Tag Archives: Women’s Health

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!

Vagina Month is Here!

April is vagina month and here are a few tips from our amazing team of Naturopaths to keeping your vagina healthy.

1.  Yogurt and berriesEat 1 cup of plain yogurt everyday – Make sure the yogurt you are eating contains “live cultures”. These friendly bacteria help maintain the delicate ecosystem in your vaginal canal and can help prevent yeast infections and bacterial infections such as bacterial vaginosis. If you would like to sweeten your yogurt, try adding fruit or a bit of honey.

2. Maintain adequate vitamin D levels in your blood – Low levels of vitamin D are associated with a higher risk of bacterial vaginosis. This condition can be particularly harmful in pregnancy as it can cause pre-term labour. Even in non-pregnant women, it can increase the chances of becoming infected with sexually transmitted diseases, and can be quite unpleasant and difficult to treat. Take a daily vitamin D supplement (especially from October to April) and consider having your vitamin D levels checked occasionally to make sure you are taking the appropriate dose.

3. Use only water when cleaning “down there”- when functioning properly, your vagina is like a self-cleaning oven! While bathing, be sure to only use water when cleaning the vaginal area. Soaps can be irritating to the delicate skin and mucous membranes of the vagina and can throw off the pH of your vagina.

4. DocIf something seems off, seek help – If you notice a strange odour, or something seems off, it is best to seek professional help. Most vaginal infections are not yeast infections but rather bacterial infections. The naturopathic team at PhysioExcellence can assess your concern by checking the vaginal pH and doing a swab for culture to determine exactly what is going on. There are several natural treatment options for a variety of vaginal health concerns but it is important to get the proper diagnosis first.

Want more? Have questions? Call to book your Free 15 minutes consult.

Guest Post – 6 weeksPost Op

Six weeks! Six weeks! The magical day when I leap tallbuildings, run a marathon and swim across the lake!! Well, that is what Ithought prior to surgery. Today was still an excellent day. I just now knowthat this was MAJOR surgery and building back up to a strong, athleticindividual is going to take some time….despite what the surgeon says. He says Iam all set to ‘go back to doing what I usually do’. Hmmm, we’ll leave thesurgery to him and the physical recovery to my physiotherapist expert, Julia.So, no, I won’t start training for a summer Ironman.

I had my first post-op appointment with Julia today. It wasvery positive. I think I was a bit worried that she would look at me and gasp “Ack!What did he do?” Or that she would start feeling around my abdominal musclesand declare the surgery a failure. Of course, things are weak and mobility isnot the best, (I haven’t done anything much for 6 weeks!), but I was able todemonstrate some solid core breaths. My rib cage is strangely prominent and theskin around the incision is sticking in place and it felt weird when Juliarubbed my new navel….I can deal with those things. My take home exercises arenot going to have me sweating and gasping for breath but working on my posture,clam shells and core breaths are a first step.

I am anxious to start running and cycling outdoors, but whyspend thousands on surgery and then neglect the proper steps to recovery?!Julia did say as I walking out the door that I could ride on a stationary bike.Yipee! Something else to satisfy my cardio craving rather than just walking andwalking and walking some more. (Why is running so much more enjoyable?)

I saw the surgeon after my physiotherapy appointment tocheck in on the icky part of my incision. He said it is doing what he wouldexpect it to at this point and it should heal over within a week. Continue withthe washing, gauze and polysporin. My next appointment is in 6 months!

Guest Post – 5 weeks Post Op

I am standing straight and tall and walking 2 hours withease. I was feeling very positive … then I tried to pick up thepace across the street as the light was changing. Nope! Impossible! There is abig void in the middle of my body. Nothing. No muscles to support my body in arunning form. Building up strength for athletic pursuits is going to take sometime.

Guest Post – 4 weeks Post Op

Antibiotics! Infection! Definitely not what I wanted to hearat this point in my recovery, but I knew it was coming. About a week ago a verysmall spot on my incision starting leaving spots of blood on my undershirt.Then the blood started coming through the undershirt to my binder. I emailedthe nurse a few times and she said that this happens when sutures have troubledissolving. She suggested washing the area twice a day and continuing with thePolysporin. I did, but the red area grew. Now it is about 2 inches long andpuffy. The doctor prescribed an antibiotic, continued washing, Polysporin,gauze covering and a check-in with him in 2 weeks.

Otherwise, everything is healing as it should and he said Ican ‘resume doing what I usually do’. If I just ate, sat, walked a bit andslept this would be true. Running? Cycling? Lifting weights? Carrying children?I don’t think so.

Guest Post – 3 weeks Post Op

Finally I think I have turned the corner in my recovery! Itis about time! At 2 weeks I was feeling rather low. The literature from thesurgeon said I could walk and do light stretching at 2 weeks. I was envisioninghour long strolls to clear my head. Nope, couldn’t stand up straight or walkmore than 5 minutes.

Today I went for a 40 minute walk! It was a far cry from theexhilaration of a hard hour long run, but boy did I feel better. I am stillstooped over but finally getting straighter so the back pain is less.

My husband picked up a different binder from the surgeon’soffice today. Much more comfortable! It is 9” instead of 12”, more flexible andsofter. The original binder caused too much interference with my underwear andpant waist and wraps around me over one and a half times.

Guest Post – Day 9 Post Op

Oh my goodness! A little crumb when down my throat the wrongway and coughing ensued. Ow Oww Owwweee! I felt like that nicely sewn-togetherfascia ripped apart. Avoid coughing! Also avoid blowing your nose and laughing,even that polite little conversational laugh. My kids are very amusing. I mustleave the room and think sad thoughts when they get going.


Guest Post – Day 8 Post Op

Robaxacet! Brilliant!! The commercials with the puppets withback pain…. Acetaminophen combined with methocarbomal (a muscle relaxant). Itook a pill this afternoon and felt almost immediate relief to the lower backpain that has been plaguing me since surgery. I looked up methocarbomal and itlooks like its’ abuse potential is similar to, but weaker then, lorazepam. Ithink it is the answer for now.

Heather Tennant, the physiotherapist I mentioned who had thesurgery 4 months ago, suggested Robaxacet when I said I was wary of thenarcotics. Check out her blog at http://therapeuticmobility.ca/blogfor some sound advice and a link to a great article on “diastasis rectus”.

I felt better again today. I relaxed this morning while myfather-in-law’s partner played with the kids for a few hours outside. Theafternoon was busy with eye doctor appointments for the kids, a trip to thelibrary, the drug store (for the aforementioned miracle pill) and a visit to 2parks. The kids ran around in the glorious sunshine and I sat mostlycomfortably on a park bench. Tired tonight!

Guest Post – One week Post Op

I woke with a very sore spot on the top of my right foot. It appears to be a bit of swelling in a vein. The bedcovers were hurting it. I immediately think blood clot.  Can you see a blood clot? I checked the post-op literature and it says to call if my legs suddenly swell or hurt.

Hubby said to call the doctor’s office as he left for an out of town ill-timed 2 day business trip. Just me and the kids and March break. A play-date I had arranged pre-surgery turned out to be just the thing to fill the morning. I drove the kids over to the little girl’s house. They played eagerly with her extensive toy collection and I assumed a supported and reclined position on the sofa. The nanny even brought me tea – how sweet.

The spot on the foot appeared to dissipate by mid-day. Hopefully it isn’t on its way to my heart.

An email from Julia, my physio who worked with me on closing my diastasis recti, advised no running for 12 weeks. Yikes!! I had 6 weeks marked on the calendar going into the surgery based on the surgeon’s guidelines. Julia argues that I should build up my pelvic floor and core before pounding the pavement. It is a good plan, but makes me think I am going to go crazy over the next 3 months without my daily endorphin fix. I wonder about cycling? That would be ok, right? Please say, yes!

Another physio I have connected with who had the surgery 4 months ago says I am crazy to not be taking pain meds and should take some Advil for the back pain. I know she’s right, but meds mess up the bowel movements more.

My kids’ speech therapist came by later this afternoon. “Are you ok? You look like you are in pain”. Hmmm, that says it all about how great I am NOT looking.

Today was better, I could stand longer before the need to recline on the sofa hit and I even walked to the end of the street with my son. (The doctor’s literature says start walking at 2 weeks). The stoop and shuffle I did today was not walking.

I fed my kids their first frozen dinners and skipped their baths. Makes them stronger, right? This was the first bedtime I did since surgery. My dear daughter who will be 4 years old in 3 weeks politely asked if I could give her milk. Argh, I thought this might force the weaning. I maneuvered myself into position and she nursed herself to sleep. Maneuvering out of the bed without waking her was trickier. I did it and don’t think I ripped anything apart.

My legs have been really jumpy all day. The way they would feel after a really big training day. Why now? Is it the lack of inactivity?