Pelvic Health Physiotherapy

Pelvic Health Physio in Pregnancy and Postpartum

Initial Assessment

• We begin with a personalized session to address your unique needs—whether it's pain, leaking, constipation, exercise guidance or general discomfort

• You don’t have to wait until baby arrives to feel better!

Birth Prep

• A baby only enters the world one of two ways—vaginally or via cesarean

• We prepare for either birth type including pain management strategies, advocacy, education around stages of labour, positions for labour and pushing, breathing strategies and more

If a c-section is planned, we can tailor the session specifically for that

Postpartum Prep Session (done before birth)

• Learn how to support healing from day one

• Discover safe, gentle exercises you can begin immediately after birth (vaginal or cesarean)

• Prepare your body and mind for the transition into postpartum life

• Pregnancy lasts 9 months—but postpartum lasts a lifetime. Let’s set you up for success.

After Birth

• You can come in for a postpartum assessment at any time postpartum, the only part of the assessment we must wait for 6 weeks is your first internal pelvic floor exam (once cleared by your doctor or midwife)

• We'll assess recovery, address any concerns, and plan your next steps for rehab and strength-building

Chronic pelvic pain is persistent pain felt in the lower abdomen, pelvis, hips, tailbone, genitals, or pelvic floor that lasts for three months or longer. It can affect people of all ages and may be constant or come and go, often impacting work, exercise, sleep, intimacy, and overall quality of life. Chronic pelvic pain is complex and often has multiple contributing factors, including muscle tension, nerve sensitivity, joint dysfunction, scar tissue, inflammation, and changes in how the nervous system processes pain. Common conditions associated with chronic pelvic pain include endometriosis, adenomyosis, painful bladder syndrome (interstitial cystitis), vulvodynia, pudendal neuralgia, irritable bowel syndrome (IBS), pelvic floor muscle dysfunction, persistent pain after pregnancy or surgery, and pain related to sexual activity.

A pelvic floor physiotherapist takes a comprehensive, whole-body approach to identifying the factors contributing to your pain. Treatment may include education about pain science, gentle manual therapy to improve the mobility of muscles and connective tissues, pelvic floor muscle relaxation and down-training, breathing and relaxation strategies, mobility and strengthening exercises, bladder and bowel retraining, and gradual return to meaningful activities. Your physiotherapist will work closely with you to develop an individualized treatment plan that addresses the root causes of your symptoms, helping to reduce pain, improve function, and restore confidence in movement and daily life.

Stress Urinary Incontinence (SUI) is the involuntary leakage of urine during activities that increase pressure inside the abdomen, such as coughing, sneezing, laughing, jumping, running, lifting, or exercising. Despite its name, "stress" refers to physical stress placed on the bladder rather than emotional stress. While common, urinary leakage is not a normal part of aging, pregnancy, or postpartum recovery, and it can often be successfully treated with pelvic floor physiotherapy.

Common causes and contributing factors include:

• Pregnancy and childbirth

• Weakness, poor coordination, or injury of the pelvic floor muscles

• Pelvic organ prolapse

• Menopause and hormonal changes affecting pelvic tissues

• Chronic coughing, constipation, or repetitive heavy lifting

• High-impact exercise or sports

• Previous pelvic or abdominal surgery

• Increased body weight or conditions that increase pressure on the pelvic floor

A pelvic floor physiotherapist will perform a comprehensive assessment to identify the underlying cause of your symptoms. Treatment is individualized and may include pelvic floor muscle training to improve strength, endurance, coordination, and timing; breathing and pressure management strategies; core and hip strengthening; bladder retraining; education on lifestyle modifications; and guidance for safely returning to exercise or sport. If pelvic floor muscles are overly tight or not functioning optimally, treatment may also include techniques to improve muscle relaxation and coordination. The goal is not only to reduce or eliminate leakage but also to help you return confidently to the activities you enjoy without fear of accidents.

Urgency Urinary Incontinence (UUI) is the involuntary leakage of urine that occurs when you experience a sudden, intense urge to urinate and are unable to reach the bathroom in time. Many people also notice urinary urgency (a strong, difficult-to-delay urge to void) and increased frequency of urination, including waking at night to urinate (nocturia). While urgency incontinence is common, it is not a normal part of aging, and effective, conservative treatment is often available through pelvic floor physiotherapy.

Common causes and contributing factors include:

• Overactive bladder (OAB)

• Pelvic floor muscle dysfunction, including muscles that are too tight or poorly coordinated

• Bladder irritation from certain foods and drinks (such as caffeine, alcohol, or artificial sweeteners)

• Urinary tract infections (UTIs)

• Constipation

• Pregnancy, postpartum changes, and menopause

• Neurological conditions such as multiple sclerosis, Parkinson's disease, or stroke

• Chronic stress or heightened nervous system sensitivity that can contribute to bladder urgency

A pelvic floor physiotherapist will complete a thorough assessment to determine the factors contributing to your symptoms and develop an individualized treatment plan. Treatment may include bladder retraining to gradually increase the time between bathroom visits, pelvic floor muscle training to improve strength and coordination, urge suppression techniques to help calm the bladder during episodes of urgency, breathing and relaxation strategies, education on bladder habits and fluid intake, management of constipation, and exercises to improve overall pelvic and core function. If pelvic floor muscles are overly tight or unable to relax appropriately, treatment will also focus on improving muscle flexibility and coordination. The goal is to reduce urgency and leakage, improve bladder control, and help you return to daily activities with greater comfort and confidence.

Pelvic heaviness is a sensation of pressure, fullness, dragging, or a "falling out" feeling in the vagina or pelvis. For some individuals, this sensation may be caused by pelvic organ prolapse (POP), which occurs when one or more pelvic organs—such as the bladder, uterus, vaginal walls, or rectum—descend due to reduced support from the pelvic floor muscles, ligaments, and connective tissues. Symptoms often become more noticeable after prolonged standing, lifting, exercise, or at the end of the day and may improve with rest. Some people may also experience urinary or bowel symptoms, lower back discomfort, or notice a bulge at the vaginal opening.

Common causes and contributing factors include:

• Pregnancy and vaginal childbirth

• Aging and menopause, which can affect the strength and elasticity of pelvic tissues

• Repeated heavy lifting or high-impact activities

• Chronic constipation and straining with bowel movements

• Chronic coughing or conditions that increase pressure within the abdomen

• Previous pelvic surgery, including hysterectomy

• Connective tissue disorders or a family history of prolapse

A pelvic floor physiotherapist will perform a comprehensive assessment to determine the severity of symptoms and identify contributing factors. Treatment may include pelvic floor muscle training to improve support and coordination, education on breathing and pressure management during lifting and exercise, core and hip strengthening, strategies to reduce straining with bowel movements, activity modifications, and guidance on safely returning to exercise. If appropriate, your physiotherapist may also discuss pessary use in collaboration with your healthcare provider. The goal of treatment is to reduce symptoms, improve pelvic support, prevent progression where possible, and help you confidently return to the activities that matter most.

Post-Operative Pelvic Rehabilitation is specialized physiotherapy designed to support recovery after pelvic, abdominal, gynecological, urological, colorectal, or gender-affirming surgery. Surgery can affect the muscles, connective tissues, nerves, and movement patterns of the pelvis, sometimes leading to pain, stiffness, scar tissue restrictions, pelvic floor dysfunction, bladder or bowel changes, or difficulty returning to everyday activities. Pelvic floor physiotherapy helps optimize healing, restore function, and improve confidence throughout your recovery.

Common surgeries that may benefit from pelvic rehabilitation include:

• Hysterectomy

• Pelvic organ prolapse repair

• Incontinence procedures (such as bladder sling surgery)

• Endometriosis excision surgery

• Cesarean section (C-section)

• Prostate surgery, including prostatectomy

• Colorectal surgery

• Gender-affirming pelvic surgeries

• Other abdominal or pelvic procedures involving the muscles, fascia, or pelvic organs

A pelvic floor physiotherapist will tailor treatment to your stage of healing, your surgeon's recommendations, and your individual goals. Rehabilitation may include education on safe movement and activity progression, breathing and pressure management, scar tissue mobilization (when appropriate), gentle mobility and stretching exercises, pelvic floor muscle retraining to improve strength or relaxation, core and hip strengthening, bladder and bowel retraining, and strategies to safely return to work, exercise, lifting, and recreational activities. The goal of post-operative pelvic rehabilitation is to reduce pain, restore movement and function, minimize long-term complications, and help you return to your daily life with confidence.

Perimenopause is the natural transition leading up to menopause, during which hormone levels—particularly estrogen—begin to fluctuate. This phase can last several years and may cause symptoms such as irregular menstrual cycles, hot flashes, night sweats, sleep disturbances, mood changes, joint aches, vaginal dryness, and changes in bladder and pelvic floor function. Menopause is defined as the point when a person has gone 12 consecutive months without a menstrual period. As estrogen levels decline, the tissues of the pelvic floor, bladder, and vagina can become thinner, less elastic, and less well-supported, which may contribute to new or worsening pelvic floor symptoms.

Common pelvic health concerns during perimenopause and menopause include:

• Urinary leakage (stress or urgency incontinence)

• Increased urinary urgency and frequency

• Pelvic organ prolapse or feelings of pelvic heaviness

• Vaginal dryness and discomfort

• Pain with intercourse (dyspareunia)

• Pelvic floor muscle weakness or overactivity

• Constipation and changes in bowel function

• Reduced core strength and changes in balance or bone health

A pelvic floor physiotherapist can help you manage these changes with an individualized treatment plan designed to improve comfort, function, and confidence. Treatment may include pelvic floor muscle training to improve strength, endurance, and coordination; techniques to relax overactive pelvic floor muscles; bladder and bowel retraining; core and hip strengthening; education on breathing and pressure management; and guidance on returning to exercise safely. Your physiotherapist may also provide education on vaginal moisturizers and lubricants, discuss lifestyle strategies that support pelvic health, and, when appropriate, recommend speaking with your physician about options such as local vaginal estrogen therapy. The goal is to reduce symptoms, support healthy aging, and help you remain active and enjoy the activities you love throughout perimenopause and beyond.

Diastasis Rectus Abdominis (DRA), commonly known as diastasis recti, is the separation of the left and right sides of the rectus abdominis ("six-pack") muscles due to stretching of the connective tissue (linea alba) that runs down the middle of the abdomen. It most commonly occurs during pregnancy as the growing baby places increased pressure on the abdominal wall, but it can also occur in individuals who have experienced significant changes in abdominal pressure, rapid weight fluctuations, or certain abdominal surgeries. While some separation is normal during pregnancy, it may persist after delivery and contribute to reduced abdominal support and function.

Common signs and contributing factors include:

• Pregnancy and postpartum recovery (especially multiple pregnancies)

• Twin or multiple gestation pregnancies

• Larger babies or excess abdominal pressure during pregnancy

• Poor pressure management during lifting or exercise

• Abdominal weakness or reduced core coordination

• A visible bulge or "doming" down the midline of the abdomen during movement

• Feelings of core weakness, reduced stability, low back or pelvic pain, or difficulty returning to exercise

A pelvic floor physiotherapist will perform a comprehensive assessment of your abdominal wall, pelvic floor, breathing mechanics, posture, and overall movement patterns. Treatment focuses on improving the function of the abdominal wall and core rather than simply reducing the width of the separation. This may include deep core and pelvic floor muscle retraining, breathing and pressure management strategies, progressive strengthening exercises, education on safe lifting and movement, and guidance on returning to exercise and sport. Your physiotherapist will create an individualized rehabilitation program designed to improve strength, stability, and confidence in movement while supporting your long-term pelvic and core health.