
As with any exercise program, the saying “use it or lose it” also applies to the muscles of the pelvic floor. EMSELLA strengthens your muscles but some maintenance is required to keep your muscles in top form. You can complete 3-4 EMSELLA maintenance visits per year or actively complete your Kegel exercises or some combination of both. With proper maintenance, EMSELLA results are long lasting.
The side effects of EMSELLA are very minor and in most cases are similar to what you might expect from beginning any new exercise program. Most commonly reported is an increased awareness of the muscles of the pelvic floor and some very minor discomfort of tendons. Typically, this is most noticeable after the first visit and only lasts for a couple of hours. The manufacture of the EMSELLA chair notes that side effects may include muscular pain, temporary muscle spasm, temporary joint or tendon pain, temporary increase of local circulation, increased sensitivity during intercourse, and local skin redness.
If you are pregnant, have implanted electronic devices, or have metallic implants you cannot receive EMSELLA treatment. If you have questions about contraindications please call us to discuss. If you can’t participate in EMSELLA treatment because of a contraindication don’t worry, you can still benefit from treatment with a pelvic floor physiotherapist.