Urinary incontinence and pelvic floor disorders is a topic that is often misunderstood and not discussed openly due to consequences that can occur to the individual that could compromise their quality of life. The pelvic floor musculature (named the levator ani muscles) is often termed the “forgotten muscles” however, they are very important in supporting the bladder, vagina, rectum and 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. Just like any other muscle in the body, these muscles can be retrained to improve overall vitality of the pelvic floor which will result in an increase in patient self esteem and self control.

Physiotherapy is an option available for women wanting to gain sensory awareness and strength of the pelvic floor musculature. This area of physiotherapy is particularly helpful in particular to those who suffer from urinary incontinence, pelvic pain conditions such as: pain with intercourse (dyspareunia, vaginismus, vestibulodynia), and interstitial cystitis, and those who are post surgical or who have had a failed surgery in the urogenital region. In addition, childbirth, age related changes and decreased sexual activity can also cause weakness, tightness and damage to the pelvic floor muscles. In conjunction with childbirth and pelvic floor weakness, the dropping of organs can occur called a prolapse. Just like any other injury in the body, if the pelvic floor muscles are weak and are not functioning in conjunction with the abdomen and lowback; compensation throughout the whole body can occur.


The comprehensive assessment of the pelvic floor will consist of:

History taking:

- that will evaluate the patient’s dietary intake, past surgeries, bladder/bowel patterns, history of childbirth, and medication intake.

- for pelvic pain pt’s-evaluation of patient goals, sexual history, history of any yeast or bacterial infections, any past surgeries, last physical exam with a GP.

Physical examination:

- will involve an internal vaginal and anal exam of the pelvic floor muscles to assess for tone, adhesions and restrictions.

- strength testing of the pelvic floor muscles

- assessment of related regions such as the lumbar spine, abdomen, and sacrum


- will consist of pelvic floor retraining ( addressing issues of both hypertonicity and hypotonicity), relaxation and breathing techniques, manual techniques (facilitation, myofacial release, trigger point release, perineal stretching), biofeedback and muscle stimulation, use of dilators (using a progressive approach) core stabilization exercises, and patient education (via urinary diary and symptom modification).

On September 1, 2011, revisions to the physiotherapy act and scope of practice come into effect; which is a new standard of professional practice of performing authorized activities. According to this new standard of practice, physiotherapists in Ontario require delegation from a physician to complete an internal pelvic floor exam for purposes of pelvic floor rehabilitation. For more information please refer to the College of Physiotherapists website and click on Registrants' Guide and under standards of practice for physiotherapists, click on performing authorized activities. Pelvic floor physiotherapy is a specialization that requires the physiotherapist to take post graduate courses and as of now there is a small group of physiotherapists that specialize in this area. I am one of them; and will continue to take a special interest in women’s health.

There is a definite need for this area of physiotherapy and if you have any questions regarding this information contact the clinic or via email at: