When I was writing my blog on urinary incontinence, Peeing My Way Through Perimenopause, I started researching pelvic floor therapy and found that there was a lot to unpack. I quickly realized that pelvic floor therapy for menopause incontinence was a blog in itself. 

Peeing My Way Through Perimenopause, is a personal account of my embarrassing and frustrating experience with perimenopause incontinence. I do more laundry now than when my son was a baby. 

In this blog, I’m doing a deep dive into pelvic floor therapy so that we all have a better understanding of:

– what pelvic floor therapy is,

– what to expect at an appointment,

– treatments and techniques, and

– how to find a good Pelvic Floor Therapist.

Let’s dive in…

What is the pelvic floor?

The pelvic floor are a group of muscles between the tailbone and the pubic bone. They act as a ‘floor’ for pelvic stability. These muscles hold the uterus, vagina, bladder, and bowels in place and help with bodily functions like peeing and sex. 

As we have babies, get constipated, age and hit perimenopause and post menopause, these muscles start to relax and our vaginal tissue loses elasticity as our estrogen drops. Together these factors can cause urinary incontinence for women in midlife.

What is pelvic floor therapy?

Pelvic Floor Therapy (PFT) is a specialized branch of physical therapy that targets these pelvic floor muscles to help rehabilitate them after an ‘injury’. This includes childbirth, ladies!

PFT is really effective in treating muscle weakness after childbirth. It also helps with constipation, fecal or urinary incontinence, pelvic organ prolapse, and sexual dysfunction. 

PFT helps individuals regain strength, alleviate discomfort, and improve overall pelvic health.

Kegel exercises are a great way to strengthen your pelvic floor muscles.

Reasons women go for pelvic floor therapy

Pelvic floor physiotherapy is really helpful in treating pelvic floor dysfunction. Women will experience either tight muscles or weak muscles.

Tight muscles leads to urgency incontinence (a frequent and urgent need to pee) and also painful or incomplete urination, and needing to pee regularly throughout the night. It can also lead to constipation and difficult, painful bowel movements. 

Sexual issues may also arise, like pain during penetration and orgasm, and discomfort during sexual stimulation. 

Weak muscles can cause stress incontinence, which involves the involuntary loss of urine during a physical activity, like jumping, running, coughing or sneezing.

Weak pelvic floor muscles can also contribute to pelvic organ prolapse. This is when  organs like your uterus, bladder, bowles or top of the vagina begin to shift out of their proper position. This is really uncomfortable. Symptoms include heaviness or bulging at the vaginal or rectal opening. You should get in to your doctor right away. 

What to expect at your appointment

At your first PFT appointment, your pelvic floor therapist will ask about your medical history and the current pelvic issues you’re facing. Your therapist will also conduct a comprehensive physical examination. This takes about an hour and includes both external and internal body parts. 

During the external exam, they examine your spine, abs, and the sacroiliac joints that link your pelvis to your spine. They’re looking for any signs of pain, tightness, or tenderness. 

The internal exam is a little more up close and personal. And I’ve heard from a few friends, it’s not the most comfortable. The therapist needs to insert a finger or two into your vagina and/or rectum. They are evaluating for tone, elasticity, pain, and tenderness. They’re also assessing if you can voluntarily contract and relax your pelvic floor muscles and how they move as you breath.  

After the examinations and clinical assessment, your physical therapist will discuss a treatment plan for you and schedule your subsequent sessions. Because of the nature of this therapy, they should be conducted in a private treatment room. Make sure you are comfortable with all of this and if not, don’t be afraid to speak up.

Treatments and Techniques

Depending on the type of incontinence (or other conditions you’re experiencing), the type and length of your treatment will vary. Some of the common treatments used for women’s health include:

Exercises – like Kegels to help strengthen or relax your pelvic floor muscles. 

Manual therapy – can be uncomfortable. Your physical therapist performs manual therapy techniques, including internal ones, to help relax the pelvic floor muscles. Although it probably won’t feel very relaxing in the session. 

Electrical stimulation – uses electrical currents to stimulate muscles and nerves in your pelvic floor. It activates dormant nerves to  improve contraction and flexibility. Apparently it’s not as uncomfortable as it sounds and many women do work or scroll social media while getting this done. 

Vaginal dilators – are objects inserted into the vagina, that gradually increase in girth. They gently stretch the vagina, promoting increased flexibility and reducing discomfort experienced during vaginal penetration

Weighted cones – are cone-shaped and are inserted into the vagina like a tampon to help strengthen the pelvic floor. Using them while doing PFT exercises can help to increase resistance and strengthen muscles. 

Come Prepared

As with any medical appointment, it’s important to come prepared. If you’ve been keeping a journal of your menopause incontinence, definitely bring it. If you haven’t started one, you should. Start tracking bathroom visits, instances of leakage or sudden urges, what you were doing when it happened, and your fluid intake. 

Also prepare a list of questions. It’s amazing how quickly we forget everything when we’re in a slightly uncomfortable/stressful situation. 

Wear something comfortable like you would wear to the gym. 

Shower that day and make sure you’re good with the presentation of everything down there. Both the initial consultation and subsequent sessions may include some internal work. 

Bring your health card, health insurance card and a list of any medications you’re currently taking. 

What is costs

Prices vary from clinic to clinic, but the cost in Ontario is about $150 for the initial 60 minute assessment. Subsequent sessions will be 30-60 minutes in length and cost anywhere from $100 – $200. 

The good news is that if your company’s health insurance plan covers physiotherapy, PFT should be also be included. 

How to find a pelvic floor therapist

In Canada, you do not need a referral to see a pelvic floor therapist. That said, asking your health care practitioner for a list of good ones in your area is always a great idea. I wasn’t able to find a governing body that publishes a list by region. Or ask your girlfriend if they’ve found someone they love.

If you’re going to Google it, it’s really important to make sure they are a licenced physical therapist (in the province or state you live in) and that they’ve got specialized training in:

• Pelvic Health Physical Therapy
• Pelvic Pain
• Bowel Dysfunction
• Fundamental Topics of Obstetric Physical Therapy
• Postpartum Physical Therapy

Don’t Delay

It’s important to make an appointment as soon as you notice any issues. According the National Association for Incontinence, women typically delay seeking professional diagnosis for an average of 6.5 years from the onset of initial symptoms.

The trouble with this is that unlike other muscle strains or injuries that may go away on their own, pelvic dysfunction tends to worsen over time. It may be a little leak here and there today, but take it from me, it can quickly turn into peeing your pants in public faster than you think. Trust me, you don’t want that. It’s absolutely mortifying!