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?