First, a little about me. I am a Registered Physiotherapist, which means I have ‘traditional’ physiotherapy training (Master’s degree) and know how to assess and treat regular aches and pains. Back pain, shoulder pain, neck pain, hip pain etc etc. I also have a special interest in fitness and lifting activities and their associated injuries, discomforts and points of performance.

A lot of what we will go over for a Pelvic Health Assessment will be like a ‘regular’ Physiotherapy assessment – a thorough history including current lifestyle and support factors, looking at clothed movement and palpating (touching) muscles and joints externally, depending on your concerns.

Because I have taken many additional courses in Pelvic Health Physiotherapy, this means I am able to perform internal pelvic floor assessment and treatment, when appropriate and with your consent.

The pelvic floor muscles are at the bottom of the pelvis and run from the pubic bone at the front to the tailbone at the back, as well as attaching to the sit bones and the hips at the side. The best way to assess these muscles to find out if they are strong, flexible, sensitive/tender or extra stretchy (just like any other muscle in the body) is through an “internal digital exam” which means inserting a gloved fingers into the vagina or rectum, depending on your concerns and anotomy.

This is different than a pelvic exam you get at your doctors office (for those with vaginas). I am not using a speculum (plastic or metal device that opens the vaginal canal). I am not performing a PAP smear. My goal is to help address whatever concerns you have, which may include pelvic pain or discomfort, so we are always working within your comfort level. This means you do not need to “put up with” discomfort until it is “over with” like many do with a PAP, intercourse or other internal exams. In fact, we want to address and decrease any discomfort you may have, physical or emotional, to help you address your concerns.

Unfortunately, it is not uncommon for people to have history of trauma, negative experience or abuse that involves the vulva, vagina or rectum. Not everyone is comfortable disclosing that this has occurred, whether to your physio or others in their healthcare team. This is an important piece that I always keep in mind as we progress through the internal portion slowly, always communicating and working within your comfort.

Conditions typically addressed through Pelvic Health Physio include:

• bladder concerns including frequency, urgency, leaking (incontinence) or pain (painful bladder syndrome/interstitial cystitis)
• bowel concerns including pain, smearing/leaking, constipation
• pregnancy related pelvic girdle pain, back pain or pubic symphysis pain
• exercise through pregnancy and birth preparation
• recovery after vaginal or cesarean birth including return to exercise, bladder leaking or rectus diastasis (abdominal stretch) management
• pelvic pain including low back, tailbone, hip and pubic pain
• sexual pain including pain on the outside (vulvodynia), at the entrance (vestibulodynia or vaginismus) or inside the vagina with touch or penetration (dyspareunia)
• pain associated with menstruation or endometriosis (dysmenorrhea)
• pelvic organ prolapse concerns (heaviness, pressure or falling out sensations at the vagina) including the option for pessary fittings if needed
• prehab (before) or rehab (after) care for abdominal or pelvic surgeries, including gender affirming procedures 

This internal exam is how we can get the most accurate information about what is going on for you, however it is always completely optional. Reminder – any internal or external exam is always optional and based off of your consent – even at the doctors office, even at the hospital, even during birth. Consent means you are given the pros, cons/risks and alternatives to undergoing (or not undergoing) an assessment, test or treatment and that you are able to make a decision based off your wishes and desires without being under duress or feeling pressured. You are able to withdraw your consent (stop the assessment, test or treatment) at any time. There is continual chat occuring between you and I during an assessment to ensure we are both staying on the same page and working towards YOUR goals in way that YOU are comfortable with.

Our Pelvic Health Physio treatment plan will be a colloborative effort based around your goals and may include:

– breathing and movement strategies

– pelvic floor strengthening or relaxation exercises

– gentle internal or external touch performed by you, me or a partner at home

– lifestyle modifications around sleep, stress management, nutrition and coping strategies.

I hope this has clarified what is involved with a Pelvic Health Physiotherapy assessment. As you can see, we’ll work together to address your concerns through a holistic, trauma-informed, collaborative approach. Let’s connect and get started.