What pelvic floor physiotherapists want you to know.
With Physiotherapists GilL Balboul and Tara CampBell
Pelvic floor physiotherapy can be so helpful for pregnant and postpartum individuals, yet it is still not talked about enough. We asked two dedicated physiotherapists for more information about pelvic floor physiotherapy and the approaches they take.
Gill Balboul works at In Form Physiotherapy and Rehab Centre in Woodbridge as well as Myodetox Yorkville in Hazelton Lanes Mall.
What are the common issues that you see during pregnancy and postpartum?
Gill: During pregnancy I see many clients coming in with back and pelvic pain, incontinence (leakage episodes), constipation, increased frequency of going to the bathroom and desire to gain knowledge and understanding of having a healthy pregnancy and pelvic floor.
Postpartum I see clients with incontinence (leakage episodes), pain with sex, as well as clients coming in for core strengthening and returning to their pre pregnancy activities and workouts. I also see clients who have had a c-section and go through a rehab program with them.
What does a typical pelvic floor physio program look like in your practice?
Gill: I start by taking a thorough health history and ask about any symptoms – when did they start, what they are, what aggravates/makes them better. Then I ask relevant personal questions like sexual history, period symptoms, bowel and bladder questions, previous deliveries, current birth plan and how the pregnancy is going. All that gives me an idea of what’s going on and what I need to focus the physical assessment and treatment on. Depending on the reason for coming in and client’s goals, we move to an external assessment of posture, joint mobility and we may go on to do an internal assessment, if appropriate and with consent.
Internal pelvic floor assessment provides a more direct access to the pelvic floor muscles and their function and fitness level. I do a lot of education to make sure my clients are comfortable and answer any questions. I lay down a sheet and ask the client to undress and cover with a sheet. I’ll do an external assessment of the area and if needed, use lube and place one or two fingers usually vaginally to assess strength, activation, endurance, etc. Depending on assessment findings and the client’s goals, we come up with a treatment plan that includes lots of education, best practices for pregnancy, delivery and postpartum care, exercises, manual therapy and lifestyle modification. I really try to empower each client that comes in and encourage self reliance and self treatment.
What do you wish pregnant clients knew about the work that you do?
Gill: I wish they knew it is always a good idea to come in and get a pelvic floor assessment and talk about best practices to have a healthy pregnancy, whether you are experiencing symptoms or not!
Every trimester is different and it’s important to address any issues early on, as well as work on unwanted symptoms prevention with proper education and exercises. The better ‘in shape’ your core and pelvic floor are before delivery, the easier it is to get back to your pre-pregnancy activities.
What do you wish postpartum clients knew about the work that you do?
Gill: It is never too early or too late to address any issues and to make sure you are on the right track to get back to your pre-pregnancy activities. No amount of leakage or pain is normal and they can be addressed, for example.
Tara Campbell works at the Cleveland Clinic Midtown Location on Yonge Street between Eglinton and Redpath Road (right by The Well Parents Centre) and is the founder of Maternix.ca.
What are the common issues that you see during pregnancy and postpartum?
Tara: Some of the common issues I see in the pregnant population includes low back or buttock pain, pain around the pubic symphysis or pelvic bone, pelvic heaviness, issues with incontinence or leaking urine, sciatica and other more “general” aches and pains that can become more pronounced during pregnancy. Many of the assessments I do with pregnant people are a general check-in to help clients connect to their pelvic floor, the way they manage pressure and the control they have around their trunk. This is a great thing to do to help you prevent issues from coming on and to better prepare for the postpartum recovery period.
Many of the people I work with postpartum aren’t sure exactly how to best get back into exercise and may be dealing with issues like leaking urine when they run or cough for example. We work together to address the pelvic floor, pressure management in the torso, regaining pre-pregnancy movement patterns and building back up a base of strength to return safely to more high-impact exercise.
Other common issues I treat for the postpartum population are similar to those in the pregnant population including but are not limited to low back pain, hip and glute pain, hamstring strains, diastasis recti, pelvic heaviness/ prolapse and leaking issues.
What does a typical pelvic floor physio program look like in your practice?
Tara: It all depends! There are so many variables to a functional and healthy pelvic floor and girdle. Each client is unique and every program takes into account their goals, past medical history, symptoms, and any other objective findings. I work with people as a whole and usually provide programs that not only build up strength and resilience of the pelvic floor muscles themselves, but also of the body as a whole.
Usually there is an internal exam involved in a pelvic floor assessment where we look at tissue sensitivity, any scar tissue that might be present, muscle strength and endurance. But this does not have to be the case if you aren’t comfortable with an internal exam - there is LOTS we can do together without even doing an internal assessment that can be very effective at treating the pelvic floor.
The Maternix.ca programs are also very helpful in teaching the importance of healthy habits throughout the day that help to promote strength and reduce stress on commonly-stressed areas of the body - promoting healing and reducing the prevalence of injury.
What do you wish pregnant clients knew about the work that you do?
Tara: Outside of working at the Cleveland Clinic, I started Maternix.ca - educational and exercise programming for pregnant and postpartum clients. The aim of the online courses is to help women understand and connect to their bodies so they can recover better from pregnancy, labour and delivery and prevent common injuries.
I do pelvic floor assessments throughout pregnancy and create programs for clients that not only addresses their pelvic floor but their body as a whole to keep them strong, functional and feeling the best they can throughout their pregnancy.
What do you wish postpartum clients knew about the work that you do?
Tara: I want women to know that you don’t have to live with symptoms postpartum just because they are “common” and that there are lots of treatments available to address many issues before getting a surgical “fix”. Postpartum recovery is an extremely under-serviced area and I’d like to help educate and guide women through a prehab and postpartum rehab program so that they can get back to the activities and life they want, without compromise.
The postpartum period IS a time of healing and recovery - Maternix.ca programs are designed to help people understand and work with their bodies better so they can work effectively at rebuilding their strength and preventing injury now and in the long run.
To learn more: Patients can contact me directly at CAMPBET2@CCF.ORG for an in-person or virtual assessment & treatment. Additionally, people are welcome to visit my Pregnancy & Postpartum website Maternix.ca for more information about the online educational and exercise courses I teach for Pregnant and Postpartum clients.
