Tag Archives: Incontinence

Natalia Monka, Reg. PT: Men have pelvic pain too…and there are treatment options for them too!

xrayThere is a general lack of awareness when it comes to men’s health and pelvic pain. Research suggests that 1 in 10 males suffer from pelvic pain at some point in their lives. Those who do seek medical help often find themselves bounced around from various medical specialists with inconclusive test results and unanswered questions.  Quite often, men end up suffering for years with symptoms such as painful urination, burning sensations, pain with intercourse and chronic back, abdominal or hip pain.

A pelvic health physiotherapist can provide advice and guidance in managing any of the following conditions:

  • Urinary Incontinence
  • Urinary Urgency or Frequency
  • Painful Urination
  • Interstitial Cystitis
  • Prostatitis
  • Pelvic Floor Muscle Dysfunction
  • Burning Ejaculation
  • Painful Scars/Adhesions
  • Pudendal Nerve Entrapment
  • Post Pelvic Surgeries
  • Pain with Intercourse
  • Sacroiliac (SI) pain
  • Coccyx (tailbone) pain
  • Abdominal/groin/hip pain

What to expect on your initial visit:

At PhysioExcellence, a comprehensive assessment is completed one of our registered physiotherapists who treat both male and female pelvic dysfunction. An assessment of posture, lumbar and pelvic mobility, strength and flexibility, dietary, bowel and bladder habits along with an internal exam of the pelvic floor muscles is completed. A discussion of the effects of stress, dietary habits and postural habits along with pelvic floor anatomy are reviewed in the first visit. Being an educated patient is the first step towards finding solutions for chronic pelvic pain.


Treatment Plans are all individualized and discussed following the assessment. These may include all or some of the following:

  • Manual Therapy: to restore pelvic and lumbar mobility
  • Postural re-training and re-education of abdominal and pelvic floor muscle function.
  • Home exercise program to build strength, improve flexibility and promote function.
  • Self-care program involving bowel and bladder habits and relaxation techniques to improve body awareness.
  • If necessary, biofeedback or electrical stimulation is used for pelvic floor muscle re-training.
  • Goals towards changing lifestyle factors that may be contributing to pelvic pain.

If you know someone who is suffering, share this blog with them, if its you, let’s get started, call today.

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.

Hey your pubococcygeous is really cut! The Role of the Pelvic Floor

It’s no secret that the pelvic floor is my favorite group of muscles. I often get asked why, since you can’t see what its doing; it’s hard to even know it’s there. It’s not like someone will come up to you and say “hey your pubococcygeous is really cut!” Nevertheless this muscle is a superstar. It works backstage and ensures all those other “famous” muscles can look good. Here’s just what it does:

1. Continence
When you get the urge, the pelvic floor muscles help control whether or not you make it to a bathroom in time. They also stop that little leak when you cough, sneeze, run or jump.

2. Respiration
The pelvic floor muscles work together with the diaphragm, helping air in and out by lengthening (eccentric contraction) during inspiration and shortening (concentric contraction) during expiration

3. Support
a. The pelvic floor muscles are key in keeping our organs in where they belong. Low tone and/or weakness in the pelvic floor increases your risk of pelvic organ prolapse.

4. Control/Stabilization
a. The pelvic floor muscles are part of the deep system of core stabilization. They work with the abdominals and multifidus to control movement of the lumbopelvic unit during load transfer.Image

5. Sex
a. The pelvic floor muscles are integral in sexual satisfaction. Too tight and sex can be painful (dyspareunia), too lax and the woman may not feel any stimulation whereas the man may not be able to maintain an erection.

So how do you know if your pelvic floor muscles need a tune up? Well, if you leak urine (even just a drop) when you cough, are a upper chest breather, have or suspect a prolapse, have pelvic pain or feel weak in your core, have pain during sex or a loss of sensation during sex, are pregnant, have just had a baby, are going through menopause or are just one of those health conscious people who like to know everything is working the way it should. Make an appointment to see a pelvic health physiotherapist now!

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?

Physio After Pregnancy. When to Start?

New moms ask me this all the time, so I thought it would make a great blog post!

Q: How quickly after giving birth can I begin post-natal diastasis physio?

A:The sooner you begin the better.

My preference is to start during the pregnancy, as soon as the diastasis is noticed, presumed or diagnosed. This way we can start patterning your muscles to work together, in synergy. When you are more aware of how your core abdominals work it patterns your neurological system and that’s really half the battle. It also helps bring more blood flow to these muscles, and that translates to quicker healing times. Also if I get to see you before the baby does, I can show you exactly what you need to do immediately post delivery, I’m talking minutes, ok let’s be more realistic, hours, after delivery.

If you have already delivered your baby I can see you now. In my program, the first step is education. The beginning exercises to close the diastasis deal with the synergy between the diaphragm, pelvic floor, transverses abdominis and multifidis. They are 100% safe post natally as there is no resistance involved, just posture, breathing and patterning. We then build this into your everyday patterns of movement (ADLs). Once you are cleared by your midwife or physician, we start to add resistance and peak engagement exercises.

Splinting is often recommended, depending on the size of your diastasis and integrity of the connective tissue (that linea alba between the two recti). Most of the healing happens in your first 6 weeks, so doing the right thing from the start is the most effective way to resolve a DRA.

It is truly never too late to start either. It’s just more work the later you start, and the results can take longer to achieve.

Do you have a DRA? If so, when did you get diagnosed? Have you started treatment?