ast week, I attended the Take Back The Night event in York Region. If you have never heard of Take Back The Night, it is a global awareness initiative aimed at standing up against gender-based violence that occurs in our communities.
During one of the speeches, they listed off some statistics that really put things in perspective for me:
“1 in 3 Canadian women experiences some form of sexual violence in their lifetime.”
1 in 3?!?! Math is not my greatest strength but that means that if I see 12 clients in a day, it is very possible that 4 of them may have experienced sexual violence in their lifetime.
That thought hit me and I thought: wow. This is such a big reminder for me to make sure that everyone who comes to see me feels 100% comfortable with what we are doing in our sessions.
And then I thought: how many people do not see a pelvic health physiotherapist because they are uncomfortable with having an internal exam performed? Or because they are uncomfortable talking about their pelvic floor concerns with someone?
So I thought I would address two very common questions that come up in conversations when I talk to others about what I do as a pelvic health physiotherapist.
How do I find a pelvic physiotherapist I can trust?
The short answer is...trial and error.
There are a lot of ways to find a pelvic health physiotherapist such as Google, online/local directories and listings, referrals from a doctor and recommendations from friends. There may be multiple pelvic health physiotherapists in your area but which one is the right one for you??
Let’s start off with clarifying what a pelvic health physiotherapist is. A pelvic health physiotherapist is a Registered Physiotherapist that has a license to practice physiotherapy in their province/state/country (I am licensed by the College of Physiotherapists of Ontario to practice physiotherapy in Ontario). Pelvic health physiotherapists have also taken some sort of additional training that has allowed them to do both external and internal examinations of the pelvic floor. This includes both vaginal and rectal examinations. It is important to note that the trainings and courses that are offered are not regulated so there may be variability in the quality of content of the courses.
Here are some things to keep in mind when choosing a pelvic health physiotherapist:
That leads us to the second question that comes up a lot:
What if I don’t feel comfortable having an internal exam performed?
I know that many clients are very apprehensive and anxious about the internal assessment part of pelvic health physiotherapy for many reasons. Some people may have had painful internal exams in the past, are currently dealing with pelvic or genital pain or heard from a friend that pelvic health physiotherapy is painful.
I want to make it very clear that the LAST thing I want to do is make my clients feel uncomfortable.
I will always advise my clients to take care of themselves first. This means asking questions about any of the assessment or treatment techniques that I describe, being aware of their physical, mental and emotional state during appointments and saying, “wait”, “hold on” or “stop” if ANYTHING we’re doing is not okay.
Is an internal assessment an important part of pelvic health physiotherapy?
Yes, it is. But there are SO MANY other ways that a pelvic physiotherapist can help you without doing an internal exam. And the end of the day, it’s: “your body, your choice”
Is there someone I can talk to if I’ve experienced sexual violence recently or in the past?
If you have experienced sexual violence in the past or recently, there are lots of community organizations that I have connected with that would be able to provide you with the support that you need (see below).
Yellow Brick House - www.yellowbrickhouse.org
Women’s Support Network of York Region - www.womenssupportnetwork.ca
Angel Freedman - Registered Social Worker - www.angelfreedman.com
Judy Lui - Registered Psychotherapist - www.judylui.com
And lastly, if you have a question about pelvic health physiotherapy, what is involved in assessment and treatment, REACH OUT and send me a message! I would love to chat and answer any questions or address any concerns that you have.
While peing your pants may be common, it is definitely not NORMAL! Any involuntary loss of urine is a sign that your pelvic floor muscles are not working properly. Urine leakage can happen when you cough, sneeze, laugh, walk, stand up, jump, skip, bend down, run or as you're rushing to get to the bathoom. If you get any leaking of urine at all when you don't want to leak, no matter how little, it's urinary incontinence.
Chances are you've come across at least one advertisement on TV, in magazines or social media that advertise various products related to incontinence. Special incontinence pads, tampon-like products and dietary supplements...the list goes on and on. Although its great that people are starting to talk about urinary incontinence more openly, this also makes people think that it is a normal thing to expect with aging and childbirth.
Urinary continence is very TREATABLE and should not be viewed as "normal"!
Urinary incontinence is NOT NORMAL and is VERY TREATABLE!
Let's bust some myths!
There are a lot of myths out there about urinary incontinence but we (the pelvic physios of the world) are on a mission to spread the word and educate people so that everyone knows that urinary incontinence is TREATABLE!
Myth #1: Its normal to leak urine after being pregnant and giving birth.
While urinary leaking is common after giving birth it is still not normal. Gone are the days where women should blindly accept that urinary incontinence goes hand in hand with post-partum life.
Yes, pregnancy and childbirth are risk factors for developing urinary incontinence but it doesn't mean that everyone who gives birth will experience symptoms of urinary incontinence. Approximately 40.2% of women after a vaginal birth and 30% after a cesarean section delivery experience urinary incontinence (1). In women who have never given birth, 10-15% experience urinary incontinence (1).
Seeing a pelvic floor physiotherapist during pregnancy and after delivery is a proactive way of ensuring that any urinary incontinence symptoms are treated and managed early on!
Myth #2: Its normal to leak urine as you get older.
Age-related and hormonal changes are also risk factors for developing urinary incontinence. However, this does not mean that urinary incontinence is a normal and expected part of aging.
An early and proactive approach to the treatment of urinary incontinence is key. Maintaining good pelvic floor and core strength along with proper exercise and body weight managment are all ways of keeping yourself dry as you get older.
Myth #3: Only women experience urinary incontinence
While urinary incontinence occurs more in women, men can also experience it. It's estimated that 7% of Canadian women and 3.5% of Canadian men experience urinary incontinence (2). Age and surgical procedures for the prostate are both risk factors for developing urinary incontinence.
Just like women, men can also benefit from seeing a pelvic floor physiotherapist to treat their urinary incontinence symptoms.
Myth #4: Kids and young adults don't get urinary incontinence.
Approximately 10% of 7 year olds, 3% of 11-12 year olds and 1% of 16-17 year olds experience bedwetting during the night (3). Between 3.2 to 9% of 7 year olds and 1.1 to 4.2% of 11-13 year olds experience urinary leakage during the daytime (3).
Urinary incontinence in children and young adults is also treatable. Some pelvic health physiotherapists have specific training in pediatric pelvic floor physiotherapy are able to effectively help young clients to gain control over their bladder.
Is urinary incontinence that common?
According to the Canadian Continence Foundation, 3.3 million Canadians are affected by urinary incontinence (4). That's 10% of our population!
Urinary incontinence is costly for the individual, employers and the health care system. It is estimated that individuals experiencing urinary incontinence spend between $1400 and $2100 per year on incontinence-related products (2).
So how does pelvic floor physiotherapy help?
Pelvic floor physiotherapists are trained health professionals and have taken specific courses to help treat and manage urinary incontinence.
Treatments may involve specific pelvic floor exercises, core exercises, muscle stimulation or biofeedback and functional training.
Pelvic health physiotherapy is less expensive and less invasive than surgery or medications and research shows that it is an effective first line of treatment for urinary incontinence (5). Women who are active participants in pelvic floor muscle training are more likely to report a resolution or decrease in their urinary incontinence symptoms and better quality of life (5).
If you're struggling with urinary incontinence, you will benefit from seeing a qualified and skilled pelvic floor physiotherapist!
Click HERE to book an appointment with one of our Pelvic Floor Physiotherapists using our convenient online booking system.
1. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. The prevalence of urinary incontinence 20 years after childbirth: A national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An international Journal of Obstetrics and Gynaecology 2013; 20(2):144-151.
2. The Canadian Continence Foundation. Impact of Incontinence. Available at: http://www.canadiancontinence.ca/pdfs/en-impact-of-incontinence-in-canada-2014.pdf Accessed on July 17, 2018.
3. Buckley BS, Lapitan MCM. Prevalence of urinary incontinence in men, women, and children-Current evidence: Findings of the fourth international consultation on incontinence. Urology 2010; 76(2):265-270.
4. The Canadian Continence Foundation. FAQs. Available at: http://www.canadiancontinence.ca/EN/frequently-asked-questions.php Accessed on July 12, 2018.
5. Dumoulin C, Hay-Smith EJC, Mac Habée-Séguin G. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2014; 5. Art. No.: CD005654. DOI:10.1002/14651858.CD005654.pub3.
Pain - it really is all in our heads
In the last few years, our understanding of pain has changed dramatically. We used to think the body had specific pain receptors that when activated, created a pain sensation. We now know that it's much more complicated than that. It turns out that pain is actually an output of our brain, which means that our brain actually creates pain. Our pain is influenced by our environment, our emotional state, our thoughts and even our diet!
Just because pain is created by our brains, does not mean that our pain is not real.
Our pain is very real.
Research shows us the way
New research in pain science has helped to change our understanding of how humans experience pain and in turn, how we can help clients manage and eliminate their pain. This new understanding brings hope not only to individuals in pain but to health professionals whose goals are to help clients to live pain-free.
Research has shown us a few important concepts to understand about pain.
Pelvic floor physiotherapy focuses on pain experienced in the pelvic region. This includes but is not limited to pain in the pubic symphysis area, sacroiliac joint (SIJ) region, low back, hip, tailbone and genital area. Pain may be associated with a certain activity such as pain with urinating, painful bowel movements, pain with intercourse and pain with sitting. Both men and women of all ages can experience pain in the pelvic region. Pelvic floor physiotherapists are equipped with skills to treat clients experiencing all different types of pelvic pain.
We have an opioid crisis on our hands!
A new approach to managing and treating pain couldn't come at a better time.
Canada is now in the midst of an opioid crisis. We are now the second largest per capita users of prescription opioids in the world. Many people are still prescribed opioids for pain management despite the fact that research shows that these drugs do not show a clinically important change in pain levels of people in pain. On the contrary, research DOES support interdisciplinary care, exercise and physiotherapy for the treatment of pain!
The time has come to reframe how we think about pain and consequently, how we treat pain.
How can you take charge of your pain?
An important part of managing and treating your pain is to have HOPE. Hope that your pain will go away. Hope that you will be able to return to all the activities that you enjoyed doing before.
Learning about your pain and understanding your pain is an important part of treating your pain. Your pelvic floor physiotherapist is a good resource for helping you to take the first steps to understanding your pain and giving you the confidence to tackle it. They may challenge your existing views about your pain and help you to think about your pain in a different way.
Developing a strong therapeutic relationship with your pelvic floor physiotherapst is also important. Find a health professional that understands your pain and takes the time to listen to your story. Sometimes with pelvic pain or persistent pain of any kind, there are strong emotions that are attached to our pain. Find a health practitioner that you feel comfortable with as addressing the emotions around your pain may be an important part of managing and treating your pain.
Discover ways to move that make your body feel good. Movement is one of the best ways to treat and manage pain. Our bodies were meant to move. Your pelvic floor physiotherapist can help you to rediscover and find ways to move that are not threatening to your pain.
If you are experiencing pelvic pain, genital pain, persistent low back pain or persistent hip pain - an assessment with our pelvic floor physiotherapist is the first step returning to pain-free function.
To make an appointment with our pelvic floor physiotherapist - click here!
If you would like some more information or resources, check out the following videos and websites!
Check out the latest video from Professor Lorimer Moseley from Australia -- one of the leading pain scientists in the world!
Here are some other great websites to check out:
International Pelvic Pain Society:
Pelvic Health Solutions:
Kelly Leong is a Registered Physiotherapist, pelvic health advocate, yogi, crossfitter and self-proclaimed life-long learner.
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