Pelvic Floor Therapy

Pelvic Floor

What is Pelvic Health Therapy?

Pelvic health therapy is the assessment and treatment of an individual’s pelvic floor muscles. The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvic bone and sacrum. They are like a hammock or a sling, and they support the bladder, uterus, prostate and rectum. They also wrap around your urethra, rectum, and vagina (in women). Therapists assess the external and internal muscles, looking at tone, pain and strength.

Pelvic therapy is not just Kegals.

Kegels are not for everyone, and even when indicated are often not done properly! They are not always indicated for pelvic floor problems. Sometimes they do more harm than good, and often they are NOT performed correctly.

Many people with pelvic pain have pelvic floor dysfunction, but specifically muscles with increased tone, or muscles that are too tight. These muscles must be able to contract to maintain continence and relax to allow for urination, bowel movements, and in women, sexual intercourse.

When these muscles have too much tension they will often cause pelvic pain or urgency and frequency of the bladder and bowels. When they are low-tone or weak they will contribute to stress incontinence and organ prolapse. You can also have a combination of muscles that are tense as well as weak.

When your pelvic floor muscles are tight and weak, the tension is treated before the weakness. Once the muscles have reached a normal resting tone, and are able to relax fully, their strength is reassessed and strengthening exercises are prescribed, if appropriate.

Your first pelvic therapy appointment will begin with a detailed history of your condition, taken by your physiotherapist. Questions will include urinary and bowel habits, diet, pain, sex, social history and previous injuries/conditions. We will discuss your pelvic anatomy and current concerns with you. If appropriate we will perform an internal exam to assess your tone, strength and check for pain in your pelvic floor muscles. You will be provided with an explanation of your condition, home exercises/self-treatment and a follow-up treatment plan with your therapist. Your full assessment is scheduled for one hour.

The physiotherapist who carries out this work is a highly trained, sensitive professional who will discuss these issues with you thoroughly before carrying out the treatment. Internal palpation is an integral part of treating the pelvic floor and is the gold standard. When the pelvic floor muscles are assessed this way, the research has shown that the treatments carried out by a physiotherapist for pelvic floor problems are highly successful, and should be the first line of defense (before surgery or any other medical intervention) for both pelvic pain and incontinence. However, if an internal exam is not possible, there are many other avenues of treatment that we can pursue.

Assessing the pelvic floor without doing an internal exam is like an orthopaedic surgeon or a physiotherapist doing a knee exam through a pair of jeans.

Treating any other part of the body without touching the affected body part to see which muscles are tight, or weak, and how the joints move and glide would be completely unacceptable.

Pelvic floor physiotherapy includes, but is not limited to, the following conditions;

  • Male and Female Incontinence
    • Urinary Stress Incontinence
    • Urgency/Urge Incontinence
    • Fecal Incontinence
    • Post-prostatectomy Incontinence
  • Rectus Diastasis
  • Constipation
  • Pelvic Organ Prolapse – including Pessary Fitting
  • Pelvic Pain
    • Dyspareunia (painful sex)
    • Endometriosis
    • Chronic Prostatitis
    • Vaginismus
    • Vulvodynia
    • Dysmenorrhea
    • Interstitial Cystitis
    • Bladder Pain Syndrome
    • Pudendal Neuralgia


Pediatric Incontinence and Pelvic Floor Dysfunction

Pediatric pelvic therapy is a little different than for adults. There is no internal assessment of the pelvic floor muscles. Instead we use sEMG to measure muscle activity and teach the patient how to contract and relax their pelvic floor muscles. Pelvic muscles that have too much tension or are weak can lead to problems like incontinence and pain.

Conditions Treated

  • Urinary incontinence
  • Fecal incontinence
  • Constipation
  • Bedwetting
  • Pelvic/abdominal pain