What is Pelvic Floor Physiotherapy and Why is it Important?
Awareness is spreading around pelvic floor health and the volume of individuals seeking Pelvic Floor Physiotherapy is growing year over year, but what is this niche service and why is it so important?
Pelvic Floor Physiotherapy (PFPT) is a specialized area of Physiotherapy that focuses on issues involving the muscles, ligaments, and connective tissues in the pelvic region. Pelvic Health takes a holistic approach, meaning that the assessment and treatment does not only focus on the pelvic area but involves the whole body as a system that works together.
Pelvic Floor Physiotherapists are Registered Physiotherapists (PTs), many with postgraduate Masters or Doctoral degrees in Physical Therapy, who go on to advance their skills through additional education in Pelvic Health.
Majority of the conditions that are treated through Pelvic Floor Physiotherapy involve the pelvic floor muscles.
The pelvic floor is a group of muscles that form a hammock-like structure at the base of the pelvis. Functions include supporting the pelvic organs (bladder, uterus, and rectum), controlling bowel and bladder continence, core stabilization, sexual health, and pumping lymphatic fluid through the pelvic region (in fact, it is the second biggest lymphatic fluid pump in the body). The pelvic floor muscles play a role in childbirth, as they are situated around the vaginal canal where the baby must pass through. Given the direct involvement of these muscles during the birthing process, care during and after pregnancy is especially important for maintaining the vital functions mentioned above.
What types of conditions do Pelvic Floor Physiotherapists treat?
When the pelvic floor muscles aren’t functioning properly, issues can arise such as:
Pelvic pain: Discomfort or pain in the pelvic region, which may be constant or intermittent.
Urinary problems: Urinary incontinence (involuntary leakage of urine), difficulty emptying the bladder, and/or a frequent urge to urinate including waking up in the night to pee.
Bowel issues: Constipation, straining during bowel movements, fecal incontinence, and/or difficulty controlling gas.
Sexual dysfunction: Pain during intercourse or other sexual activities, involuntary contraction of the pelvic floor muscles that prevents penetration, lack of or decreased sensation during sex, urinary incontinence during sex, and/or frequent post-coital UTIs.
Muscle spasms: Involuntary contractions or spasms of the pelvic floor muscles.
Factors known to contribute to pelvic floor dysfunction include:
Pregnancy and childbirth: The pelvic floor muscles can be stretched or weakened during pregnancy and delivery.
Chronic constipation or straining during bowel movements: This can lead to increased pressure on the pelvic floor.
Obesity: Excess weight can strain the pelvic floor muscles.
Surgery: Certain surgical procedures, especially those in the pelvic area, may impact the function of the pelvic floor.
Trauma or injury to the pelvic area: Accidents or injuries can affect the pelvic floor muscles and surrounding structures.
Where do Pelvic Floor Physiotherapists see patients?
Pelvic Floor PTs work in both inpatient and outpatient settings, meaning they can work in hospitals, rehab facilities, as well as private clinics.
What happens during a Pelvic Floor Physiotherapy appointment?
During a typical PFPT session, the Physiotherapist will perform a thorough assessment of the pelvic floor muscles and surrounding structures. This may involve internal and external examinations to evaluate muscle tone, strength, flexibility, and coordination. The PT will also assess other areas of the body relevant to the presenting issue (eg. hips, low back, core, neck). Based on the assessment, the PT will develop a treatment plan. Follow up usually involves 6-8 sessions, but can extend to a year or more depending on the issue being treated.
How is pelvic floor dysfunction treated?
Pelvic floor dysfunction is often treated using a holistic, whole-body approach, including:
Individualized exercise prescription and training to target involved areas of the body.
Education and Lifestyle Modification: Guidance on managing stress, water intake, posture, breathing, lifting techniques, microbiome and nutritional support, and more to support pelvic health.
Manual Therapy: Hands-on techniques to release tension and improve mobility in the pelvic floor and other areas of the body.
Biofeedback: Using technology to provide visual or auditory feedback to help individuals learn to control and coordinate their pelvic floor muscles.
Behavioral Strategies: Techniques to address habits or behaviors that may contribute to pelvic floor dysfunction, such as voiding habits.
Is Pelvic Floor Physiotherapy only for women?
This is a great misconception! Men can greatly benefit from Pelvic Floor Physiotherapy for conditions such as pelvic pain, bladder pain syndrome (interstitial cystitis), overactive bladder syndrome, nocturia, erectile dysfunction, non-bacterial chronic prostatitis, and post-prostatectomy issues among others. It is important for men to vocalize their symptoms to their healthcare provider and seek the necessary treatment (eg. referral to a Urologist and Pelvic Floor PT) in order to address these conditions that can worsen with time.
Is Pelvic Floor Physiotherapy covered by insurance?
Most insurance companies offer coverage for PFPT, as it a carefully regulated health care profession under the medical sciences. Pelvic Floor Physiotherapy is conservative and non-invasive. It can be a primary form of care, meaning you do not need a prescription from your doctor to see a PT (unless your insurance company requires it). PFPT can complement medical treatments as an essential component of a holistic approach to pelvic health. Individuals experiencing pelvic floor issues who are unsure about treatment options should consult with their healthcare provider to determine if PFPT is appropriate for them.
Looking to book a one-on-one session? My booking for private appointments will re-open in Fall/Winter 2024. If you are expecting, have recently given birth, or are experiencing pelvic floor issues, learn more about my online perinatal, postnatal, and rehabilitative yoga programs that can be done from the comfort of your home.
10 Tips to Improve Your Energy Levels During Pregnancy
Fatigue during pregnancy is another level of tired. During my first trimester, it felt like I was sedated. I couldn’t function if I didn’t close my eyes and sleep for hours during the day — mind you, I didn’t have any toddlers running around to take care of, which would only make it that much more exhausting.
I’m sure you know how important sleep is during pregnancy, not just for you but also for your baby. However, there are many factors that interfere with a good night’s sleep when you’re pregnant — insomnia, discomfort in the low back, hips, and/or pelvis, restlessness, and poor digestion to name a few.
Here are my top suggestions for managing extreme tiredness and fatigue during pregnancy and improving your energy levels:
Take naps: naps are essential for your body’s recovery and the baby’s growth and you don’t have to nap for very long to reap the benefits — 30-45 minutes is the perfect amount of time to rest during the day and give you that boost of energy without making you feel even more tired when you wake up.
Optimize your sleep posture: to prevent hip and pelvic pain, try placing a pillow between your legs when sleeping on your side, and you can also place a pillow behind your back to offer you some comfort and prevent you from rolling over. Also, make sure your neck pillow is designed for side-sleeping. You may have to switch this up now that you’re expecting! As a side-sleeper myself, I use the Casper original pillow and I love it.
Reset your biological clock: try going to bed and waking up at the same time every day. You will need to do this consistently for at least 14 days to make it a habit. It’s also helpful to have complete darkness when sleeping as it will allow you to fall into REM sleep — that special time that allows your brain to recover from the day. You can also try wearing a sleeping mask to block out any light. I personally love the Slip silk sleep masks.
Improve your digestion: eat smaller meals and snacks throughout the day to avoid overwhelming your system and stick to whole foods instead of highly-processed foods and refined sugars that can cause digestive discomfort at night and blood sugar crashes during the day. One supplement that has helped my digestion during pregnancy is Magnesium citrate. I take one tbsp of Cal Mag at night as recommended by my Naturopath. If you are thinking about trying supplements, I recommend visiting your Naturopath for a prescription that won’t interfere with your current prenatal vitamins and any medications you are taking!
Get your iron levels checked: I’ve struggled with anemia for a long time and it’s only gotten worse during pregnancy. With my red blood cell count and hemoglobin levels at all-time lows, I’ve been feeling extra sleepy, dizzy, and faint. I was previously taking FeraMAX 150mg every day, but it made my morning sickness and constipation so much worse during my first trimester. I have since switched to Ferosom Forte 20mg and I haven’t been experiencing any of the negative side effects. I’m also taking 3 capsules of NFH Prenatal Sap containing 30mg of iron total. I try to take my iron at lunchtime and prenatals at night to decrease the risk of these side effects. If you’re not sure about whether your iron levels are low, see your provider for a blood test and ask them for recommendations on iron supplements if you are struggling with iron-deficiency during pregnancy.
Exercise regularly: exercise does wonders for your body that you can’t always see or measure. Not only does it help to improve your quality of sleep, which gives you more energy and makes you feel less tired during the day, but also helps to prevent low back, hip, and pelvic pain which can make it difficult to sleep at night. I recommend working out for 20-30 minutes at least 3x per week — this can be any type of movement you enjoy — and walking for 30 minutes at least 5x/week. Click here to learn about my Preparing for Birth live and on-demand prenatal fitness program with specialized classes designed to suit every week of your pregnancy (added bonus, all of my classes are safe for your core and pelvic floor!).
Minimize your caffeine intake: this one seems obvious because we need to limit our caffeine intake during pregnancy anyway, but aside from affecting the baby, caffeine can disrupt your sleep-wake cycle, worsen your insomnia, and keep you awake at night making you more tired the next day. Your energy levels may not be affected right away, but they can slowly deteriorate with prolonged and excessive use of caffeine. Try going a week without coffee and see how you feel! You can also try switching to decaf in the afternoon and reducing your overall intake while still enjoying that morning cup.
Manage your stress levels: stress negatively impacts your digestion and sleep, but it also contributes to burnout, muscle tension, and mental exhaustion over time. Try building a relaxing nighttime routine: take a warm bath, stay away from your phone at least an hour before bed, lather yourself in a pregnancy-safe body oil (I love this one from Evereden), and listen to a 10-minute sleep meditation before drifting off to sleep. You can also try booking a prenatal massage or acupuncture appointment to help alleviate any pain that is worsening your stress and keeping you awake at night.
Hydrate, hydrate, hydrate: dehydration can make you very tired. Keep a water bottle close by and track your water intake (aim for 2 litres/day). If you’re awful at tracking your water intake like me, this bottle from Bink is designed for mamas and makes it easy to stay on top of your necessary water intake (this is also a great gift to go on your registry!). Remember that herbal teas and electrolyte mixes also contribute to your water intake, so you can try switching it up if water is making you nauseous.
Nutrition: adequate energy and nutrient intake is essential for your baby’s development, to fuel your exercise and recovery, and to give you the energy to meet the day’s demands. If you struggle with nutrition and find yourself reaching for processed, easy-to-access snacks a little too frequently, it’s time to reassess your food intake and start nourishing your body with whole foods to help improve your energy levels, sleep, mental wellbeing, and so much more. For prenatal nutrition coaching and workshops, I recommend Certified Nutritionists Carly and Laila from @ebbandflownutrition.
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