I was recently asked to sit on a panel about pelvic floor and in preparation for the event I was asked what kind of topics women would most want to discuss.
I knew what I wanted to discuss immediately.
I want to talk about why we don’t talk about pelvic floor.
In Europe, pelvic floor is a regular part of the medical system, not a distant cousin of healthcare we hide in the shadows. In France, women automatically receive 8 to 10 pelvic floor sessions postnatally as part of their subsidized healthcare system. In Britain, surgeons will not perform any type of abdominal or pelvic surgery until clients have undergone a course of conservative pelvic floor physiotherapy first.
In modest Canada however, we are just starting to talk about these things and in most cases it is in hushed conversations with close friends, not as part of our regular medical discourse. Most of my clients are being referred from friends and colleagues but only a handful are being referred from well-informed and proactive medical doctors. I myself have two children and neither of my obstetricians, despite being excellent practitioners, even mentioned pelvic floor therapy as an option for postpartum recovery.
It is no wonder we are not seeing nearly the number of women and men who actually are in desperate need of our services. The research in support of pelvic health is excellent. We know we can make a significant impact on symptoms like incontinence, chronic pain and prolapse. However, without normalizing the conversation, many clients still don’t even understand it is an option.
If we are going to make pelvic floor therapy more accessible, we actually need to talk about it in a way that is neither embarrassing or shameful.
That being said, many of the clients who actually make it to my door still have reservations. They are still bashful and often still have questions, many of which they feel are too silly to ask.
So let’s get rid of the barriers. Let’s ask the silly questions (which are never actually silly) so you can feel better informed and more at ease about making one of the best health decisions you can make today.
Here are some of the not-so-silly questions I’ve heard in my practice and hopefully the answers that will put any anxiety you may have to rest:
I’ve heard it is internal, is that true?
Yes, the only way to access your pelvic floor muscles is internally via the vagina or rectum. It is important that your therapist be able to palpate the tone of your muscles and be able to feel the contractility of the muscles which can’t be done externally. Your therapist should always detail the procedure before hand and will always ask for your consent before starting.
My initial assessment is a hour-long. What do you do for a WHOLE hour?
The bulk of the assessment time is spent talking. We want to gather as much information about you and your particular symptoms to best create an individualized treatment plan. In some cases we don’t even get to the internal. Many of our clients have complicated reasons that have led them to us and we want you to feel totally comfortable about your session. If that means taking the time to answer all of your questions as well as to get all the information we need to best assess your symptoms, we may not even get to the internal on the first appointment.
The actual internal only takes a small portion of the initial assessment time.
What are we going to talk about for all that time?
Well, a lot. We will talk about your symptoms and what brought you in. We will also get a detailed history of your urinary and bowel health, digestion, nutrition, hydration, exercise, sexual history, birth experiences, past medical history, mental health, stress levels and anything else that might be pertinent to solving your condition. Research has shown that pelvic health is best-managed through a biopsychosocial model meaning we need to examine all aspects of your health to come up with the best approach.
What if I am uncomfortable talking about some of those things?
No problem. You are always in control of your session and what you share is at your discretion. That being said, anything you share with us is completely confidential and done in a safe space. If there is a topic you would like to discuss but is outside of the scope of our expertise, we will refer you to a specialist who can collaborate in your treatment.
Is it going to hurt?
An assessment by a trained pelvic floor therapist should not be painful. I often describe the experience as more comfortable than a pap smear. That being said some of our clients are coming to us because they have chronic pain and have very sensitive tissues. You are in control I always encourage clients to give me feedback and let them know they can stop at any time if they are uncomfortable.
Do you use any devices?
Unlike an exam with your gynaecologist, we do not use tools like a speculum. Most of the exam is done with a clean, gloved hand. We may on occasion use a Q-tip and some of our treatments may employ things like a muscle stimulator or a wand to help release muscle tension. If we do use anything, we will fully explain it to you first.
Did you know 1 in 3 people will experience symptoms of pelvic floor dysfunction in their lifetime but only 1 in 12 will seek out treatment? Research has shown that pelvic floor physiotherapy is an extremely effective treatment for issues of incontinence, urinary frequency, painful intercourse, low back pain and pelvic floor prolapse.
If you suffer from any of these symptoms, book an appointment today and improve the way you feel. We offer both in clinic and in home treatments. You do not need to live with pelvic floor dysfunction regardless of how long you have had symptoms.
What if I have my period?
No problem. We simply drape the table differently. Menstruation does not change our ability to examine or treat you.
Do I need to shave?
That is completely up to you and not necessary for your therapist. I would suggest you come however you are most comfortable.
Will it smell funny? Should I do something to cover my natural smell?
The body does produce odour and that is totally normal. I treat ankles and feet and they bring their own smells, none of which bother me. I would encourage you not to use anything with fragrance as it might irritate your symptoms and sometimes odour is a good diagnostic tool for pathology so you might be masking an important clue.
Do I have to have a rectal?
No. You don’t have to do anything you don’t want to. We do suggest it though as the back half of your pelvic floor is best accessed via the rectum and it also gives us important information about fecal continence and reasons for constipation.
Is there a chance I might poop on the table?
I have never had anyone poop on my table yet. I suspect you will not be the first. Some clients do come for issues of fecal incontinence and if ever it did happen it would be handled discretely and professionally.
Do you ever feel awkward giving the exam?
Not at all. I have worked with bodies for almost 20 years and from a therapist perspective it is very clinical. For me there is no difference between doing a vaginal exam and treating any other part of the body. Like all other areas of my work, we are essentially treating muscles and joints which is the approach I take. I do however understand that a pelvic exam is more intimate and vulnerable for my clients and because of that I will likely check in more frequently to gauge how you are feeling as the patient.
Do you have a question we haven’t answered? I would be happy to answer any of your questions personally, especially if it makes you more comfortable about coming for treatment. I can be reached at email@example.com.
Remember, there are no silly questions when it comes to solving serious problems.
Melanie Stevens Sutherland, Clinic Director & Senior Orthopaedic and Pelvic Floor Physiotherapist
Melanie is a graduate of McMaster University and brings 17 years of experience as a senior physiotherapist to Body Co. She has enjoyed a long tenure working with active populations at prestigious sport medicine clinics. Past clients include Provincial, National and Olympic level athletes as well as members of the National Football League, the Canadian Football League, the Ontario Hockey League, the American Hockey League, the National Lacrosse League and Major League Soccer.
Following the birth of her own children, Melanie developed a strong interest in women’s health. She has taken specialized courses in pelvic floor physiotherapy and women’s nutrition. She is passionate about helping women find strength and confidence in their post-natal bodies following pregnancy and delivery.
If you would like to work with me directly, you can book an appointment in my schedule online.