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Questions about pelvic floor physiotherapy? I did too! Interview with Sarah Trottier

I often recommend clients look into pelvic floor physiotherapy however my knowledge on the topic is limited. I know that a pelvic floor physiotherapist can help with incontinence issues, but that was about it. Recently, I asked in the Pregnant in Ottawa Facebook group if anyone had questions they wanted answered by a pelvic floor physiotherapist, here are the top ten questions answered by Sarah Trottier:

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What exactly is pelvic floor physiotherapy?

  • Pelvic floor Physiotherapy is a form of physical therapy that aims at treating pelvic floor muscles, nerves and tissues. Pelvic Health Physiotherapists have post-graduate training that allows them to perform internal pelvic exams to properly assess the pelvic floor.

  • The pelvic floor is in charge of supporting your pelvic organs (bladder, rectum, and for females, uterus), assists in bladder and bowel control, resists any increase in abdominal pressure so that we don’t leak (i.e. when we cough or sneeze), contributes to sexual function, and provides support to our low back, as it is one of our 4 core muscles!

What are signs that I should be seeing someone? When is the best time?

  • We treat women and men of all ages, not only after giving birth!

  • Prenatal: due to all the changes the body experiences, we treat for joint pain (pubic bone, back, hips, groin), urinary leakage, urgency to urinate, painful intercourse, bulging or ballooning of your abdomen (sign of Diastasis Recti Abdominis or DRA), and pre-birth preparation.

  • Post-natal: it is usually suggested to see a pelvic health physiotherapist 6 weeks post partum! We treat for stress urinary incontinence (leaking urine or bowels when you cough, laugh, sneeze or exercise), urgency urinary incontinence (leaking when you can’t get to the bathroom fast enough), painful intercourse (especially after tearing at the perineum or an episiotomy), scarring from C-section or tearing, pressure or heaviness in the pelvis, bulging or ballooning of your abdomen (DRA) and core weakness.

Is this only a concern for those who have vaginal births or cesareans as well?

  • I love this question!!! A lot of women who have had cesareans have asked me this exact question. One of the most common myths that we hear is that having a C-section will “save” your pelvic floor. But just because the birth wasn’t vaginal does not mean that the pelvic floor has not been affected. During pregnancy, your pelvic floor supports the increase in pressure of the baby, which can cause the pelvic floor to lengthen and weaken. This can lead to pelvic floor dysfunctions (leaking, heaviness/pressure, painful intercourse, etc.).

  • Additionally, during a cesarean section, the incision must go through skin and fascia. This can cause core muscle weakness and abdominal, low back or hip pain.

  • Just put it this way, if you have any knee or shoulder surgery, you will most likely be sent to physiotherapy for post-op rehab. But why aren’t women automatically sent for physiotherapy post cesarean section? You’re usually told to wait at least 6 weeks before lifting anything heavier than your baby, and then after the 6 weeks, you’re clear to resume activity! Now what? Pelvic health physiotherapists are trained to assess your core control and strength, and treat your c-section scar. They will prescribe a home exercise program tailored to your needs that you can perform independently (i.e core exercises, self massage techniques, etc.).

Women often joke about peeing when they cough or sneeze, is this really normal?

  • It’s important to understand that leaking when you cough, sneeze or exercise is very COMMON after giving birth, but that it is NOT NORMAL, at ANY age! Even though pelvic floor dysfunctions are quite common, they are in fact treatable!

Is there anything that I can do at home to prevent things from getting worse?

  • It is highly suggested to get assessed by a pelvic health physiotherapist prior to starting any pelvic floor exercises.

  • Most people have read/been told that if they have pelvic floor issues, they should be doing Kegels (strengthening exercise for the pelvic floor). When we assess the pelvic floor, we evaluate the tone of the muscles. Often times, muscles can be very tight and tense, which can lead to pelvic pain, or even incontinence. Therefore, if we start doing Kegels with already tight pelvic floor muscles, it could cause even more dysfunction. It is important to remember that not everyone should be doing Kegels!

  • “to Kegel or not to Kegel” — that is one of the questions that we answer!!!

What exactly can I expect to be done during an appointment with you?

  • In an initial assessment (60 mins), a full history is taken (questions that involve how well your pelvic floor is functioning, medical history, etc). We then proceed with a physical examination, where we assess posture, stability and core control, hip/back/pelvic movements, breathing pattern, and finally, and with your consent, we perform an internal pelvic exam (which can either be vaginal, rectal, or both), where we assess pelvic floor strength, tone, coordination and function. The initial assessment includes a lot of education and a home exercise program tailored to your needs.

  • Follow-up treatments will be determined following initial assessment, and can range from 30-45mins. Depending on what we are treating you for, follow-ups can usually be 2-3 weeks apart.

  • An internal exam is NOT mandatory, but highly recommended. If you hurt your knee, and your physio only looked at your ankle and hips, would you be mad that they didn’t even assess the area in which was causing you pain?

  • A doctor’s referral is not needed to see a pelvic health physiotherapist (although some insurance companies require a referral if you have extended health care).

Can I see any physiotherapist or is this something you have specialized in?

  • To become a pelvic health physiotherapist, you must take additional courses to become rostered within the Ontario Physiotherapy Association to perform internal pelvic exams. Therefore, it is suggested to seek out a therapist that is rostered to perform internal exams!

How many treatments are generally needed?

  • Your pelvic health physiotherapist will work with you to provide a treatment plan that suits your individual needs, based on your initial assessment and physiotherapy goals. Each person is unique, therefore, treatment plans and duration can vary!

Can I bring my baby to my appointment?

  • Yes of course!!! It’s one of the best parts of being a pelvic health physiotherapist! You can also nurse at anytime, and treatments are tailored to the babies needs. However, if you have support at home, sometimes it’s nice to just have time to take care of yourself :)

How can people get in touch with you?

Sarah Trottier is a bilingual registered physiotherapist who completed her Bachelors of Health Sciences in 2012 and her Masters of Physiotherapy in 2015 both at the University of Ottawa. She grew up in North Bay, and was very active in the sporting community, which played a huge role in her becoming a physiotherapist. After years of living in Ottawa for school, she had fallen in love with the city and decided to continue her physiotherapy career in the nation’s Capital. Sarah has been working in a private practice setting utilizing skills such as myofascial release, visceral manipulation, manual therapy, acupuncture and dry needling to treat a variety of injuries and conditions.

Through her work, Sarah realized early on in her career that she had an interest in pelvic health. She completed post graduate training in pelvic floor rehabilitation, which included courses to assess and treat many pelvic health conditions, such as bladder and bowel incontinence, pelvic organ prolapse, chronic pelvic pain, painful intercourse, and many other related conditions.

Sarah understands that pelvic floor issues may be a vulnerable topic, but she believes that her compassionate and positive approach can help clients feel empowered in a comfortable and safe environment.