Pelvic Floor Physiotherapy with PhysiGO (In Home or Clinic)

Regain Control & Comfort: Pelvic Floor Physiotherapy

What is pelvic floor physiotherapy?

Have you ever considered the impact your pelvic floor muscles have on your overall health and well-being? Your pelvic floor muscles have many functions but one of the main functions is providing support for your bladder, bowel and reproductive organs. Your pelvic floor is part of your core muscle group that helps control bladder and bowel function as well as contributes to sexual health. Pelvic floor issues can be widespread and are common, especially after childbirth, and can impact your quality of life.

How will I know if I have pelvic floor issues? Some of the biggest complaints we hear from patients include:

-leaking urine while coughing, laughing or jumping

-pain in the pelvic area

-sensation of heaviness and downward movement

-pain with sex

-and more!

Every patient we see has a different issue and we strive to help you work through these issues to get you back to what you love. We see patients in all walks of life that are struggling with pelvic floor symptoms.

We have created a thorough guide on this page to take you through various pelvic floor health topics including:

-symptoms of weak pelvic floor muscles and how to strengthen

-common pelvic floor issues

-effective pelvic floor exercises

-tips for incorporating pelvic floor specific exercises into workouts (“kegels”)

Please keep scrolling to learn more!

What are the most common pelvic floor issues?

So, what exactly is a pelvic floor? Our pelvic floor is a group of muscles that attach to the front and back of the pelvis. They work together to do the following:

Support organs – The muscles create a sling at the bottom of our pelvis that supports our bladder, uterus, rectum and other organs in our abdomen. They stop the downward pressure of the organs that work against gravity to keep everything in place.
Stability – Due to the location of the muscles and their attachments they provide stability for the lower back and pelvis.
Sexual Intercourse – if there is pelvic floor dysfunction one can experience pain with intercourse and/or difficulty achieving orgasm.
Sphincteric Function – these muscles are the openings to the ureter (opening for urine) and rectum (opening for feces) and allow us to hold them and have control of bowel and bladder functions.
Pump Blood Back to the Heart – when pelvic floor muscles contract they cause blood to be pumped from the bottom of the abdominal cavity back to the heart

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Pelvic floor issues can often be categorized in 2 different ways: too tight or too weak. Let’s dive in!

Pelvic floor muscles are considered weak when they are struggling to support the internal structures of the abdominal cavity and no longer can hold in urine, feces or gas. This can happen for many reasons:

Pregnancy and childbirth – this is the most common reason we see in our current patients. As we become pregnant our pelvic floor has to support the growing babe inside of us which often causes the pelvic floor to weaken. Not to mention that when we birth our children it causes a stretching of the pelvic floor.
Obesity – The heavier we are the more downward pressure and gravity that is put on our pelvic floor. Over time this can cause our muscles to weaken.
Chronic Constipation – If we are having trouble with bowel movements we usually strain through the pelvic floor area. The more we strain the more, it can lead to prolapse and negatively impact our pelvic floor.
Overtraining or using incorrect techniques – did you know that women who have never had children, but who are high level athletes have increased rates of pelvic floor issues? Your pelvic floor needs to match your activity level. If you use incorrect posture and breathing techniques or lift too heavy of weights you can develop symptoms of prolapse
Surgery – any type of surgery to this area can affect how the pelvic floor muscles are functioning, the most common type of surgery that affects is a hysterectomy
Menopause – as women hit menopause it causes a shift in many systems in our body which can in turn affect the pelvic floor
Aging – it is well known information that we start to naturally lose muscle mass at a certain age, the pelvic floor is not exempt from this and it can cause weakness over time
Plus more including high impact exercise, posture, traumatic injuries, neurological conditions and radiation therapy.

The most common symptoms of a weak pelvic floor are leakage of urine or feces, constipation, pain, bulge down there, sensation of heaviness between the legs and lower back pain. These symptoms are very common amongst women but are also related to the male pelvic floor as well.

Pelvic floor muscles can also be categorized as too tight which often creates their own set of issues including:

Holding in urine or stool – if we are holding in urine or stool especially for an extended period of time it can cause the pelvic floor to become tight
Injury or trauma – any type of trauma to the area can cause the area to tighten
Muscular dysfunction – if we stay in one position too long or walk in a way that causes us to tighten our pelvic floor
Pain causing conditions – conditions such as endometriosis or anything causing pain lower in our abdomen will cause us to tighten through the pelvic floor muscles
Stress, depression and anxiety – our pelvic floor is closely related to our emotions and can affect how tight we are down there
Chronic holding patterns – if we are constantly sucking in our gut to clenching through the glutes this can create a tightness
Hypermobility – hypermobility means that someone has too much movement through their joints, to control this we tighten up our muscles in response to create more stability

The most common symptoms of a tight pelvic floor include painful sex, pelvic pain, lower back pain, constipation, urinary incontinence, urgency to get to the bathroom and tailbone pain.

How To Tell If Your Pelvic Floor Is Too Tight or Too Weak

Understanding the difference between pelvic floor muscles that are tight or weak helps to properly address the symptoms. Both conditions can interfere with quality of life and need a different approach for treatment. Exercises for each condition look different. You can do a quick self check method to know if you are too tight or too weak.

Self-Assessment for Pelvic Health

The easiest way to assess is to have someone certified in pelvic floor physiotherapy do a full assessment to take into account your full history and current symptoms. However, if you would like to do a quick self check this is what we suggest:

Check for Weakness: next time you are going to the bathroom, stop your flow of urine (just one time) to see how easy it is. If this is difficult to do then you might have a weak pelvic floor.
Check for Tightness: if you are inserting a tampon or having intercourse do you often notice pain, you can further test this by trying to relax through the pelvic floor muscles, again if this is difficult then you may be tight through your pelvic floor muscles

As said before, the best way to check is to have a pelvic floor physiotherapist perform a complete exam which includes an internal exam of the pelvic floor muscles to feel for tightness and an internal assessment of strength (done through a vaginal exam). A full exam includes looking at the range of motion of the pelvis, lower back and hips as well as strength through those areas. A full assessment will let your physiotherapist develop a comprehensive treatment plan including exercises that target your specific needs.

How Do I Strengthen My Pelvic Floor

Strengthening your pelvic floor is advantageous for many reasons including improving core stability, bathroom urgency and pelvic health. It doesn’t matter what stage of life you are in or if you just had a baby, the right exercises can improve the weakness in your pelvic floor. Follow below for how to get started.

Step 1: Identify what it feels like to use your pelvic floor muscles

-The easiest way to do this is to imagine stopping your flow of urine when you go to the bathroom. Remember what that feels like as we will be trying to activate the same muscles.

-The other option is to try to think and contract the muscles you would use to prevent yourself from passing gas, similar muscles are used for this.

Step 2: Basic Pelvic Floor Exercises

-the first step is to get into a comfortable position so you can focus on using the correct muscles. People are usually the most comfortable lying or sitting down.

-next we want to learn to focus on “stopping the flow of urine” or “preventing gas from being passed” while in that comfortable position. A physiotherapist will prescribe the best number of repetitions for this exercise based on your individual needs.

-it’s important to continue breathing as you do these exercises (kegels) and to try to relax the muscles in the surrounding areas (e.g. you do not want to be clenching your butt as you do your pelvic floor strengthening)

Step 3: Advance the exercises

-it is great to be able to contract your pelvic floor in a comfortable position but we want to progress to other positions that are more functional

-from laying to sitting or standing is a usual progression and then moving into more functional movements ie: squatting

-if you are highly active, then you need to train your pelvic floor even more in order for it to match your activity. If you’re pelvic floor is too weak to maintain a contraction during a deadlift for example with weight, then you could be doing more harm than good!

The instructions are easy but it often is very difficult to start to isolate your pelvic floor muscles. Having a trained professional walk you through these steps and make sure they are the correct exercises for you and that they are being done correctly is essential to improving symptoms. Don’t forget that consistency is key to making a change in your pelvic health.

Pelvic Floor Exercises

The more often you do your pelvic floor exercises the better results that you will see with your symptoms. Once you master the basic pelvic floor exercises then there are many progressions and they vary depending on the goals you have. Exercises are very different for a mom that is postpartum vs a grandma that is waking up multiple times at night vs a competitive athlete.

The most common mistakes seen in our pelvic floor patients are:

Over squeezing while tightening the pelvic floor muscles – if we do this too much there is a chance that your pelvic floor will start to tighten as well as get strong which can lead to more issues
Stopping breathing – our pelvic floor is very closely related to our pelvic floor and when we hold our breath while doing these exercises it increases difficulty
Failing to relax the rest of your body – If our whole pelvis is contracting while we are trying to get our pelvic floor to strengthen we will not get the same effect on the musculature, we want to try and have control over those muscles without contracting other muscles like the glutes
Not doing your exercises regularly – sometimes it can help if we have some type of cue that reminds us to do our exercises. A few strategies we have used with patients include setting an alarm on your phone, putting a post it note with a reminder, always doing it at the same time every day so it becomes a habit and incorporating it into your current exercise routine.

If you aren’t sure if you need to start going pelvic floor exercises then please book an assessment and let us guide you through what exercises are appropriate for you!

What are the most common pelvic floor issues?

Someone that is struggling with pelvic floor issues can have the symptoms appear in multiple ways but it almost always affects quality of life. The issues that stem from a group of muscles being tight or weak are endless and way more common than you think. Let’s chat about the top conditions we see at home.

Urinary Incontinence – the TOP pelvic floor issue! The most common complaint we see is that people are unable to hold their urine while doing an activity (e.g. laughing or jumping) and leakage occurs. Incontinence can be either stress or urge depending on the symptoms and is usually caused by pregnancy and childbirth, aging/menopause and chronic coughing or pressure on the pelvic floor. Treatment is highly personalized depending on the trigger but often includes some form of strengthening and bladder training techniques.
Pelvic Organ Prolapse – If your pelvic floor muscles have been weakened then they won’t be able to support your organs which can cause them to shift and be out of place. The most common complaints include a heaviness down there, feeling a bulge in the vagina and pain with intercourse. Childbirth, repetitive straining and obesity can all cause this to happen. There are a few different types of pelvic organ prolapses that your physiotherapist can help guide you on. Intervention includes strengthening the pelvic floor muscles and in extreme causes patients will be fit for a pessary and potentially need surgery.
Pelvic Pain – this is one is very self explanatory! Pain in the area of your pelvis is often caused from a tight pelvic floor which can lead to a lot of tension and even muscle spasms. Most people experience pain on and off in the pelvic area as well as pain with intercourse or inserting a tampon. Sometimes it is even difficult to empty the bowel and bladder. The causes are tightness in the pelvic area, trauma or injury and stress/anxiety. Treatment includes manual release to the pelvic floor muscles, relaxation techniques and trying to improve coordination.
Constipation and Bowel Dysfunction – Depending on the overall health of your pelvic floor is can influence your bowel function which often leads to constipation or difficulty in controlling your bowel movements. Common symptoms include straining while going to the bathroom, not being able to fully evacuate your bowels and leakage of stool. Often these symptoms are associated with a tight pelvic floor, weakness and chronic straining. For these patients we implement a relaxation exercises, dietary changes and retraining of muscle coordination involved with bowel movements.
Postpartum Pelvic Floor Dysfunction – Carrying a child and then birthing a child whether vaginally or by c section places a lot of strain on the pelvic floor which often results in symptoms postpartum and sometimes even before the babe is born. Most common symptoms include urinary and fecal incontinence, pain with sex and prolapse. This is most often associated with a vaginal delivery however hormonal changes and carrying excess weight during pregnancy will put you more at risk. Treatment often includes exercises that are specific to postpartum and general physiotherapy treatment to help with recovery.
Sexual Dysfunction – many patients come in complaining of pain during sex which makes it very difficult to have intercourse with their partner. Pelvic floor physiotherapists are trained to help with pain during sex, difficulty achieving orgasm and reduced sexual sensation. Most common causes are tight or weak pelvic floor muscles, scar tissue from surgery or being postpartum and psychological factors as well. Treatment depends on what is causing the issue but often includes addressing muscle imbalances as well as relaxation techniques.

If any of these sound familiar and are something you have been dealing with then please know that it is 100% treatable and is worth getting a professional assessment done by a certified pelvic floor physiotherapist.

Why Postpartum Pelvic Floor Exercises are Important

As already mentioned, the pre and post-partum experience can impact our pelvic floor. Pregnancy alone stretches the ligaments and tissues that support your pelvic floor and is a very important time to start training your pelvic floor. In addition, some women think they do not need pelvic floor after a c-section, however 9 months of carrying added weight can lead to plenty of pelvic floor issues. Did you know that almost 50% of women experience a prolapse after a vaginal delivery? That statistic is HUGE! We are going to highlight the benefits of pelvic floor health in the postpartum period to facilitate recovery and long term well being!

The pelvic floor is the main support for bladder, uterus, rectum, and you guessed it is the muscles responsible for holding the weight of the growing baby! A lot of women during pregnancy experience back pain due to the stretching of the abdominal wall to accommodate the growing belly, this changes the way your body utilizes it’s core to help also support other structures, like the back. Your body relies on a strong pelvic floor especially as your abdominal wall is stretching. After pregnancy, the abdominal wall doesn’t just close up automatically, it takes time and activity modifications in order to optimize the healing, if you do not heal optimally it can lead to a diastasis recti. In addition your pelvic floor will be weak after a vaginal delivery and therefore implementing postpartum core and pelvic floor retraining at the appropriate time is key for a successful recovery!

What are the most common postpartum pelvic floor issues?

Urinary incontinence (leaking with coughing, sneezing, or laughing).
Pelvic organ prolapse and the feeling of heaviness in the pelvic area.
Pain during sexual activity or physical exercise.
Difficulty with bowel movements or constipation.
C-section scar sensitivity and pain

Postpartum pelvic floor exercises can help improve bladder and bowel control, lead to faster healing, prevent long term complications such as pelvic organ prolapse, pain or diastatis recti and improve quality of life!

It can be difficult to know when to start postpartum pelvic floor exercises. Should I wait for the 6 week check up? The quick answer is you can start as soon as you feel ready assuming you are pain-free. After the 6 week check up is when it is important to be assessed by a pelvic floor physiotherapist and receive a tailored treatment plan for your needs. Not all postpartum issues resolve on their own, exercises and activity modifications are essential for recovery. You don’t need to experience symptoms to benefit from pelvic floor, early prolapses can often go undetected which is why it is very important to be assessed before the prolapse worsens!

Recovery postpartum, is a journey and process that takes time. Implementing treatment earlier will lead to better outcomes. However, we know it can be challenging to fit the exercise into a busy schedule with a new baby. Pelvic floor exercises do not need to take a lot of time, reminders around your house can help as well as prioritizing some self care and time to get YOU back to YOURSELF.

Why see a pelvic floor physiotherapist?

Pelvic floor physiotherapists treat all individuals across the lifespan, all genders and identities, with a range of conditions most commonly being during the postpartum period, athletes, and aging adults.

The role of pelvic floor physiotherapy is to assess and create a tailored treatment plan as no two pelvic floor patients are alike. They are trained to provide education on anatomy, function, and lifestyle modifications that can be implemented after the first session. The key is EARLY intervention. Sometimes pelvic floor issues can have no symptoms, and having an assessment can pinpoint certain issues from worsening. If pelvic floor issues are left untreated the effects of age and gravity can have negative consequences in the future.

There are many benefits of pelvic floor physiotherapy including:

Strengthening to better improve bladder and bowel control, musculature, prevention of worsening issues, and improved sensation and orgasms during intercourse
Relieving pain to get you back to the activities you love
Enhancing quality of life and improved confidence in your day to day

There are many myths around pelvic floor physiotherapy. First, many think that the treatment is only providing kegels. Kegels come in many reps, styles, and positions. If you over or under train your pelvic floor by just doing a kegel alone you could create new pelvic floor issues including tightness, pain, or worsening symptoms. In addition, education, breathing techniques, lifestyle modifications and hands-on techniques are used very commonly in the treatment plan. Second, pelvic floor physiotherapy is only for women. Men have pelvic floors too!

How do I find a pelvic floor physiotherapist? We have 3 trained physiotherapists with a special interest in pelvic floor on the PhysiGO team in Winnipeg, Morris, and Calgary ready to help you and get you on the road to recovery.

To summarize, pelvic floor issues can arise at any age during any lifestage and early intervention is crucial for a positive outcome. Pelvic floor physiotherapy is so much more than just kegels and it is important to match with someone you feel comfortable with and who is able to provide a tailored treatment plan to help you achieve improved confidence so you can get back to all of your activities!

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FAQ

What are the benefits of Kegels?

Pelvic floor strengthening exercises, commonly referred to as Kegels, can benefit your pelvic floor in many ways ranging from improved strength, improved blood flow, less symptoms of incontinence, increased sensation during intercourse, and improved ability to reach orgasm. They can be performed using different techniques and in many different positions. It should be noted that Kegels are not always implemented in a treatment plan and sometimes can worsen some pelvic floor issues. It is very important to seek out a pelvic floor physiotherapist to provide a tailored treatment plan which may also include activity modification, hands-on techniques, education, and more!

How long does it take to see results with pelvic floor physiotherapy?

Consistency is key when it comes to seeing results with pelvic floor issues. After the first session you will have the knowledge that you can begin implementing immediately that can make some significant changes. The initial strengthening period with someone experiencing pelvic floor weakness can take some time, however the goal is to enter a maintenance phase where you will see more spaced our frequencies and repetitions however all the while maintaining pelvic floor strength. Patients with pelvic floor pain who require more hands-on treatment may initially require more regular sessions, however once the pelvic floor has released there are many ways that patients can maintain the length achieved to their pelvic floor at home.

Are pelvic floor issues permanent

Pelvic floor issues are not necessarily permanent. Conditions such as incontinence, pain, pelvic organ prolapse can all be managed with early and appropriate intervention. Prolapses have been researched to improve in grades of severity after receiving pelvic floor physiotherapy and can help avoid the need for pessaries and/or surgery altogether! The key to success is consistency. It can feel hard and mundane to perform your pelvic floor exercises regularly, however putting in the time and coordinating it during an activity you already do everyday ie: brushing your teeth can have huge impacts on successful outcomes.