Pelvic health is a broad and vital field that encompasses many aspects. Currently, we specialize in addressing specific pelvic health concerns: urinary incontinence, pelvic organ prolapse, diastasis recti, pelvic floor muscle strengthening, and post-partum recovery. Our focus is on providing expert care and tailored treatments to help manage and improve these conditions, restoring strength, function, and comfort. We are dedicated to supporting your recovery and well-being through evidence-based therapies designed for these specific pelvic health issues.

Here’s a quick breakdown of each of those components:

• Urinary Incontinence: This condition involves the loss of bladder control, leading to accidental leakage of urine. It’s often caused by weakened pelvic floor muscles or damage to the muscles, nerves, and tissues that support the bladder. Strengthening the pelvic floor muscles through exercises like Kegels can help manage and improve symptoms.
• Prolapse: This occurs when one or more pelvic organs (such as the bladder, uterus, or rectum) descend from their normal position due to weakened pelvic floor muscles or ligaments. Pelvic organ prolapse (POP) can range from mild to severe and may require interventions such as pelvic floor therapy, lifestyle changes, or surgery in more severe cases.
• Diastasis Recti: This is a separation of the abdominal muscles (specifically the rectus abdominis) that commonly occurs during pregnancy. It can lead to issues with posture, core strength, and overall abdominal support. Physical therapy and exercises targeting the deep core muscles can help close the gap and strengthen the area.
• Pelvic Floor Muscle Strengthening: This refers to exercises aimed at improving the strength and function of the pelvic floor muscles. These muscles support organs like the bladder, uterus, and rectum. Strengthening them through targeted exercises (such as Kegels, Pilates, or specific physical therapy routines) can improve urinary control, prevent prolapse, and help with recovery post-partum.
• Post-Partum Health: After childbirth, the body undergoes numerous changes, and pelvic health is a major concern. Many women experience issues like incontinence, prolapse, and diastasis recti. Post-partum pelvic floor rehabilitation helps address these issues, restore strength, and prevent future complications. It’s vital to ensure recovery is gradual and guided by professionals to avoid further injury.

The pelvic floor consists of a group of muscles and connective tissues that support the bladder, urethra and pelvic organs. Like other muscles in the body, the pelvic floor can become stretched and weak or may become over-active and tight in response to illness or injury. Physical therapists treat pelvic health conditions by addressing muscle weakness or dysfunction to correct or improve problems such as incontinence, organ prolapse and pelvic pain.

• What does a physical therapy pelvic health internal examination look like?

Before treating any condition, a physical therapist must first determine what the client’s health concern is, and its cause. This requires a thorough assessment of the client’s health. The assessment will vary depending on the client’s health concern.

An assessment will begin by gathering information from the client about their general medical history, symptoms, and concerns. After this discussion, the physical therapist will complete an assessment of the client’s condition. This typically begins with a general assessment to rule out any underlying problems that the physical therapist is not able to treat and becomes more specific to the client’s concern as it continues. When assessing health conditions such as urinary incontinence, the physical therapy assessment generally includes an internal examination to assess the muscles of the pelvic floor and the presence of other concerns.

Clients can expect that physical therapists will explain the assessment procedures they are using and their rationale. Clients can also expect that the physical therapist will obtain the client’s consent to proceed before completing any part of the examination.

• Why/when is an internal exam needed?

An internal examination is often required when a physical therapist is assessing or treating a condition of the pelvic floor. The internal examination is needed in order to assess pelvic floor muscle tone and strength the presence or absence of pelvic organ prolapse.

This assessment helps the physical therapist determine a plan of care to address the client’s concern. However, clients may not always be comfortable with the idea of having an internal examination. Clients can expect that their physical therapist will work with them to build rapport and find approaches to assessment and treatment that the client is comfortable with over the course of the physical therapy treatment program.

Clients always have the right to decline a physical therapy assessment or treatment procedure.

What education and training should a physical therapist have?

Physical therapists are required to have post-graduate training to work in pelvic health. Some physical therapists may have also had the opportunity to work under mentorship of physical therapists experienced in this area of practice. It is also important that a physical therapist regularly use their skills in order to maintain them.

There is a wide range of courses available to physical therapists who wish to develop their skills in this area. Physical therapists are required to evaluate courses to determine those which will provide them with the skills required to provide pelvic health (internal examinations) services. The College of Health and Care Professionals of BC does not endorse any education program but does provide guidance regarding minimum curriculum expectations for courses.

As important as the physical therapist’s education and experience is how effectively they develop rapport with their clients. The client should feel safe, respected, and listened to when in the physical therapist’s care. The development of an effective therapeutic relationship is essential to the success of all physical therapy services.

Physical therapists should readily provide information about the coursework or training they took in order to develop their skills and abilities and their authorization to provide these services. The physical therapist should also provide information about how they maintain their skills. The client must be able to make an informed choice of providers, balancing considerations of education, experience, and rapport to find a physical therapist who can address their needs and provide quality physical therapy care.