All About Pelvic Floor Physiotherapy in Toronto

I’ve always been a huge supporter of pelvic floor physiotherapy - there’s likely not a single person I’ve worked with for prenatal support, that hasn’t heard me mention it. Admittedly, I did not see a pelvic floor physiotherapist for my first pregnancy - there really wasn’t as much awareness about it 8 years ago. Thankfully, we’ve come a long way and pelvic floor physio has become the norm for pregnant and postpartum humans!

This pregnancy (I’m due soon 😬) I worked with Leah Forrestall, who works in the East End of Toronto. I’d seen her for regular physiotherapy, prior to pregnancy, and reached back out during my pregnancy. She is wonderful and knowledgeable - and has tons to share about the benefits of pelvic floor physio therapy. Here’s what Leah has to share:

What is pelvic floor physiotherapy? 

The pelvic floor is a network of muscles, ligaments, and fascia that act as a support system (like a hammock). It has many layers and is very innervated with nerves and blood vessels. Everyone has one and it only varies slightly between males and females!

Pelvic floor physiotherapy is an area of practice that specializes on these structures, in addition to the rest of the body. Pelvic floor physiotherapy can help with any issues within or around the pelvis, including but not limited to:

• Uncontrolled urinary leakage or urgency (incontinence)

• Prolapse management (pressure)

• Pre and postpartum management

• Constipation

• Nerve irritation or damage

  and

• Pain (with or without intercourse, urination and/or orgasm) in your pelvis, low back, or hips.

  You can also see pelvic floor physio for post-surgical management from a C-Section, hernia repair, and prostate removal. Pelvic floor physio is also great as a prevention strategy prenatally to incorporate evidence-based strategies and education to help you during and after your pregnancy, as well as during labour.

Who would benefit from pelvic floor physio? 

Anyone with a pelvis :) 

Should every pregnant person pursue pelvic floor physiotherapy? What if I'm having a C-Section? 

Absolutely! There is always something to learn from a pelvic floor physiotherapist even if you are not experiencing any issues during your pregnancy. Pelvic floor physio may help you prevent future issues and allow you to be proactive in your health and wellbeing. We encourage everyone to touch base with us to get advice on birthing preparation, delivery strategies and postpartum care.

Even with a C-Section your core and pelvic floor will undergo changes throughout your pregnancy journey. It is helpful to learn how to take care of your C-Section scar and core, postpartum, and that's where we can help. Additionally, C-Section deliveries can still lead to pelvic floor dysfunctions (i.e. pain, incontinence, constipation) so it's great to learn ahead of time how to prevent these issues! 

What will happen at an appointment? 

Depending on what brings you in to see a pelvic floor physio your experience may vary slightly.

Assessment:

Just as your typical physio appointment would go, your therapist will take a detailed subjective history of your presenting condition. This part typically takes up most of the first appointment.
We ask you about everything from when your presenting concerns started to what your bowel movements look like (check out the Bristol Stool Chart .. this always brings some light-hearted laughs to the appointment!) to how your sleep schedule typically is.

Once we’ve chatted in detail about your pelvic and general health we will discuss physical assessment options. This may include the recommendation of an internal pelvic floor exam. Yup, we said internal! We promise this is not as bad as it sounds. We use gloves and lubrication to insert 1-2 fingers vaginally (and sometimes rectally, in specific cases) and walk you through what we’re doing the whole time. We try to make you feel as calm and comfortable as possible!

Of course, this is with your informed consent and you can choose to opt-out of this (but it does make our job as therapists easier to feel what’s happening within the pelvic floor and give you the best feedback). On the flip side, internal exams are not always indicated and we may only need to assess things such as your hip, glute, and back movements/strength.

Treatment:

Treatment will vary as well depending on your unique condition. This will include TONS of education! We teach you about your anatomy, your habits, your physical and mental health. We teach you things to do to improve your bladder and bowel habits and your sexual health!

We educate you on your pelvic strength and/or tension and what you should do to strengthen or lengthen (Surprise! It’s not just teaching you to do kegels until the cows come home! Kegels may not be for you!). We can provide you with internal cues to contract or relax your pelvic floor better and use tools to give you feedback on your pelvic floor contractions. We may teach you massage techniques or tissue mobility exercises to help with scar tissue and restrictions in the pelvis and abdomen. 

Pelvic floor physio for each person varies but all treatments include teamwork between you and your therapist to achieve your unique goals. And we promise you’ll learn loads along the way!

When should I book an appointment?

 If you are experiencing any of the issues listed above or something you feel you need help with, book in right away! If you are just being proactive I usually advise around 20 weeks to see where you are with things, still allowing time through your pregnancy to make changes if needed. I then typically see patients around 32-37 weeks for some birthing prep education and exercises. Again, frequency of appointments depends on the issues you are experiencing and the goals you are hoping to achieve. 

Where can I access pelvic floor physiotherapy in Toronto? 

Luckily, most private physiotherapy clinics in Toronto have a pelvic floor physiotherapist! You can always do a quick google search and look at the credentials of their therapists to ensure they are trained in pelvic floor physiotherapy. Unfortunately, OHIP and publicly funded pelvic floor physiotherapy services are extremely limited at this time.

Check out this page here, to find the closest Pelvic Floot Physiotherapist near you!

Author, Leah Forrestall is a Pelvic Floor Physiotherapist. She has spent years supporting bodies across Toronto.