The bones of a human pelvis in a doctor's office.

Pelvic Floor Physiotherapy

Pelvic floor physiotherapy is an effective treatment for incontinence, pelvic pain, pelvic organ prolapse, and a variety of other conditions affecting all genders.  Pelvic floor physiotherapy is more than just doing Kegels.  A pelvic floor physiotherapist will provide you with the specific treatment, exercises, and lifestyle changes to help you live healthy, confidently and pain free.  Pure Pelvic Health is a safe, friendly environment and we encourage anyone who needs help to book a consultation.  The results could be life changing.

What is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy or pelvic health physiotherapy is the physiotherapy-based treatment of common dysfunctions associated with the muscles and other soft tissues of the pelvis and surrounding structures.  Dysfunctions may include but are not limited to pain, sexual dysfunction, fecal or urinary incontinence (leaks or accidents) and pelvic organ prolapse.  Pelvic health concerns are very common in all genders and ages but are often not discussed due to shame or embarrassment.

Who are Pelvic Floor Physiotherapists?

Pelvic floor physiotherapists are registered physiotherapists who are uniquely trained to assess, educate, empower and treat pelvic floor dysfunction.  Their understanding of the human body’s interrelated structures and the indicators and symptoms of dysfunction provide their patients with evidence-based treatment and optimal results.  Pelvic floor physiotherapy is a relatively new specialty within the practice of physiotherapy so always ask your pelvic floor physiotherapist what additional education the have obtained and how long have they been practicing as a pelvic floor physiotherapist.  Pelvic floor physiotherapists at Pure Pelvic Health each have more than a decade of experience and have completed numerous pelvic health related continuing education courses.

Is pelvic floor physiotherapy effective?

Pelvic floor physiotherapy is the first line of treatment for many pelvic floor conditions and it is  quite effective.  The muscles, connective tissues and structures of the pelvic floor react to strengthening, stretching, and retraining just as any other part of the body.  The unique challenge of treating the pelvic floor is these muscles and structures are not visible to the patient.    Results may vary from individual to individual but overall you can expect to see a significant improvement in your condition with pelvic floor physiotherapy.

Mature woman running with fall leaves

What happens at my first visit?

Many new patients are understandably nervous about their first visit to Pure Pelvic Health.  We get it completely and we are committed to making your experience a positive one.  Here’s what you can expect at your first appointment.  When you arrive a Pure Pelvic Health you will be greeted by Maureen’s friendly smile.  When it is time for your appointment your physiotherapist will introduce herself and invite you into a private consultation room.  Your first appointment is an hour long and  most of this time is spent speaking with your physiotherapist about your concerns.  She will review your health history information with you and ask lots of questions to ensure she fully understands your symptoms, concerns, and goals for treatment.  During this visit your physiotherapist will discuss the benefits of an internal examination with you.  An internal examination is always optional but it is the best way to palpate (to feel) the muscles of your pelvic floor and determine what muscles are causing your symptoms.  Your comfort is the number one priority and you can still participate in pelvic floor physiotherapy if you would prefer not to have an internal examination.

Why am I having pelvic floor symptoms?

Pelvic floor dysfunction is generally caused by hypotonicity or hypertonicity of the pelvic floor muscles. More simply, dysfunction is caused by weakness or tightness of the pelvic floor muscles. Weakness can lead to incontinence or pelvic organ prolapse. Tightness can lead to pelvic pain, painful sex, vaginismus, vulvodynia, bladder pain, endometriosis, urge and urge incontinence. Identifying weakness or tightness or a combination of both is part of the initial physical assessment. Your pelvic floor physiotherapist will often suggest an internal exam to best identify what muscles are causing your symptoms. An internal exam is always optional. You can read more here about why pelvic floor physiotherapists do an internal examination.

View our FAQ here.

Sad and tired woman with postpartum pain working beside table, looking on laptop, sitting in messy room

But I’m only in my 30s!

Pelvic floor muscles are similar to any other muscles in your body.  They are susceptible to injury, overuse and underuse, and may respond physically to traumatic and emotional situations.  If you are in your 20s or 30s and wondering why you are experiencing pelvic floor symptoms please know that you are not alone.  Every week Pure Pelvic Health sees patients from all genders ranging from young adults to seniors.

Is Pelvic Floor Physiotherapy only for Women?

Pelvic floor physiotherapy is not just for women.  Pain, leaks and sexual dysfunction are common in all genders and often have a complicated web of causal factors.  These may include trauma or injury, dysfunction secondary to a surgery such as a prostatectomy, or behavioral and emotional factors that can lead to dysfunction over time.  A Pure Pelvic Health pelvic floor physiotherapist can help a patient of any gender to manage or overcome pelvic floor dysfunction and live the life they deserve.

Senior couple walking in the sunshine

“Went there 6 weeks post partum and saw Silvana!  She is amazing!  Wouldn’t go anywhere else!”

Marlee Smith

“Danielle is a wonderful pelvic floor physiotherapist and has a holistic approach.  She goes above and beyond to make her patients feel comfortable and understand their symptoms.  She is a great listener and asks meaningful questions so that the patient makes deeper connections with their health.  You’re in good hands with Danielle.”

Dr. Lisa Tabrizi

“I’ve had three sessions with Danielle this far (4 if you include the assessment).  She is very knowledgeable and uses evidence based approaches.  I’ve had pelvic floor physiotherapy in the past with another practitioner, but have gotten better results with Danielle’s approach.”

Rebecca Henry

“I’ve been seeing Danielle for over a year.  I couldn’t have wished for a better experience.  She is amazing and has always made me feel comfortable and in control of body and health.  She is helping me recover from stubborn coccidynia.”

Susanna Miles

“I send a lot of patients who have urinary issues like urinary urgency, frequency and incontinence, especially post-partum, post-menopausal and post-prostatectomy.  Danielle is very knowledgeable and helpful.”

Dr. Justin Gallant

“I had a very positive experience at Pure Pelvic Health. I was recommended to this clinic specifically by my RMT. And this was a wonderful recommendation because I made so much progress and healing in my postpartum journey. I am very grateful for the care I received from Silvana. She was very knowledgeable, kind, understanding and patient. I learned a lot in my 6 months of treatment! Maureen does a lovely job of maintaining the office, she is prompt in greeting and answering the phone/emails! I always felt welcomed each time I was there. Thank you all!”

Sarah

“I cannot say enough good things about Pure Pelvic Health. Silvana is amazing! She helped me with a long-term problem and the results were life-changing. I had no idea there was that kind of help available. I would see Silvana and Maureen at each visit and they both made me feel completely comfortable and welcome. If there was an option for ten stars, I would choose that.”

Colleen

“I met with Danielle one of the physiotherapists and I felt I was in good hands, 5 minutes into the consultation.  She was kind, patient explaining every step of the way.  Her knowledge helped me decide confidently on a different therapy approach with her.  All positive!”

Line G

“What an amazing place!  Maureen, the OA, was always helpful arranging appointments around my work hours.  Silvana’s sense of humour and relaxed manner made what could have been somewhat uncomfortable appointments into very manageable ones.  I had great results with the therapy and continue to use the exercises for continued improvements.  Thanks!”

K Gur

“I went here and saw Danielle 5 weeks postpartum.  She is very knowledgeable, made me feel comfortable, and has helped me a lot!  Highly recommend!”

Sarah Boot

“Great experience.”

Ciara Timson

“I had a great experience here with Silvana.”

Relle LB

Conditions Treated

There are three main types of urinary incontinence:

Stress Urinary Incontinence – Occurs when urine leaks during activity where there is increased abdominal pressure or impact such as coughing, sneezing, laughing, jumping, running, lifting, etc.

Urge Urinary Incontinence – Is when a strong urge to empty the bladder is accompanied by leaking. Mixed Urinary Incontinence – Is a mixture of stress and urge incontinence.

Urinary Incontinence often occurs when the pelvic floor muscles are not working effectively. This may be due to weakness, decreased coordination, decreased muscle awareness, increased pelvic floor muscle tension or difficulty relaxing the pelvic floor.

In Stress Incontinence, the pelvic floor muscles normally contract automatically to support the pelvic organs (including the bladder) and prevent leakage when you increase the pressure in your abdomen by coughing, laughing, sneezing, lifting, jumping or running. If your pelvic floor muscles are too tight or too weak, they may not be able to contract effectively to prevent this leakage. Another issue could be that your pelvic floor muscles no longer contract automatically.

In Urge Incontinence, the pelvic floor muscles are responsible for controlling when you release urine. When your pelvic floor contracts, it causes the bladder (a muscle) to relax and continue to fill. When your pelvic floor is too tight or too weak, it cannot effectively inhibit the bladder muscle, causing urge that you cannot delay.

EMSELLA and pelvic floor physiotherapy are effective treatments for all types of urinary incontinence.

Urinary incontinence is common in men who have had surgery or radiation for prostate cancer. The severity of incontinence varies between men. It is often related to decreased effectiveness of the pelvic floor muscles due to weakness, tension, or decreased awareness of the muscles.

Urinary urgency and / or frequency is often called Overactive Bladder. It occurs when there is a frequent, strong urge to urinate that interferes with daily life. Often these urges are out of proportion with how much urine is actually in the bladder.

The pelvic floor muscles are responsible for controlling when you release urine. When your pelvic floor contracts, it causes the bladder (a muscle) to relax and continue to fill. When your pelvic floor is too tight or too weak, it cannot effectively inhibit the bladder muscle, causing urge that you cannot delay.

Other things that can contribute to urinary urge are diet, drinking habits, toileting habits, stress and anxiety. It is commonly thought that drinking less will help decrease urge. This can in fact have the opposite effect as this will concentrate urine, irritating the bladder.

Pelvic floor physiotherapy can help to decrease tension in your pelvic floor, or strengthen your pelvic floor, depending on your needs. Your pelvic floor physiotherapist will also teach you how to use your pelvic floor, as well as other techniques to first decrease the intensity of your urge, and then how to actually delay urge. She may make recommendations on fluid intake.

Pelvic floor physiotherapy is an effective treatment for overactive bladder (OAB) and urge. Your pelvic floor physiotherapist will assess all factors contributing to your condition including your pelvic floor tension and strength, diet, drinking habits, toileting habits, stress and anxiety. Pelvic floor physiotherapy may include education on bladder function and urge, education on the effects of diet and activities, bladder training, pelvic floor muscle training (Kegels or EMSELLA), stretches, and the release of tight pelvic floor muscles.

Vulvodynia essentially means pain in the vulva. It is diagnosed where other medical conditions or infections have been ruled out. It often occurs when your pelvic floor muscles and surrounding tissues have become very tight. It is usually accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic organ prolapse is when one or more of the pelvic organs (the bladder, uterus, or rectum) encroach on the vaginal space. Symptoms of a prolapse may include pressure or discomfort in the perineal area, a feeling of something “coming down”, or noticing something protruding from the vagina.

Pelvic organ prolapse affects approximately 50% of women who have had children, and also occurs in a significant number of women who have never been pregnant. Pelvic organ prolapse is often due to weak or ineffective pelvic floor muscles that are unable to support the downward pressure of the pelvic organs. Pregnancy, childbirth, chronic constipation and hormonal changes all contribute to pelvic organ prolapse.

A pelvic floor physiotherapist will help you to release trigger points and address tension that may be resulting in pain or discomfort. She will also help you address the prolapse itself by creating an exercise program tailored to your specific needs. One-on-one physiotherapy has been shown to be an effective treatment for pelvic organ prolapse.

Painful bladder syndrome, often referred to as Interstitial Cystitis, is pain or burning with a full or filling bladder, or with emptying the bladder. It may be accompanied by an increase in urinary frequency. It occurs in 2.7 to 6.5% of women. It is more commonly diagnosed in women than men, with 90% being women. Women with Painful Bladder Syndrome/Interstitial Cystitis may often also have endometriosis, dyspareunia (painful sex), vulvodynia (vulvar pain) or irritable bowel syndrome (IBS). There are many similarities in symptoms between Painful Bladder Syndrome/Interstitial Cystitis and Overactive Bladder (OAB).

In men, there is a significant overlap in symptoms between Painful Bladder Syndrome and Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CPPS). Because of this, many men are diagnosed with Chronic Prostatitis or Chronic Pelvic Pain Syndrome instead of Painful Bladder Syndrome/Interstitial Cystitis.

Symptoms of Painful Bladder Syndrome/Interstitial Cystitis are often exacerbated by diet. Coffee, tea, citrus, carbonated or alcoholic beverages, tomatoes, spicy foods, artificial sweeteners and wheat products are some of the more common irritants.

Painful bladder syndrome is often accompanied by tight pelvic floor muscles and surrounding tissues. In fact, 87% of patients with Painful Bladder Syndrome/Interstitial Cystitis have pelvic floor pain, tension or trigger points. Painful Bladder Syndrome/Interstitial Cystitis may or may not be accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

The Canadian Urology Association recommends that patients with Painful Bladder Syndrome/Interstitial Cystitis participate in Pelvic Floor Physiotherapy, as it has been shown to provide moderate improvement to complete resolution in 71-83% of patients.

Bowel incontinence is the involuntary loss of stool. Bowel incontinence may be accompanied by either constipation or loose stools. It is often related to ineffective pelvic floor muscles, which may be due to weakness, tightness, or decreased awareness of these muscles.
Pelvic floor therapy is an effective treatment option for bowel incontinence.

Vaginismus is the inability to insert anything (such as a penis) into the vagina. It is usually accompanied by tight pelvic floor muscles that will tighten further with attempted penetration, or even the thought of penetration. This may or may not be accompanied by pain.

Dyspareunia is pain with sex. It is often accompanied by tight pelvic floor muscles and surrounding tissue.

Both vaginismus and dyspareunia are accompanied by increased sensitivity in the surrounding nerves and the nervous system as a whole. A pelvic floor physiotherapist will provide treatment options to improve vaginismus and/or dyspareunia.

This is the pain in the pelvis, hips or low back that occurs during or after pregnancy. It is often accompanied by difficulty rolling in bed, as well as difficulty getting moving after being still (either sitting or lying) or getting dressed. It is often due to increased or uneven mobility in the pelvic joints. Though this is often referred to as “instability”, your pelvis is one of the most stable joints in your body. Though it may feel like it, your pelvis will not “fall apart”. Pregnancy related pelvic, low back and hip pain may be accompanied by pelvic floor dysfunction, either tension or weakness.

Persistent pelvic pain is a broad term that refers to pain in the pelvic and genital region. It often occurs when the pelvic floor muscles and surrounding tissues have become very tight. It is often accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Chronic Prostatitis or Chronic Pelvic Pain Syndrome is a chronic pain condition in men. While the suffix “itis” suggests inflammation or infection, Chronic Prostatitis/CPPS is diagnosed when infection has been ruled out. Major contributing factors include tension in the pelvic floor muscles and surrounding tissues. It is often accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Irritable Bowel Syndrome (IBS) is a common disorder that affects the large intestine. Common symptoms include: cramping, abdominal pain, bloating, gas, diarrhea and constipation. It is often accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Dysmenorrhea is the medical term for menstrual pain or cramps that occur before or during menstruation. Dysmenorrhea is the most common menstrual disorder and affects as many as 90% of women of reproductive age. It often occurs when the pelvic floor muscles and surrounding tissues have become very tight. It may be accompanied by increased sensitivity in the surrounding nerves and nervous system as a whole.

Pelvic Health Starts Here