FAQ

In Ontario, physiotherapists who perform pelvic floor rehab with internal exams and treatments are required to register themselves with Ontario College of Physiotherapists. These registered therapists have undergone advanced training in pelvic floor dysfunction.

In order to properly assess the structures of the pelvic floor, penetration beyond the vagina and/or rectum is necessary. Internal muscle function cannot be properly assessed and treated from an external examination. These muscles play a primary role in incontinence and are associated with pain.

Pelvic floor physiotherapy is not only for women. There are conditions unique to men such as chronic prostatitis (class 3B) and incontinence due to prostatectomy that can be treated with physiotherapy by a pelvic health physiotherapist. Other conditions such as persistent pelvic pain, painful bladder syndrome, low back pain, sacroiliac joint pain and hip pain that are musculoskeletal in nature may be appropriate for pelvic floor physiotherapy.

Physiotherapy patients do not need a physician’s referral to visit KW Pelvic Health, but we do maintain a close relationship with each patient’s physician throughout treatment. Some insurance companies require written medical referrals.

• The pelvic floor is a group of muscles that support the pelvic organs, control bowel and bladder function, aid in sexual function and is 25% of your “core”
• The pelvic floor works with your diaphragm, multifidi and transverse abdominis to stabilize you core whenever you move
• The pelvic floor can be rehabilitated just like any other muscle group in the body
• In France, every woman who has a vaginal birth starts 11 treatments of pelvic floor physiotherapy 6 weeks post partum
• In the UK, in order to be considered a surgical candidate for stress urinary incontinence, pelvic floor muscle training must be done with a trained physiotherapist (ICS conference, 2010)
• Joint statement policy provided by the Canadian Physiotherapy Association and the Society of Obstetricians and Gynecologists of Canada recommends:
• Pelvic floor muscle training with a physiotherapist is recommended to prevent urinary incontinence during pregnancy and after delivery (1-A)
• Core stability training with a physiotherapist is recommended to prevent and treat back and pelvic pain during and following pregnancy (1-B)

• In 1948, Dr. Kegel created the “Kegel”
• The intention was to strengthen the pelvic floor after delivery to increase continence
• They were designed to be done with internal palpation and biofeedback, ensuring proper technique…..we have moved a long way from that
• Kegels are appropriate for someone who has weakened and lengthened muscles…..but how do you know if there’s been no internal exam?
• If you Kegel with a tight or short pelvic floor, you can create pain or make incontinence symptoms worse
• Be sure to check with a pelvic floor physiotherapist before starting any pelvic floor strengthening program to ensure you are doing what is right for you!

• There is Level 1, Grade A evidence (Wilson, 2005, 2009 ICS conference, Cochrane collaboration 2010) that supports pelvic floor muscle training with a trained physiotherapist should be the 1st line of defence for the treatment of stress and mixed urinary incontinence in women
• Urinary incontinence costs Canadians $11.5 billion dollars/year (Canadian Urinary Bladder Survey 2003)
• 30-40% of women have urinary incontinence (UI) either during pregnancy or after delivery (Morkved 2003)
• Symptoms can persist 2-3 decades following the first vaginal birth (Dolan et al 2006)
• 40% of first time pregnant women experience UI during pregnancy and 15% develop new symptoms after delivery (Glazener et al 2006)
• Urinary incontinence is reported by 78% of women with LBP (Eliasson et al 2008)
• Urinary incontinence is common but it is not normal and can be treated