Q: I have never done any kind of exercise and am not sure if the pelvic floor work can change my leakage. When is it too late to address one’s incontinence?

 

A: Pelvic floor muscles are a voluntary group of muscles. When a person is aware of the location of the muscle and technique of the work out-anybody can make a change in their muscle strength and their ability to manage bladder and bowel. It is never too late to start working out!

We continue to walk, run, bike, do yoga, golf regardless of our age. Why not take care of the pelvic floor health?

Q: I am pregnant and would like to have a pelvic floor physiotherapy after delivery. How soon after the delivery should I book the visit?

 

A: The actual delivery can be a couple of weeks before or after the estimated due date.

Usually, if all is well, six weeks postpartum is the average time a person would follow up with a pelvic floor physiotherapy. However, if there are immediate concerns, healing issues, or abdominal separation, it is possible to start rehabilitation sooner. A vaginal exam would be postponed, but there are other ways of doing an assessment and initiating treatment.

Q: In general, for my future reference, if a patient is on her period, would she be able to attend her physio appointment? Or would it depend on how heavy it is?

 

A: Usually it does not matter if the client is on their period, we still can go forward with the session with the discrete draping it is not a concern. 

However, if the you are cramping a lot, and it is painful or if there is very heavy flow and the you would not feel comfortable - then it is better to reschedule the visit, so you can have the most benefit and comfort during the appointment.

Q: I had really good sessions with Maryla and was open to trying and able to use the vaginal inserts during these sessions.  My first go at it at home wasn't so successful; however, a few days after, things went much better.  Generally speaking, is it normal to have not so good days with the inserts especially at home, compared to sessions with a physiotherapist?

 

A: When you are working with the vaginal inserts at home, it is important to allow yourself time to get comfortable with the idea of this new concept and have a safe space where you will have privacy and time to figure out the steps. It is normal to have better and worse days, sometimes you will find the practice easy, sometimes it will be more challenging. 

Don’t get frustrated, but observe if any particular circumstances are working to your benefit making this practice easier or to your disadvantage, making it more difficult? 

Fatigue, stress, and anxiety, as well as pain (any pain in your body even not the vaginal one), can be making it more challenging to progress with the vaginal inserts. Being relaxed, well-rested, calm -often makes this work easier to do and to progress with.

It is all a learning experience. You are in charge and figuring out the optimal relaxation, eliminating anxiety on vaginal insertion/removal, and working towards being able to have vaginal penetration and medical care in a more positive way. You are optimizing your health. 

If you find that you struggle too much or get too anxious about the insert work, it might be useful to follow up with a pelvic floor physiotherapist. She/or he will be able to continue providing support and guidance in the progression of the work. Sometimes all is needed is a review and possible problem solving as things come up, so you can be successful in achieving your goals.

Q: Who is qualified to do a pelvic floor assessment? What is a scope of practice?

 

“Scope of practice statements are the concise descriptions, in broad, non-exclusive terms, of each regulated profession's activities and areas of professional practice. These statements describe in general what each profession does and how it does it.”  Scope of Practice, Province of British Columbia.

 

Examples of professions where a pelvic floor exam is within the scope of practice: 

  • primary care physician

  • internal medicine specialist

  • an obstetrician/gynecologist (OB/GYN) 

  • another trained health professional, such as a physician assistant, nurse midwife or nurse practitioner

  • naturopath

  • physiotherapist with a postgraduate pelvic floor/internal exam training

 

Other professionals might attempt to do pelvic floor assessments reading from the external cues which do not involve persons’ genitalia. External observation does not provide information on muscle engagement or contractibility, strength, support of the pelvic organs, pain patterns, hypo or hypertonicity of the pelvic floor muscles.