Tag Archives: Core

What is a pelvic floor physiotherapist?

Pelvic health physiotherapists have additional post graduate training in assessment and treatment of pelvic dysfunctions such as urinary and fecal incontinence, pelvic organ prolapse, and pelvic girdle pain syndromes such as vulvodynia, vestibulodynia, dyspareunia (pain during sex), SI joint dysfunction, and piriformis syndrome.  When I told my husband I was taking the internal pelvic health course his reaction was” you want to do what? Really?” So what is it that I do? I teach my patients how to properly use their pelvic floor to regain core strength and get back to their beloved activities (back to pain free living).

So how do I do that?

The same way I retrain an injured hamstring – manually testing the muscles’ strength, releasing any trigger points, facilitating a stronger more efficient contraction, re-patterning the correct strategies and giving you a home program to get yourself better. What does that all mean you ask? Well, it means I get my hands on it and in it!

ImageAnd how exactly do I do that?

The pelvic floor muscles are often described as a hammock in your pelvis from front to back, although I prefer Katy Bowman’s terminology of a trampoline. I asses vaginally and rectally which allows me to feel the muscles contract and relax against my finger, I can also feel for scar tissue from trauma (pregnancy, birth, surgery, fractured pelvis, tailbone or coccyx), and I can feel the movement of the coccyx.  I can tell which muscles are working well and which ones need help. I can see if there is any pelvic organ prolapse and the effects of movement and loading on the muscles and tissues. Treatment involves identifying the cause of the dysfunction and finding the solution that will work best for you.

Who should see a pelvic floor physiotherapist?

Do you suffer from things like diastasis recti (aka mummy tummy)? doming or tenting of your belly when you exercise? scars from an episiotomy, c-section or perineal tear? pressure or pain in your vagina or rectum? pelvic organ prolapse? pain during sex? pelvic girdle pain? leaking when you cough or sneeze or laugh or jump or run? feel like you can’t make it to the bathroom in time?  If you answered ‘yes’ to any of these then YOU should see a pelvic floor physiotherapist.  We also like to work on the prevention side of things pre-conception, during pregnancy and post natally.

And it’s not only about the women. Men have a pelvic floor too! Men who have urinary incontinence, pelvic girdle pain, or difficulty maintaining an erection can also benefit from seeing a pelvic health physiotherapist.

girl running

How do you find a pelvic floor physiotherapist?

We are located in downtown Toronto. There are a handful of us in the GTA. We are all listed on the Women’s Health Division website (Find a physiotherapist – Women’s Health Division http://www.physiotherapy.ca/PublicUploads/229746WHD_%20Povince.pdf) and all physiotherapists that do internal work must be rostered with the college of Physiotherapists of Ontario http://publicregister.collegept.org/PublicServices/Start.aspx

Have you had your pelvic floor assessed? Tell us about your experience.

Is it Worth it?

I treat a lot of women with diastasis recti (DRA) one of the most common questions I get asked is:  I want to have another baby is it worth all this effort if it’s just going to separate again? Well, the simple answer is YES!!!

Here’s why:

All the work you do now to close the separation, prior to getting pregnant will pay off now, during the pregnancy, during the delivery and after when you need strength to look after your new bundle of joy, and want your tummy flat again.


DRA is the separation of the rectus abdominis muscle. It happens during pregnancy or repetitive strain on the abs (like doing crunches). DRA causes muscle weakness and imbalance throughout the core. A weakened core puts you at risk for injuries to your back, neck and pelvic floor (incontinence, and prolapse among others). Doing appropriate DRA exercises will help restore the proper neuromuscular patterning of the core. When your muscles work properly, everything falls into place (including that flat tummy)

During pregnancy

Yes, with every pregnancy you increase your risk of developing a DRA. However, doing appropriate exercises during your pregnancy will help keep you strong, especially if you have a toddler or two at home to keep up with. It will also help decrease the severity of the separation. Strong muscles will also help maintain your posture as the baby grows. Proper posture is critical for preventing injuries to your back and neck. It will also encourage proper patterning of your pelvic floor helping to avoid incontinence. There is also strong evidence that appropriate exercises during pregnancy has health benefits for your baby.

During delivery

Having control of your pelvic floor muscles (PFM) and your transversis abdominis will be beneficial during the pushing stage, easing delivery and recovery and decreasing complications. Learning how to contract and more importantly relax the pelvic floor muscles is critical. If you are able to relax the PFM the baby can descend more easily through the birthing canal.


Muscles have memory. The more frequently an exercise was done before, the easier it is to pattern after. It’s like riding a bike. An exercised muscle also has more blood flow to it so it repairs faster (think elite athlete vs couch potato). It’s much easier to start an exercise you’ve done before than to learn one on little sleep. The core breath can be done immediately after delivery and used as a foundation for the rest of the core program. Basically, learning the exercises prior to delivery will increase their efficacy after delivery.

Now if you didn’t start before, don’t worry, it’s never too late. I have had women in their twenties, thirties, forties, fifties, and yes even in their sixties feel better and close their separation. Stay tuned for a later blog post that will talk about the proper exercises we should all be doing!

So, are you convinced? Is it worth it?