Pelvic health

We start with your symptoms: when you leak or feel pressure, how often you go to the bathroom, and any pain. We ask how they affect daily life, exercise and sex, and about pregnancy, birth, surgery and your general health. You can share as much or as little as you like.

Then we check your breathing, posture, back, hips and belly muscles, and how they work with the pelvic floor when you lift, run or jump.

If it would help, we may offer an internal examination. It happens only with your consent, and it is never required.

Some pelvic floors need strengthening. Others hold too much tension and need to learn to relax first. Treatment often includes:

• Pelvic floor training: learning to squeeze, lift and fully let go, then building strength and timing for coughing, lifting and running.
• Relaxation and breathing: for muscles that stay tense, which can add to pelvic pain, urgency or pain with sex.
• Bladder training: a plan to slowly stretch the time between bathroom trips and settle sudden urges.
• Biofeedback and muscle stimulation: tools that show how your muscles are working, or help weak muscles switch on.
• Core and whole-body exercise: for the belly, back and hips, which work with the pelvic floor.
• Hands-on treatment (manual therapy): for tight or tender muscles, scars, and the joints of the pelvis and low back.

See pelvic floor physiotherapy for more.

During pregnancy and after birth

During pregnancy, we treat back pain and pain around the pelvis (pelvic girdle pain), and help you stay active. Registered massage therapists can also ease aches and discomfort in pregnancy. See massage therapy. After a vaginal birth or a caesarean (C-section), we check how the pelvic floor and belly muscles are healing. That includes any gap between the belly muscles down the middle (diastasis recti).

Running, jumping, skiing and snowboarding put high loads through the pelvic floor. We plan your return around the activity you want back.

After birth, your postnatal check with a doctor, nurse practitioner or midwife comes first. Before you run, we test how your pelvic floor copes with hopping, jogging on the spot and single-leg strength work. We then build up in stages, from strength and low-impact exercise to running and jumping. The same staged approach applies to anyone who leaks on trail runs or when landing jumps.

Pilates can be a gentle way to rebuild core strength after pregnancy.

Book an assessment if you leak urine, gas or stool, feel heaviness or a bulge, or have pelvic pain or pain with sex. You can also book during pregnancy, after birth, or before you return to running or skiing. We also see some men with pelvic floor problems, such as leaking after prostate surgery or pelvic pain. That care is limited and decided case by case, so call the clinic first and our pelvic health physiotherapist will tell you whether we can help.

Go to the emergency department right away, or call 911, if any of these happen:

• you cannot pass any urine at all
• new numbness around the groin or buttocks
• sudden loss of bladder or bowel control with back pain, or new weakness in both legs
• heavy bleeding, whether during pregnancy, after birth or at any other time
• severe pain in the belly or pelvis, or a fever with pelvic pain
• chest pain, trouble breathing, or a painful, swollen calf, during pregnancy or after birth