pelvic health

the forgotten muscles

Image used with permission from Pelvic Guru, LLC pelvicglobal.com

Looking forward to better health?

PREGNANCY & POSTPARTUM

Scarring from c-section, tearing or episiotomy (surgical cut made in the perineum between the vagina and anus to enlarge the vaginal opening prior to delivery).
Leaking urine , gas or stool, when you laugh, cough, sneeze, walk, run, and jump.
Incomplete bladder or bowel emptying.
Experiencing pressure, heaviness, or a bulging sensation in the vagina (prolapse).
Ongoing pain in the vagina, rectum, hip, pubic bone, tail bone, abdomen or lower back.
Diastasis recti.

MEN'S PELVIC HEALTH

Post radical prostectomy -removal of the prostate as a result of cancer can cause
urinary incontinence and erectile dysfunction.
Prostatitis-increase urinary frequency and disturbed sleep throughout the night
due to urgency.
Post Transuretheral resection of the prostate (TURP) procedure-risks of this surgery is urinary incontinence and erectile dysfunction.
Post void dribbling due to weak pelvic floor muscles.

POST SURGICAL PAIN

Pelvic cancers located in the bladder, uterus, ovaries, prostate.
Transgender individuals who have undergone bottom surgery.
Chronic post surgical pain in the pelvis from a hip fracture or labral tear or repair.
Patients who have had failed surgery in the urogenital region (meshing or taping
procedure).

PAIN CONDITIONS

Dyspurenia- pain with intercourse.
Vaginissmus- a reflexive muscle tightening when any objects (tampon, speculum,
penis ) are inserted into the vaginal region.
Vestibulodynia-pain that occurs at the entrance of the vagina or other external
parts of the vulva.
Endometriosis-cells similar to the lining of the uterus or endometrium grow
outside the uterus.
Adenomyosis-occurs when the tissue that lines the uterus grows into the
muscular wall of the uterus.

INCONTINENCE

Stress incontinence ( urinary leakage with activities like coughing, sneezing, laughing, jumping).
Urinary incontinence with activities like heavy lifting , walking, and sit to stand.
Urinary urgency (increase frequency to void during the day and at night ).
Incomplete bladder and bowel emptying.
Interstitial cystitis (inflammation of the bladder).
Painful bladder syndrome

CHILDREN'S PELVIC HEALTH

Encorpresis (aka fecal incontinence or soiling) secondary to constipation or emotional issues.
Nocturnal enuresis-aka bed wetting during the night.
Stress incontinence.
Increased urgency and frequency.

The importance of pelvic health.

Pelvic floor disorders is a topic that is often misunderstood and not discussed openly due to the consequences that can occur to the individual that could compromise their quality of life. The pelvic floor musculature are often termed the “forgotten muscles” however they are very important in supporting the bladder, vagina, rectum and the inner organs of the abdomen.

The reason these muscles are termed forgotten is because they lie invisible in the bottom center of the pelvis and lie between the sits bone, tailbone and pubic bone- this is referred to as the urogenital triangle. Just like any other muscle in the body, these muscles can be retrained to improve the overall vitality of the pelvic floor which will result in an increase in patient self esteem and self control .

Not many people know that physiotherapy is an option available for both women, men and children wanting to gain sensory awareness and strength of the pelvic floor musculature.

Step 1

ASSESSMENT

One hour pelvic health assessment
Subjective history taking involving questions regarding your pelvic issues, bladder and bowel functioning, previous medical history, previous births, other healthcare professionals involved in your care
Objective exam involves a postural assessment, lumbar ROM, and breathing evaluation.
An external examination of the pelvis and genitalia and depending on your pelvic issue it will involve an internal exam of the vagina or rectum.
We are aware that the internal examination may not be the most comfortable experience. If you are unsure if you are willing to get an internal exam please let the physiotherapist know and she will be willing to address any questions or concerns you may have.

Step 2

TREATMENT

30 Minute follow up appointment
Exercises | Stretching and strengthening
Manual techniques
Muscle stimulation
Biofeedback
Taping
Acupuncture
Postural Education

pregnancy & postpartum

Prenatally, preparing for birth is like training for a marathon. The more preparation you do the better you will be with navigating your unique birth experience whether it will be vaginal or c-section. Prepping for birth beforehand will improve your post partum outcomes.

What role does physiotherapy play prenatally?

Education on how to become aware of your pelvic floor muscles, your diaphragm muscle (which is the main breathing muscle), and your core muscles; which play a crucial role in giving birth.
Education on the different positions for labour
Education on perineal massage/ stretching for the patient and their partner/spouse.
Common symptoms experienced prenatally like low back , hip , pelvic and pubic bone pain can be addressed and treated . One of the most common conditions treated prenatally is symphysis pubic dysfunction (SPD) where pain is located in the pubic bone and affects daily functions like rolling in bed, stairs and getting in and out of a car.
Postpartum , after a 6 week followup with either your ob/gyn or midwife pending no complications you can start pelvic floor physio.

What role does physiotherapy play postpartum?

Scarring from c-section, tearing or episiotomy (surgical cut made in the perineum between the vagina and anus to enlarge the vaginal opening prior to delivery)
Leaking urine , gas or stool, when you laugh, cough, sneeze, walk, run, and jump.
Incomplete bladder or bowel emptying.
Experiencing pressure, heaviness, or a bulging sensation in the vagina otherwise known as a prolapse.
Ongoing pain in the vagina, rectum, hip, pubic bone, tail bone, abdomen or lower back.
Tenting or bulging in the middle of the abdomen is called diastasis recti when
there is decreased tension in the connective tissue that support the abdomen as a
result of weak core muscles.

BREASTFEEDING

Our role is to restore optimal functioning of mother’s who are experiencing issues with tissue inflammation, swelling, pain and skin integrity which are within our scope of practice.

Intervention options that we can offer mother’s to help treat the above issues:

Massage, scar mobilization, stretching, positioning and ergonomics, acupuncture, taping techniques, modalities (ultrasound and ice), education (posture, signs of inflammation and self management), strategies for relaxation and mindfulness.

Conditions that can be treated are mastitis, blocked milk ducts, engorgement.

Mastitis-gentle stroking massage from the areola towards the armpit. If there is specific area of swelling noted the massage is started from the affected area towards the axilla. Massage is alternated with hand expression.

Blocked ducts- gentle stroking massage close to the plugged area towards the axilla. To prevent tissue damage direct hard pressure on the plugged area is avoided. Massage is alternated with hand expression.

Engorgement- alternating gentle fingertip massage within the areola with gentle stroking breast massage towards the axilla. Massage is alternated with hand expression to promote softening of the areola and assist with drainage and avoid further excess build up of milk in the breast.

If a women has had any breast surgeries that could cause disruption to her milk supply, PT’s can work on the scar/connective tissue to help loosen the area that is affected.

*The goal is to ensure breastfeeding success for each individual and to work collaboratively with the other health care professionals involved such as lactation consultants, midwives, family physicians, obstetrican/gynecologists etc.

BLOG POSTS

What role does pelvic floor physiotherapy play in the transgender and gender diverse population?

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November 23, 2022

Physiotherapists have the training to care for the transgender and gender diverse population. As healthcare professionals we acknowledge the fact that patients will have …

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About SILVANA YEE

Silvana Yee (She/Her) graduated from Queen’s University in 2001 with a Bachelor of Science in Physiotherapy and also graduated with honours with a Bachelor of Arts in Physical Education from Wilfrid Laurier University in 1997. She initially began her career in sports medicine and orthopaedics physiotherapy for the first ten years of her career. In 2011, Silvana began to incorporate pelvic floor physiotherapy into her practice and never looked back. As she started to see positive results with her patient’s she became more passionate about increasing awareness and making pelvic floor physiotherapy more readily available for the public. As a lifelong learner, she continues to see educational opportunities to further develop her skills and knowledge in the pelvic health field to service women, men, children and individuals in the transgender community who are preparing or who have undergone bottom surgery. In her spare time, Silvana enjoys travelling abroad, cooking and trying new recipes with her family, and watching and playing sports of any kind.

Contact for an appointment

905 383 3096

ujp1508@gmail.com