Pelvic floor Physical Therapy or Pelvi-Perineal Re-education is the assessment and treatment of pelvic and perineal problems such as incontinence and pelvic pain.

Approximately one in four women suffers from urinary incontinence. Urinary or fecal incontinence is the involuntary loss of any amount of urine or stool. It is often due to weakening or disuse of the muscles under the bladder. Sometimes during labour and delivery, or a pelvic surgery such as a hysterectomy, there is damage to these muscles. When these muscles are not functioning properly, you may develop a prolapse (bulging or descending) of the bladder or rectum. The muscles may develop an area of muscle spasm ('knots'), which can lead to pelvic pain. Nerves in the pelvis may become irritated, and lead to pain or tingling into the back, hips, or legs. Since the pelvic floor muscles attach to the tailbone, pubic bone, and are near the hip and back, lower back pain may occur.

You may suffer from urinary or fetal urgency or incontinence that interferes with your ability to perform your work, hobbies or sports. Perhaps you have pelvic pain that interferes with sleep, activity, sexual function and relationships. You may have tried exercises without success. With our treatment, you can experience relief of these difficulties and significant improvement to your quality of life.

In our Pelvi-Perineal re-education program, we only treat women. (not children, or men).

First, we ask about your symptoms, any previous pregnancies or surgeries, or other medical conditions. The pelvic exam involves observation, and palpation (feeling) of the soft tissue and muscles around and inside the vagina and rectum. This is similar to how your doctor does an internal exam. The rectal exam is an important part of the exam: it allows more accurate palpation of the pelvic floor muscles, and of the tailbone. The Therapist assesses the pelvic floor muscle's tension, strength, power and endurance, and the presence of pain or spasm in the muscles.

We begin by changing urinary habits through behaviour modification. Exercises are used to strengthen the pelvic floor muscles, and to train them to reduce incontinence. Perhaps you have tried these exercises ('Kegels' exercises) without seeing an improvement. It is often in these cases that the muscles are tight, in spasm, or weak in a certain area. The Therapist can address this by physically stretching the pelvic floor muscles or using trigger point massage for the muscles. If an area of muscle is particularly weak, we use Òmanual biofeedbackÓ. This means that the therapist feels the muscle contraction, and gives feedback to the patient to help her isolate or focus the contraction to a certain area of the muscle. Your Physical Therapist can also address issues related to your low back pain, abdominal weakness, hip and Sacroiliac dysfunctions that commonly are a part of pelvic floor problems.

We are very careful to create a private and sterile environment during assessment and treatment. We utilize a private treatment room, non-latex gloves and hypoallergenic gel, and wash or dispose of equipment properly. Your dignity and comfort is our highest priority. There is a risk that you might feel discomfort in the pelvic area after a treatment, particularly if it has involved stretching or trigger point massage to tight or tender muscles.

Not all Physical Therapists are certified to treat Pelvic Floor dysfunction. In order to perform internal examinations, your Physical Therapist has taken specific training, has written a certificate exam, and has qualified to be on the Pelvic Floor Roster established by the College of Physical Therapist of Alberta.

When you call the NCSPT Beddington clinic (ph. 295-8590), state that you are a Women's Health patient and would like to book an initial assessment for Pelvic Floor Treatment. The receptionist will ask you questions, and find a time that fits your schedule.

Bring information about any relevant medical examinations (eg. urodynamics, urine culture) that you may have had. Know which medications you may be taking, particularly those related to the bowel/bladder. A Physician's referral is not necessary, unless required by our health benefit plan.

The exam can be done while a woman is pregnant, as long as her water has not broken. It can be done when a woman is menstruating, if it is at or near the end of the menstrual phase.

The initial assessment is approximately 45-60 minutes in length. Please arrive 20 minutes early to complete paperwork. Follow up treatments are 30-45 minutes long, and involve one on one treatment time. It is very important that you arrive on time for all treatment sessions, as the Physical Therapist has set reserved one on one time to treat you.

The initial assessment is $110 and follow up treatments are $90; please call ph# 295-8590 to confirm the current fee schedule. Most patients have extended health coverage for Physical Therapy, and it can be used for pelvic floor therapy. We also treat patients covered by motor vehicle accident (MVA) insurance, if the pelvic dysfunction is related to the MVA. If you are being treated under CHR for low income, you may qualify to receive pelvic floor treatment.

Treatment is usually once per week for 3 to 4 weeks, then less frequently (eg. once every 2-4 weeks) for 2-3 months. Naturally every individual's needs will vary, and this is only an approximate timeline. The Therapist will discuss your individual treatment plan after the initial assessment.

We ask that you book in advance, and choose a treatment time that best suits your schedule. If you do need to cancel, we request that you give 24 hours notice. If you fail to show up for the treatment without notifying us, the cancellation fee is $25 for a missed appointment.

If you think that you or a woman you know might benefit from Pelvic Floor Physical Therapy, phone our clinic to schedule an assessment. You will need to let the reception staff know you are a "Women's Health patient", and that you want to book with Physical Therapist Heather Enns.

A Physician's referral is not necessary prior to beginning Physical Therapy, although it may be needed for reimbursement from an extended health benefit plan. Also, if you feel you may have an infection or undiagnosed medical disorder, ask your Physician.

If you are unsure if Physical Therapy can help you, please call the clinic for clarification of any questions or email Heather: henns@ ncspt.com