Pelvic Floor Physiotherapy Barrie


Pelvic Floor Physiotherapy in Barrie

Pelvic Floor Physiotherapy in Barrie is an evidence-based treatment for pelvic floor dysfunction. Pelvic floor dysfunction refers to  abnormal functioning of pelvic floor muscles,  and can lead to a wide range of pelvic health symptoms such as urine and fecal incontinence, pelvic organ prolapse,  urinary urgency and frequency,  constipation, pain with intercourse and more.

The pelvic floor dysfunction corresponds to overactivity (hypertonicity or tightness), or underactivity (hypotonicity or weakness) or lack of coordination of pelvic floor muscles with other muscles of the body. Sometimes a patient can have both overactivity and underactivity simultaneously. Pelvic muscle overactivity / hypotonicity (flexibility): contributes to symptoms of incontinence and pelvic organ prolapse.

Pelvic muscle Overactivity / Hypertonicity (Congestion): persistent pelvic pain, dysareunia (pain during intercourse), vaginismus, vulvodynia, pudendal neuralgia, interstitial cystitis / gall bladder syndrome, endometriosis, chronic prostatitis, chronic prostatitis, symptoms calling for fecal urgency and not discomfort.

The pelvic floor muscles are a group of muscles that attach to the front, back, and sides of the pelvis and sacrum, acting like a sling. It also surrounds the urethra, bladder, uterus,  rectum, and the vagina (in women). The pelvic floor muscles must be able to function properly and allow for urination, bowel movements, and intercourse in women. 

Pelvic health physiotherapy is well established in the literature as a first-line treatment for pelvic inflammatory disease, pelvic inflammatory disease, pelvic pain. Physiotherapists require specialized and extensive training in order to have the appropriate skills to assess and treat your pelvic floor through internal palpation. In Ontario, a pelvic floor  physiotherapist can only perform pelvic floor internal exams if they are registered with the College of Physiotherapists of Ontario and are rostered for pelvic floor internal palpation. Performing an internal pelvic exam using gloved digits or any tool such as speculum is considered a controlled act and that’s the reason why it must be performed by a highly trained, registered physiotherapist who is rostering with its regulatory board for performing this act.

What Causes Pelvic Floor Dysfunction?

The pelvic floor muscles are a group of muscles that attach to the front, back, and sides of the pelvis and sacrum, acting like a hook or sling. It also surrounds the urethra (where urine exits), the rectum, and the vagina (in women). The pelvic floor muscles must be able to relax to maintain continuity and allow for urination, bowel movements, and intercourse in women.

What Does Pelvic Floor Physiotherapy Entails?

Pelvic floor physiotherapy begins with a comprehensive initial assessment on the first visit which could take an hour or longer to complete depending on your condition. An initial assessment begins with a process of obtaining an informed consent, followed by a comprehensive subjective and objective assessment. A subjective assessment may include a review of your past medical history and appropriate questions about pain, bladder and bowel, sexual function, and biopsychosocial factors utilizing validated and reliable outcome measures.

Objective assessment may include testing breathing pattern, posture, balance, movement patterns, general strength and conditioning, lumbar and thoracic spine, and pelvic floor muscle function including internal pelvic exam. This is done to determine all contributing factors to your symptoms, establish a diagnosis and set short term and long term SMART (specific, measurable, achievable, realistic, and timely) goals. This process is followed by the development of patient centered (personalized) treatment plan. Patient is given lots of opportunity to ask questions, tell their story and discuss treatment options during the process. 

During the assessment patient privacy is maintained. The data is stored electronically locked with security codes and any correspondence with  patients and other healthcare providers is done through secure platforms that are PIPEDA (Personal Information Protection and Electronic Documents Act ) complaint.

What is Internal Pelvic Physiotherapy Assessment and Why is it Important to Perform?

Internal Pelvic Exam or treatment is an important part of pelvic floor physiotherapy. This resembles what your gynecologist or your family doctor performs during a pap test. But a pelvic floor physiotherapy internal exam is not a pap test. It involves digital palpation  of pelvic floor muscles to determine if they are hypertonic or hypotonic. Sometimes we use a speculum to observe tissues and look for a pelvic organ prolapse.

Importance of Internal Pelvic Floor Assessment or Treatment

Internal Pelvic Assessment or treatment is globally considered the “gold standard” of pelvic floor therapy and the most accurate way to assess muscle strength, tightness and motor control. It is the best way to teach ‘Kegel exercises‘ to a patient and help to improve pelvic floor function. Lack of this important component of pelvic floor physiotherapy during assessment and treatment can result in an inaccurate diagnosis and poor treatment outcomes.

Your pelvic floor muscles are no different then other muscles of your body in terms of composition and they contract and relax, coordinate with each other and other muscles to provide important functions. Some of the important functions are providing stability for your back and pelvic girdle, sphincter control to prevent bladder and bowel leakage, support for internal pelvic organs, and healthy sexual function. These and many other pelvic floor conditions or symptoms corresponds to the overactivity or underactivity of the pelvic floor muscles and ligament or connective tissue damage. The only way to diagnose correctly is to do an internal exam.

internal pelvic floor assesment

Consider an example of a painful knot in your trapezius muscle, you would want a massage therapist to work on that point and release the knot. Is it possible to do it without touching the muscle? Is it as effective is done over the cloths? Another example would be of a knee arthritis with significant weakness of quadricep muscle.

For a patient to gain strength in his or her quadricep muscle, isn’t it important to first find out the grade of strength in that muscle? Grading the muscle strength will guide the physiotherapist as to which form of treatment is required and also assists with tracking the progress. Similarly, knowing the strength and being able to grade it will direct the physiotherapist in the right direction in regards to appropriate method of treatment for that patient. Most commonly prescribed exercise for pelvic floor is called ‘Kegels’ and it is firstly not recommended for everyone and secondly, they are often not done correctly because people do not know where these muscles are. The only sure way to know if they are being performed correctly or if they are even prescribed appropriately is with internal palpation. Kegels are not always indicated and can sometimes make your symptoms worse.

The study concluded that physiotherapists with advanced training in pelvic rehabilitation (using internal examination to palpate the pelvic area) should be the first line of defense for stress, urge and mixed incontinence in women. However, we don’t know what the “condition” of the pelvic floor muscles is until we have an internal assessment. The only times it is not performed are when it is contraindicated in a patient; for instance, in a pregnant female with an incompetent cervix, or when the patient did not consent to internal exam. 

The Process​

The process of conducting pelvic floor assessment or treatment begins with obtaining an informed consent on each visit. This consent is ongoing throughout the session. For internal pelvic exams we follow infection control and use clean technique. Clean technique involves hand washing, maintaining a clean environment, using clean gloves and sterile instruments. This is done to prevent direct contamination of materials and supplies. It is performed in private closed room and the patient is appropriately draped. We use ‘Surgilube’, a lubricant that most healthcare practitioner prefer for internal pelvic exams. This is non toxic, water soluble, sterile, bacteriostatic,  latex free lubricant.

Side Effects​

There are some side effects of internal palpation and these will be discussed with you during the consent taking process. Some of the side effects are light spotting after the examination, discomfort during and after the exam, allergic reaction to gel, emotional distress, and  light headedness.

Some Common Pelvic Conditions Seen at Medic Physiotherapy

  • Urinary Incontinence
  • Overactive Bladder
  • Pelvic Organ Prolapse
  • Bowel Dysfunction
  • Bowel Incontinence
  • Dyspareunia
  • Low Back and Pelvic Girdle Pain
  • Vaginismus
  • Vulvodynia
  • Interstitial Cystitis and Bladder Pain Syndrome Endometriosis
  • Pudendal Nerve Irritation
  • Pre and Post Partum Care
  • Pregnancy Related low back pain, Pelvic Girdle and hip pain Diastasis Recti
  • Coccyx Pain
  • Preparing for Pelvic Surgery
  • Post Pelvic Cancer Rehabilitation
  • Irritable Bowel Syndrome
  • Dysmenorrhea
  • Chronic Persistent Low Back and Pelvic Pain
  • Post Breast Surgery Rehabilitation
  • Lichens Simplex, and Planus

If you’re ready to take the next step towards improving your pelvic health and well-being, don’t hesitate to contact us at Pelvic Floor Physiotherapy in Barrie. We understand the sensitive nature of pelvic floor concerns, and we prioritize your comfort and privacy throughout the treatment process. Whether you’re dealing with pelvic pain, urinary incontinence, or other pelvic floor issues, we have the expertise and knowledge to help you find relief and regain control. Reach out to us today to schedule your appointment and start your journey towards a stronger, healthier pelvic floor.