As I had promised in a previous post, I would continue the conversation about the importance of pelvic health by interviewing an expert in the field who can get more into the details of why women (not just mothers) should consider seeing one. Lamiya is a Pelvic Floor Physiotherapist at Toronto Yoga Mamas here in Toronto and this week she completed my detailed assessment, which I will also share with you. But first, get the answers to some commonly asked questions when it comes to Pelvic Floor Physiotherapy!

Ask the Expert

Firstly, I have to give a big thanks to Lamiya for taking the time to answer these questions. Of course, if you would like further information on any of the info listed below, please send me an email and I will make sure to get back to you!

Lamiya, Pelvic Floor Physiotherapist at Toronto Yoga Mamas

1. What is pelvic floor dysfunction? How does one get pelvic floor dysfunction?

A Pelvic Floor Dysfunction is a condition where the pelvic floor muscles are not working in optimal fashion. To understand this, we must understand where these muscles are located and what they do.

The pelvic floor muscles are layers of muscles that span the bottom of the pelvis. They start from the front going to the back- pubic bone to tailbone, and side-to-side – from sitz bone to sitz bone. For females, three passages pass through the muscles (urethra, vagina, and anus), and males have two passages (the urethra, and anus).

The functions of these muscles include providing us stabilization of the pelvis and spine, supporting the organs that sit on top, allowing us to be remain dry and they provide a sexual function to both females and males.

A dysfunction can occur when these muscles to become very tense and weakened or very lengthened and weakened.

What causes these dysfunctions? (some but not limited too...)

Stress
Pregnancy
Straining on toilet
Heavy Lifting
High Impact activities

Pelvic floor dysfunctions can also be a secondary issue to other conditions. A common and well-documented one is chronic low back pain!

Addressing these dysfunctions is very important, as they may lead to conditions that can be frustrating to deal with, such as urinary incontinence, chronic constipation, pelvic organ prolapse, and many others.

2. How does one best locate their own pelvic floor?

Explore! This is the best way, if you can feel for it, you will understand it much more, and have better control! How should one do this? Try this:

Use a small mirror to find the entrance of the vagina. Having a lubricated finger (you can use coconut oil/olive oil as a natural lubricate, if you have no allergies to it), insert your index and/or second finger into the vaginal canal, up to the 2-3 knuckle. This can be done on your back or in side-lying.

Once you have inserted, press gently backwards, this is the wall between the vagina and rectum, pressing forwards is the bladder. The pelvic floor muscles line the vaginal tube on the sides.

To feel them contract, imagine holding your pee. Imagine holding your gas (don't let yourself fart) or do a kegel. You should feel the walls of the vagina squeeze your finger and lift them upwards. Repeat this a few times, and see if you are able to relax the movement as well.

Give this a try in crossed sitting or on a ball! Keep your eyes closed to see if you have connected to the pelvic muscles better!

3. What does a typical PFPT assessment consist of?

Pelvic Floor Physiotherapy assessments typically run for one hour. The therapist goes over a detailed history of the patient medical, gynecological, urological history, and goals/expectations/concerns. A physical examination follows, of the external (whole body) and internal components (pelvic floor muscles-PFM).

Once history taking is completed, I educate the patient on the anatomy and functions of the pelvic floor, and how their symptoms/issues may be related to directly or indirectly to these muscles and their functions. I speak openly about the steps of the external and internal components of the examination (going over the risks and benefits associated) to ensure the patients feels knowledgeable and comfortable with proceeding.

Externally, I examine movements of the low back, midback, and hips/knees, and check the integrity of the skin and mobility of the connective tissue. If warranted, I perform special test to rule out any concerns at these joints, and how they may impact the PFMs. An important piece I closely monitor throughout the assessment is the breathing pattern of the patient.

The last portion of the assessment involves an internal component, via the vaginal and/or rectal canal. The PFMs are indirectly felt through the walls of the canals. Patients are asked to undress from the waist down, and given drapery. Therapists only use their own fingers, gloved with lubrication to feel for the muscles. No other instruments are used. I can feel for the response of the patient’s pelvic floor as I cue the patient. I ask patients to perform what they think are kegels, hold the kegel, relax the kegel, and many other cues.

After I have gathered the information I need, the examination is completed. I review my findings, and discuss the options for treatment and course of treatment and answer any questions or concerns the patient may have!

4. What are your top tips you give your clients regarding pelvic health?

Get Familiar with your Pelvic Floor Muscles - Explore!
Improve breathing mechanics
Take some time to Work-In (relaxation techniques, meditation, yoga, tai-chi)
Have good Bowel Habits - Squat
Avoid having just in case pees
Sex should NOT be painful
If pregnant, or thinking of getting pregnant, seek out a Pelvic Floor Physiotherapist!

5. Where do you see the role of fitness trainers in what you do?

I see Fitness Trainers and Pelvic Floor Physiotherapists working very closely together to help achieve the goals of our patients/client!

Fitness Trainers play an integral part in helping patients stay healthy and active. They allow patients to remain active during pregnancy, and return to the physical abilities postpartum! They play a big role in pelvic health, and can become advocators for it! They are able to screen patients to early signs and symptoms of pelvic floor dysfunctions, helping refer they clients onto a therapist if needed. Also being aware of pre-existing pelvic floor dysfunctions they can tailor the programs to fit the needs of the client, and progress them as needed!

Get the green light from your doctor and pelvic floor physiotherapist before getting back to your regular fitness routine postpartum.

My Experience With Pelvic Floor Physiotherapy

I strongly believe in the importance of seeing a pelvic floor physiotherapist before, during and after pregnancy and even for women who are not mothers. I had seen one regularly throughout my pregnancy with Harper and after. It was so helpful especially when getting back to my regular fitness routine. I was more aware of my pelvic floor and more conscious of my breathing throughout movement in and outside of the gym.

For this pregnancy, I knew things were changing when it came to my pelvic floor; let’s just say even coughing wasn’t pleasant. Despite how many people would say this is normal, I knew that it wasn’t. Lamiya provided a thorough assessment and I was given all the info I needed to feel confident that I will regain the strength and awareness back in my pelvic floor. Sure, it will take time and it will take commitment from me to do various exercises and check in with my pelvic floor physiotherapist regularly, but I am willing to do it.

I’ve spoken to so many women who live with some form of pelvic floor dysfunction, whether it is incontinence or pain during intercourse and they convince themselves that it’s "normal if you’ve had kids". Mamas, it’s not normal! The first and best place to start is to book an appointment with a Pelvic Floor Physiotherapist.

“May Your Coffee, Pelvic Floor, Intuition and Self-Appreciation be Strong.”

Especially for mothers who feel ready to get back into their fitness routine after babe - get the green light from your doctor AND your pelvic floor physiotherapist! A lot of us end up doing more harm if we don’t and I’ve seen it happen one too many times. So mamas, do not overlook the importance of pelvic floor physiotherapy - your body will definitely thank you later!