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pelvic health

the forgotten muscles
pelvis diagram

Image used with permission from Pelvic Guru, LLC

Looking forward to better health?


  • 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.


  • 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.


  • 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


  • 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.


  • 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


  • 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
Step 2

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.


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.


Our clients say

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.

Silvana Yee Pelvic Health
Contact for an appointment

905 383 3096