Physiotherapy
Pelvic Health Conditions
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Pelvic Health
Urinary Incontinence
What is Urinary Incontinence?
Many women and men think that urinary incontinence and bladder health issues are conditions they must simply accept. However, although urinary incontinence affects 10% of Canadians¹ and 1 in 3 women², effective management and, in many cases, treatment options are available to alleviate their symptoms.
Urinary incontinence is the unintentional loss of urine caused by the continence system’s inability to control urine flow through the urethra. This system includes the pelvic floor muscles, the connective tissues supporting the pelvic organs, the bladder, the urethra, and the pelvic bones.
The Role of the Pelvic Floor in Urinary Incontinence/Bladder Health
When bladder and pelvic health symptoms occur, the pelvic floor muscles are either underactive or overactive. Underactive muscles do not contract efficiently, often being hypotonic (too relaxed) and weak. Overactive muscles contract excessively and frequently, leading to hypertonic (tight) muscles that can become weak over time due to their inability to contract further. Both conditions can cause various types of incontinence and bladder issues. This imbalance affects muscle function, causing symptoms such as pelvic pain, urinary urgency, difficulty emptying the bladder, and sexual dysfunction.
Types of Urinary Incontinence and Bladder Health Conditions
Urge Incontinence:
Urge incontinence is the involuntary loss of urine that happens when you experience a sudden, strong urge to urinate that you cannot control or delay. It feels like you have to urinate immediately, and you may leak urine before reaching the bathroom.
Stress Incontinence:
Stress incontinence is the unintentional loss of urine that occurs when physical activities or movements increase pressure inside the abdomen. Common triggers include sneezing, coughing, laughing, jumping, and running, which put sudden pressure on the bladder and cause urine to leak.
Mixed Incontinence:
Mixed incontinence is a combination of stress and urge incontinence.
Overflow Incontinence:
Overflow incontinence is characterized by the continuous leakage of small amounts of urine due to an overly full bladder that cannot empty properly. This condition is often linked to a distended bladder caused by blockages, weak bladder muscles, or nerve damage that prevents complete emptying, leading to urine buildup and frequent leaks.
Urinary frequency (Overactive bladder):
This describes a persistent urge to urinate more often than every 2 to 3 hours.
Urinary Urgency:
Similar to urge incontinence, urinary urgency is the sudden and intense need to urinate immediately upon feeling the urge. However, unlike urge incontinence, urinary urgency does not involve any urine leakage.
Incomplete emptying:
This describes the sensation or diagnosis of incomplete bladder emptying after urination. It may feel like you need to stay on the toilet for a long time to fully empty your bladder or that you have to urinate again shortly after because your bladder did not empty completely.
What does Treatment involve?
Treatment is always personalized to each individual. Your physiotherapist will review your health history, perform a physical examination, and consider your functional goals to design the most effective treatment plan. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle training and strengthening
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Diastasis Recti Abdominis retraining
-
Pelvic Organ Prolapse management strategies
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Neuromuscular Stimulation for the Pelvic Floor
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Fecal Incontinence, Bowel Health, and Pelvic Health Physiotherapy
Fecal incontinence is a complex condition that severely impacts the daily lives of 2-3% of the Canadian population⁵
Bowel health conditions are often not openly discussed due to social stigma, causing many people to delay or avoid seeking treatment because they may feel isolated or unsure where to turn. However, research shows these conditions are common: digestive diseases affect millions globally, with over 2.2 billion prevalent cases worldwide in 2019 alone. This widespread prevalence highlights the importance of recognizing bowel health issues and seeking appropriate care.
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Fecal incontinence is a complex condition that severely impacts the daily lives of 2-3% of the Canadian population⁵
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Constipation impacts 20% of the general population⁶
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Rectoceles are found in more than half of women presenting with pelvic floor disorders⁷
At Ottawa Pelvic Health, we normalize the topic of bowel health, and work with individuals on a daily basis to diagnose, manage, and treat their bowel related symptoms and conditions.
Bowel Health Conditions:
Fecal Urgency
Fecal urgency is the sudden, uncontrollable need to have a bowel movement, causing you to rush to the bathroom to avoid accidents. It can occur alone or alongside fecal incontinence.
Fecal Incontinence
Fecal incontinence is the involuntary passage of stool, resulting in loss of bowel control.
Obstetrical Anal Sphincter Injuries (OASIS)
OASIS refers to pelvic floor injuries sustained during childbirth, typically involving third- and fourth-degree tears or assisted deliveries. The most common symptom of OASIS is double incontinence, affecting both urinary and fecal control.
Constipation
Constipation is a complex condition defined by two or more of the following: straining to defecate, pellet-like stools, feeling of incomplete emptying, sensation of blockage, fewer than three bowel movements per week, or the need for manual maneuvers to pass stool.
Rectal Prolapse (Rectocele)
A rectocele occurs when the rectum bulges into the vaginal wall, often caused by chronic straining during bowel movements or childbirth-related anal injuries.
Hemorrhoids & Anal Fissures
Hemorrhoids and anal fissures commonly result from chronic straining and increased pressure on the pelvic floor muscles.
Anal Pain & Spasms
Anal pain and spasms may arise from various conditions, frequently linked to hypertonic (overly tight) pelvic floor muscles in the ano-rectal region.
What does Treatment involve?
Treatment is always personalized and tailored to each individual. Your physiotherapist will assess your health history, physical examination results, and functional goals to determine the most appropriate treatment plan. Options may include:
• Education regarding your symptoms, condition, assessment findings, and treatment plan
• Bladder retraining
• Constipation management and bowel retraining
• Rectal Balloon Technique
• Targeted manual therapy of the myofascial system
• Visceral mobilizations
• Pelvic floor muscle downregulation and relaxation
• Pelvic floor muscle strengthening and training
• Motor control training and strengthening of the deep core musculature
• Motor control training and strengthening of the abdominal wall, hips and thorax
• Postural education and retraining
• Pelvic Organ Prolapse management strategies
• Functional retraining of the neuro-muscular system to achieve movement and activity goals
• Neuromuscular Stimulation of the Pelvic Floor
• Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Health
Pelvic Organ Prolapse
What is a Pelvic Organ Prolapse (POP)?
A Pelvic Organ Prolapse (POP) is the descent of one or more pelvic organs into the vaginal canal or beyond the vaginal opening. The severity of POP is classified into Grades 1 through 4, with Grade 1 being the mildest and Grade 4 the most advanced. The primary cause of POP is chronic or sustained increases in intra-abdominal pressure, which exert downward force on the pelvic organs. Common contributors include vaginal childbirth, chronic constipation, persistent coughing, heavy lifting, and holding the breath while lifting or carrying. These factors, combined with pelvic floor muscle or connective tissue dysfunction, can lead to the signs and symptoms many women experience. Additional risk factors include older age, menopause, connective tissue disorders or hypermobility, smoking, and previous abdominal or pelvic surgery.
Pelvic Health Physiotherapy is one of the main nonsurgical options for women with POP¹¹ Research shows that women who perform pelvic floor muscle training experience an improvement in both symptoms and severity of a POP¹².
Let’s dive in further into what a POP is, and how Pelvic Health Physiotherapy can help.
Types of Pelvic Organ Prolapses
● Cystocele: prolapse of the bladder
● Urethrocele: prolapse of the urethra
● Uterine prolapse: prolapse of the uterus
● Vaginal vault prolapse: prolapse of the vagina
● Enterocele: small bowel/intestine prolapse
● Rectocele: rectal prolapse
Symptoms of a Pelvic Organ Prolapses
● Heaviness, pressure, or fullness in the pelvic region
● A sensation of ‘something being there’ in the pelvic region
● Urinary frequency, urgency, or incontinence
● Urinary retention
● Fecal incontinence
● Constipation
● Using manual techniques to help evacuate stool
● Pain with intercourse
● Altered sensation during intercourse
● Back/pelvic pain
● Inability to keep a tampon in
● Noticing a bulge at the vaginal opening
The role of the Pelvic Floor in Pelvic Organ Prolapses
Pelvic floor dysfunction occurs when these muscles either do not activate enough and become hypotonic (too relaxed), or when they are overactive and become hypertonic (too tight). In both cases, the muscles fail to generate sufficient force to properly support the pelvic organs, which can contribute to the development of a pelvic organ prolapse (POP).
What does Treatment involve?
Treatment is always customized and specific to each individual. Your Physiotherapist will review your health history, conduct a physical examination, and consider your functional goals to develop the most effective treatment plan. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Pelvic Organ Prolapse management and treatment
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Discuss appropriate supportive devices
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular Stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Painful Intercourse (Dyspareunia)
Painful intercourse, or dyspareunia, is a common pelvic health condition that can significantly affect a person’s quality of life. It refers to pain experienced before, during, or after penetrative sex and can affect both women and men. The prevalence of dyspareunia varies from 3 to 18% worldwide, and can affect 10-28% of the population in a lifetime. (19,20)
Dyspareunia, or painful intercourse, can have many causes including pregnancy, childbirth, abdominal or genitourinary surgery, trauma, hormonal imbalances, stress, anxiety, and pelvic floor muscle overactivity.
Regardless of the cause, painful intercourse is not something you have to endure indefinitely. Pelvic Health Physiotherapy offers effective treatment options to help manage and reduce pain. Seeking professional care can significantly improve symptoms and quality of life.
Pelvic Health
Specific Pelvic Health Conditions associated with Painful Intercourse
Women’s health:
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Vaginismus: Inability to penetrate vagina due to muscle spasm
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Vulvar pain & Vulvodynia: Pain & discomfort (burning & sensitivity) in the external vaginal structures (vulva) occurring constantly or when provoked
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Vestibulodynia: Pain & sensitivity of the vestibule (opening of the vagina) to touch and pressure
Men’s health:
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Chronic Nonbacterial Prostatitis/chronic pelvic pain syndrome: a condition that causes long-term pelvic pain and urinary symptoms. Pain is often in and around the prostate gland.
Symptoms associated with Painful Intercourse
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Burning/sharp pain at the vulva
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Sensitivity of the vulva to different stimuli ex. Clothing, touch, penetration
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Bleeding and cracking of the vestibule (opening of the vagina)
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Painful intercourse
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Inability to have vaginal penetration (tampons, speculum, penis)
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Unwanted genital arousal unrelated to sexual desire
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Clitoral pain and sensitivity
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Decreased vaginal lubrication and pelvic floor muscle atrophy
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Altered sensation during intercourse
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Back/pelvic/hip pain
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Noticing a bulge at the vaginal opening
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Ejaculatory pain
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will review your health history, conduct a physical examination, and consider your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Dilator therapy
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Pelvic Organ Prolapse management and treatment
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Discuss appropriate supportive devices
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Pain Conditions
What is Pelvic Pain?
Pelvic pain is a common but often under-discussed condition characterized by discomfort in the lower abdomen, lower back, pelvis, and related ligaments, tendons, and pelvic floor muscles. It can be chronic and persistent or occur only during specific activities. While pelvic pain has many possible causes, it is frequently linked to pregnancy, childbirth, abdominal or genitourinary surgery, trauma, hormonal imbalances, and pelvic floor muscle overactivity.
Whatever the cause of the pain, pelvic pain is not something you have to suffer with for the rest of your life, as Pelvic Health Physiotherapy can help.
Pelvic Pain Conditions
Female Pelvic Pain
Vaginismus: Inability to penetrate vagina due to muscle spasm
Dyspareunia: Painful vaginal penetration
Vulvar pain & Vulvodynia: Pain & discomfort (burning & sensitivity) in the external vaginal structures (vulva) occurring constantly or when provoked
Vestibulodynia: Pain & sensitivity of the vestibule (opening of the vagina) to touch and pressure
Persistent Genital Arousal Disorder (PGAD): unwanted genital arousal unrelated to sexual desire
Genitourinary Syndrome of Menopause (GSM): collection of signs & symptoms involving changes to the vulva and vagina as a result of menopause
Male Pelvic Pain
Chronic Nonbacterial Prostatitis/chronic pelvic pain syndrome: a condition that causes long-term pelvic pain and urinary symptoms. Pain is often in and around the prostate gland
Male and Female Pelvic Pain
Coccydynia (Tailbone pain): Pain at the tailbone most often with prolonged sitting
Pudendal Neuralgia: pain associated with the structures innervated by the pudendal nerve
Symptoms of Pelvic Pain
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Burning/sharp pain at the vulva
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Sensitivity of the vulva to different stimuli ex. Clothing, touch, penetration
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Bleeding and cracking of the vestibule (opening of the vagina)
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Painful intercourse
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Inability to have vaginal penetration (tampons, speculum, penis)
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Urinary urgency & frequency
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Unwanted genital arousal unrelated to sexual desire
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Clitoral pain and sensitivity
-
Decreased vaginal lubrication and pelvic floor muscle atrophy
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Altered sensation during intercourse
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Constipation
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Back/pelvic pain
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Inability to keep a tampon in
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Noticing a bulge at the vaginal opening
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Ejaculatory pain
The Role of the Pelvic Floor in Pelvic Pain
Our pelvic floor muscles, like any other muscles in the body, can become too tight. This may happen for various reasons, including overuse from physical activity, stress, pregnancy, constipation, bladder issues, and surgery. When these muscles are tight, they do not work optimally, which can lead to problems such as weakness, nerve compression, reduced blood flow, and altered movement patterns. In some cases of pelvic pain, the pelvic floor muscles may also be too relaxed, failing to provide sufficient support to the surrounding structures.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Dilator therapy
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Pelvic Organ Prolapse management and treatment
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Discuss appropriate supportive devices
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Low back, Hip, Pelvic pain, and Pelvic Health Physiotherapy
Many people are aware that physiotherapy can help with low back, hip, and pelvic pain, but fewer realize that Pelvic Health Physiotherapy can be a crucial part of their recovery. In fact, several studies have linked low back pain to pelvic floor dysfunction, including one study that demonstrated that 78% of women with low back pain had urinary incontinence (25), and another study showing that 95.3% of women with low back pain experienced pelvic floor dysfunction (26). These studies have guided the world of rehabilitative therapy to further explore the role of the pelvic floor in low back pain.
Common Pelvic Health Symptoms that may be linked to Low back, Hip, or Pelvic Pain
● Urinary incontinence, urgency or frequency
● Urinary retention or incomplete emptying
● Fecal incontinence, urgency, or frequency
● Constipation
● Sensation of pressure or heaviness in the pelvis
● Pelvic Organ Prolapse
● Burning, stinging, itching in the pelvic region
● Sexual pain and dysfunction, vaginismus
● Dysmenorrhea: menstrual pain
● Pre- and post-partum pelvic pain and dysfunction
● Diastasis recti abdominis
● Endometriosis
● Vulvodynia and Vestibulodynia
● Chronic low back, hip, pelvic, or hamstring pain
The Pelvic Floor and the Core
The pelvic floor muscles are located within the pelvis, attaching to the pubic bone at the front, the tailbone (coccyx) at the back, and the sitting bones (ischial tuberosities) on either side, forming a hammock-like structure that supports the pelvic organs. These muscles include the levator ani group—comprising the puborectalis, pubococcygeus, and iliococcygeus muscles—and the coccygeus muscle, which together create a muscular diaphragm that supports the bladder, uterus or prostate, and rectum.
Beyond structural support, the pelvic floor muscles play essential roles in bladder and bowel control by regulating the openings of the urethra and anus, sexual health, circulation, and core stability. They work in coordination with other core muscles—the transverse abdominis, diaphragm, and multifidus—to stabilize the spine, pelvis, and thorax, maintaining posture and efficient movement throughout the day.
This core muscle group acts as a dynamic support system, providing endurance and coordination necessary for everyday activities and protecting pelvic and abdominal organs. Proper function of the pelvic floor muscles is vital for continence, sexual function, and overall core strength.
Pelvic Floor Dysfunction
When pelvic health symptoms such as low back, hip, or pelvic pain are present, the pelvic floor muscles may be either underactive or overactive. Underactivity means the muscles are not contracting efficiently, often resulting in hypotonic (too relaxed) and weak muscles. Overactivity occurs when the muscles are excessively and frequently activated, leading to hypertonic (too tight) muscles that, over time, may also become weak because their constant tightness prevents further effective contraction.
The link to Low back, Hip, and Pelvic pain
Either overactivity or underactivity of the pelvic floor muscles can lead to low back, hip, or pelvic pain because dysfunction in these muscles disrupts the normal coordination and activation of the core muscles. When the pelvic floor is not functioning properly, other muscles—such as those in the lower back, glutes, and hamstrings—compensate to support the core. However, these muscles are not designed for sustained endurance support, which can cause pain due to two main reasons:
1) They become overworked, tight, and may develop trigger points, which can become a source of pain.
2) They activate when they are not necessarily supposed to, resulting in altered postures and movement patterns, which can over time, become a source of pain.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your physiotherapist will evaluate your health history, physical exam findings, and functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Breathing coordination and training
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Diastasis Recti Abdominis retraining
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Endometriosis/Adenomyosis and Pelvic Health Physiotherapy
What is Endometriosis/Adenomyosis?
Endometriosis is a complex chronic pelvic pain condition that impacts 10% of women of reproductive age globally (29). Endometriosis is characterized by the presence of endometrial tissue outside the uterus. These endometrial lesions can implant on various structures in the lower abdomen, including the reproductive system, urinary system, and digestive system. The pain associated with endometriosis is often cyclical, with many women experiencing pain linked to their menstrual periods (dysmenorrhea). However, symptoms vary widely among individuals, and not all women experience the same pain or severity.
Similarly to endometriosis, adenomyosis is a complex chronic pelvic pain condition characterized by the presence of endometrial tissue; however, in adenomyosis, this tissue grows deep within the muscular wall of the uterus (the myometrium) rather than outside the uterus.
Symptoms of Endometriosis
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Painful periods (dysmenorrhea)
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Heavy and excessive periods
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Cyclical pain associated with the menstrual cycle (before, during, after)
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Constant or intermittent pelvic &/or low back pain
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Abdominal pain and bloating
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Fatigue, mood disturbances
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Painful intercourse (dyspareunia)
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Constipation, diarrhea, rectal bleeding
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Pain with voiding or bladder/bowels
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your physiotherapist will evaluate your health history, physical exam findings, and your functional goals to determine the best course of treatment. Options may include:
-
Education regarding your symptoms, condition, assessment findings, and treatment plan
-
Bladder retraining
-
Constipation management and bowel retraining
-
Targeted manual therapy of the myofascial system
-
Visceral mobilizations
-
Pelvic floor muscle downregulation and relaxation
-
Pelvic floor muscle strengthening and training
-
Pelvic Organ Prolapse management and treatment
-
Motor control training and strengthening of the deep core musculature
-
Motor control training and strengthening of the abdominal wall, hips and thorax
-
Postural education and retraining
-
Discuss appropriate supportive devices
-
Functional retraining of the neuro-muscular system to achieve movement and activity goals
-
Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Interstitial Cystitis
Bladder Pain Syndrome
Interstitial Cystitis (IC), also known as Bladder Pain Syndrome (BPS), is a chronic and debilitating condition of the urinary bladder. It is officially defined as ‘An unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with lower urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.” (32)
It is a chronic condition causing bladder-related pain, pressure, and urinary symptoms lasting over six weeks without infection or other causes.
Recent research shows Pelvic Health Physiotherapy is one of the most effective treatments, often outperforming medications and bladder therapies. The Interstitial Cystitis network notes that three of the five IC/BPS subtypes can be managed successfully with pelvic floor physical therapy, which helps improve muscle function and reduce pain.
Interstitial Cystitis/Bladder Pain Syndrome Subtypes (IC/BPS) (33)
*Pelvic Health Physiotherapy can help with subtypes 3-5
1 - Hunner’s Lesions
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Wounds on the bladder associated with inflammation
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Can be very painful
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Occurs in 5-10% of patients with IC/BPS
2 - Bladder Wall Injury
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The injury leads to urine being able penetrate into the tissues, causing irritation
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Causes Include: UTI, chemotherapy, poor dietary habit, and chemical exposure
3 - Pelvic Floor Injury/Hypertonicity*
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A tight pelvic floor can tighten around the bladder, nerves, and blood vessels, resulting in bladder symptoms, pain, and pelvic symptoms
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Causes Include: trauma to the pelvic floor from an accident, stress (which can result in chronic subconscious tightening of the pelvic floor muscles), childbirth
4- Pudendal Neuralgia*
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Results from pelvic floor muscles being so tight that they press on the pudendal nerve
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Causes include: bike riding, stress, trauma to pelvic floor
5 - Chronic Overlapping Pain Conditions / Central Sensitization Syndrome*
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This describes patients who have 2 or more Pain Conditions
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Other pain conditions include vulvodynia, prostatodynia, IBS, TMJ syndrome
Symptoms of Interstitial Cystitis/Bladder Pain Syndrome
- Urinary frequency and urgency
- Painful urination
- Nocturia (waking up excessively at night to urinate)
- Pain associated with intercourse (before, during, after)
- Chronic supra-pubic (lower abdomen) pain/pelvic pain
- Prostatitis-like symptoms
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, the physical exam findings, and your functional goals to determine the best course of treatment.
Treatment options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Stress management, relaxation techniques, and pain management techniques
● Central Nervous System remapping exercises and strategies
● Postural education and retraining
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
Pelvic Health
Diastasis Recti Abdominis
What is Diastasis Recti Abdominis (DRA)?
Diastasis Recti Abdominis (DRA) is the horizontal separation of the two muscle bellies of the rectus abdominis (the "six-pack" muscles). This happens when the linea alba, the white connective tissue running down the center of the abdomen that connects these muscles, stretches due to pressure, creating space between them. This pressure can come from increased intra-abdominal pressure, such as holding your breath to lift something heavy, or from direct mechanical pressure on the abdomen, like during pregnancy.
It is important to know that some degree of DRA is found in 100% of women at 35 weeks of pregnancy.(15) It is one of the body’s way of adapting to the growing bump. That said, a DRA during pregnancy does not mean that a woman will have a DRA postpartum.
DRA’s are also found in men, women who haven’t been pregnant, and children.
A DRA could occur above, at, or below the belly button, or in all 3 of those regions.
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Common Symptoms of DRA
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A separation of the rectus abdominis muscle, that may be visible or felt
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Low back, pelvic, or hip pain
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Poor trunk posture
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Feeling weak through the midsection, unable to activate the core
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Doming or tenting of the middle of the stomach. This can occur during activities such as lifting, rolling over in bed, or certain exercises
The Pelvic Floor, the Core, and their role in Diastasis Recti Abdominis
The pelvic floor muscles sit within the pelvis, attaching to the pubic bone, tailbone, and sitting bones, acting like a hammock to support our organs. Besides support, they help with bladder and bowel control, sexual health, circulation, and core strength.
As part of the core—along with the transverse abdominis (TA), multifidus, and diaphragm—the pelvic floor plays a key role in rehabilitating Diastasis Recti Abdominis (DRA), mainly due to its connection with the TA muscle.
The TA is a broad muscle located just beneath the linea alba, connected to it through fascia. When the TA contracts, it creates tension on the linea alba, helping restore its strength and integrity.
Pairing pelvic floor contractions with TA contractions increases TA activation, which transmits more tension to the linea alba.
In summary, contracting the pelvic floor enhances TA contraction, increasing tension on the linea alba, which helps strengthen the tissue and aids in resolving DRA.
What does Treatment involve?
Treatment is always tailored and specific to each individual. Your Physiotherapist will evaluate your health history, physical exam findings, and functional goals to determine the best course of treatment. Options may include:
● Education regarding your symptoms, condition, assessment findings, and treatment plan
● Bladder retraining
● Constipation management and bowel retraining
● Targeted manual therapy of the myofascial system
● Visceral mobilizations
● Pelvic floor muscle downregulation and relaxation
● Pelvic floor muscle strengthening and training
● Motor control training and strengthening of the deep core musculature
● Motor control training and strengthening of the abdominal wall, hips and thorax
● Postural education and retraining
● Diastasis Recti Abdominis retraining
● Pelvic Organ Prolapse management strategies
● Functional retraining of the neuro-muscular system to achieve movement and activity goals
● Neuromuscular Stimulation of the Pelvic Floor
● Liaising with your other healthcare professionals to achieve holistic and comprehensive treatment outcomes
If you are unsure of whether Pelvic Floor Physiotherapy will help with your symptoms and condition, we highly encourage you to contact us for a 15 minute Free Phone Consultation. One of our specialised Pelvic Floor Physiotherapists will discuss your concerns with you, and help you determine whether this is the best course of treatment for you.