If you decide you should go see a pelvic floor physiotherapist, what can you expect from the appointment?
Yesterday Sheela Zelmer, a physiotherapist who specializes in pelvic floor issues, shared with me how a pelvic floor physiotherapist may be able to help you–with your vaginismus, incontinence, other pelvic pain, and more. Many in the comments talked about how they were really helped by seeing a pelvic floor physiotherapist.
Still, I know that the idea of seeing one can seem scary. First, you may have talked to your doctor about these issues for years sometimes and not gotten anywhere. Will another specialist really be able to help? But also, if you’re experiencing pain “down there”, do you really want physiotherapy there?
So Sheela volunteered to come back today and talk to us about what to expect if you go see a pelvic floor physiotherapist. This month, we’re talking about sexual health, and how our bodies work (and don’t work). And I’m very passionate about this! So here’s Sheela:
Recently, I was in the lobby at church chatting with a group of women I had recently met and was faced with the inevitable question: “what do you do for a living”.
I am a pelvic floor physiotherapist.
Often, when I tell someone that, I am met with wide eyes and an awkward head nod since most people have never heard of pelvic floor physiotherapy. That brief moment in the lobby wasn’t enough to explain what I do, and since I am more of a one on one kind of gal, this is what I would share if we had the chance to sit down over coffee.
Yes, pelvic floor physiotherapy is a thing.
The pelvic floor is the name for the group of muscles below the belt that extends from the pubic bone in the front to the tailbone in the back and side to side from one sitting bone to another. It surrounds the abdomen, bladder, uterus, bowel, vagina and rectum. A pelvic floor dysfunction is when the pelvic floor isn’t working the way it is supposed to. Examples of pelvic floor dysfunctions include things like bladder leakage, painful intercourse (vaginismus and other conditions), prolapse, and pelvic pain.
Unfortunately, many women will experience pelvic floor dysfunction.
- Up to half of all of women experience bladder leakage over the course of their lives
- Between 10-33% of women report that sex is painful
- and almost 10% of women report that they experience persistent pelvic pain
But the sad thing is that less than half of all women seek treatment, and it can take years to get a diagnosis (4). That is a significant number of women that are experiencing problems, but far too few are getting help. But I want to tell you, you’re not alone and there is help.
As a pelvic floor physiotherapist, I have advanced training in the pelvic floor and I work with women, men and kids to treat their pelvic floor dysfunction. But what does that mean?
When you arrive for your appointment you will have a lot of paperwork to fill out. Take your time and be honest. The questions can be quite personal, but your answers really help guide my assessment and treatment.
When it is time for your appointment to start, we will go into a private assessment room. Don’t worry, it is not out in the open or behind a curtained cubicle. I want you to be comfortable and feel safe to share what you are experiencing. I will review your paper work and probably ask you a few more questions just to make sure I understand what has been happening. It may be the first time someone has asked you about the details of what your experiencing, but it is so important that you feel you can fill me in on everything. I’ll also ask you what you hope to get out of our sessions. Every woman and every situation is different, so our treatment will be more successful if we both understand what we are working towards.
No, pelvic floor physiotherapy doesn’t hurt
The physical exam. For most women, it is the part that they dread, and it is my job to make sure you feel comfortable and safe. I will take my time explaining exactly what will happen during the examination, and how we will proceed. It is very important that you are comfortable with everything we will be doing and that you know you are free to ask as many questions as you need. I will only proceed once I get your go ahead, and we can stop at any time.
During the physiotherapy examination I will begin by examining your abdomen, hips and low back. Then I will examine the external part of your vulva and rectum. I am looking for anything that looks out of the ordinary like redness or scars. Once that is completed, I will proceed to the internal vaginal and rectal examination. This is nothing like a pap test. I will keep you covered with a paper sheet to maintain your dignity and proceed slowly explaining everything as we go. It should not be painful, and we can stop at any time if you are uncomfortable.
Based on your paperwork and on the physical examination, I will take the time to explain what I feel is causing your symptoms and make recommendations about how we can work together to treat the dysfunction. These recommendations might include exercises, tools such as dilators and wands, information about hydration, fibre, and general fitness as well as any manual treatment work I feel would be beneficial. I will also suggest how often you should come for treatment and estimate how long our treatment plan will take. You should leave your appointment with a clear idea about where to go from here.
Treatment plans for pelvic floor issues vary, just like us.
Some dysfunctions can be addressed in 6-8 weeks and others can take up to a year, but I will do my best to communicate reasonable expectations so we can maximize our time together.
So where do I go from here?
(*** Disclosure of conflict: I am a paid independent contractor for Pelvic Health Solutions***)
It is interesting that there seems to be a physiotherapy clinic on every street corner, but very few pelvic floor physiotherapists. At the moment, we are a relatively small group of physiotherapists but we are growing. In Canada, each province has a regulatory College for practicing physiotherapists. You can use the search feature to find a pelvic floor physiotherapist near you. Also, many mom’s groups have Facebook groups and they may be able to give you the name of someone they’ve found helpful. And finally, there are independent registries for pelvic floor physiotherapists, but this varies between countries, states and provinces. Pelvic Health Solutions has an excellent Canadian list.
One final word about pelvic floor physiotherapy
Pelvic floor dysfunction is very common, but seldom talked about. When things are hidden and silent, shame grows. When we talk about our experiences it heals not only ourselves but others too and shame has nowhere to hide. Our bodies are a beautiful gift, so let’s keep honest conversations going. Our daughters and granddaughters will thank us.
I’m so glad Sheela joined us, because I believe many of us are suffering needlessly when there is help available. Have you ever been to a pelvic floor physiotherapist? Do you want to share what happened in your appointment?
Thank you very much. I had never heard about this, and it sounds like it might actually be helpful for some of my issues. If I can find such a specialist here.
I hope you do!
I had Pelvic PT after both of my children’s births because I had very bad tearing with my first delivery and the scar tissue made sex very painful. Then my second delivery wasn’t as bad but it reactivated my issues. Both times the therapist did a gentle exam followed by a few months of weekly sessions where she manually helped get rid of my scar tissue through external and internal manipulation. It was not painful, just awkward, but my therapist was professional and warm and kind and it did a world of good for me. I recommend it highly!
Thank you, Kari!
Would this work for a low cervix? Mine has seemed to drop after having 3 large babies and now sex is horrible.
I know she said that she does deal with prolapse, and that may be part of the same issue. There is a “contact us” page on the Pelvic Health Solutions site that Sheela is a part of–they may be able to help you.
yes Kim! Pelvic Floor physio could definitely help with what you are experiencing. There are a lot of factors that contribute to a low cervix and sexual issues. Good luck!
I’m in the UK and have recently had my first appointment with a pelvic physio having been referred by a gynaecologist. I’d lots of mild symptoms over the past few months which are worsening and seem to be prolapses, which can be bladder, bowel or cervix bulging into the vagina. My youngest child is 4 and I’m only in my early 30s so I never expected this could be a problem that would happen to me but apparently it’s far more common than we realise. My first appointment was an hour long where we just discussed symptoms and it really helped to feel like it wasn’t in my head, and that I wasn’t rushing to say everything like other medical appointments. She also left physical examinations until the next time so I had begun to feel comfortable with her. While I’ve had no physical issues with sex really, I’ve definitely felt less attractive and less of a woman because of it. However I’m beginning to feel much more confident that it’s going to improve and much better about myself having seen someone who understood and cared about what I was going through and could help.
Oh, I’m glad, Roberta! There really is help. It’s funny how we feel so much responsibility for that area of our body, like if something goes wrong we should handle it ourselves. If our shoulder suddenly started acting up, we’d be in to the doctor in a heartbeat. Glad you’re getting help!
A bit late to the comments, but I just wanted to share my experience with physiotherapy. I have been struggling with vaginismus for 4 years now. A year of frequently painful sex after we got married was brought to a head when I went for my first pap smear….and the GP physically couldn’t even use the smallest speculum. Was referred to the gynaecologist who suspected a partially imperforate hymen, so she suggested surgery. Not knowing any better, I went along with it and had the surgery…..as a result, I went from being able to have sex (although with frequent pain) to physically not being able to have sex at all. After multiple appointments and dilator attempts getting nowhere, she suggested (note: as a last-ditch effort) that I see a psychologist….and a physiotherapist, who was an hour an a half’s drive from where I live.
I finally booked with the PT and I can’t tell you how kind and understanding she was. I am still struggling with it all and only making small steps at a time, but at least I understand now that vaginismus is literally not being able to control pelvic floor muscles, and things I can do to work on it. Incidentally, I had previously asked the gyno about “Kegels” and if they would do anything to help me, and she basically told me that my pelvic floor is already too active, I don’t need to do anything to strengthen it(!). Now I know that it was just weak and uncontrollable! But looking back I am sad to suspect how little the gyno knew about the relationship of all the muscles….2.5 years later I still can’t have sex due to muscle spasms after even such a minor surgery. These days I suspect that I probably didn’t need surgery after all that, just some help from a PT at the very beginning of our marriage.
Thanks for talking about this, Sheila – I wish more women knew about it and that it was an option. If anyone out there with vaginismus is reading this, please don’t be afraid to seek help from a PT 😊
Oh, Sarah, thank you so much for sharing, and I’m so sorry that you’re going through this! So very sorry. But thank you for giving your story. I hope people read it and understand that it’s okay to ask for help. If you’re not able to control and relax those muscles, it’s not a shameful thing, like there’s something psychologically wrong with you. There really isn’t it!