PELVIC HEALTH PHYSIOTHERAPY

What is Pelvic Health Physiotherapy?

Pelvic Health Physio is a service provided by specially trained physiotherapists to help women and men that are experiencing challenges with intimate issues related to their bladder, bowel, sexual function, and/or pelvic pain.  

 

Envision Physiotherapy has a team of five pelvic health physiotherapists that have the knowledge, skills and tools to help you understand and sensitively manage dysfunctions related to pelvis.  

 

Vancouver Pelvic Floor Physiotherapy services are offered at both our clinics, at South Granville and at False Creek.

 

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What Does a Session Involve?

Appointments are approximately and hour and will start with a conversation about your story, your challenges, and your goals.

 

Your pelvic floor physio will teach you about some of the relevant anatomy and walk you through a whole-body assessment that may involve an internal vaginal and/or rectal exam to help understand what you are experiencing.  We recognize and respect that an internal assessment may be triggering for our clients and want to emphasize that an internal exam is helpful, but not mandatory.  

 

Your physiotherapist may also use a Real Time Ultrasound to help you visualize your abdominal muscles and/or a biofeedback device that helps you connect with muscles that you have lost touch with.  You will develop goals together with your physio and come away from your appointment with a proposed treatment plan.

 

Follow up sessions are commonly fifty minutes and may involve guidance on exercise, education, manual therapy, biofeedback, dry needling and or real-time ultrasound.  Your appointments will be tailored to your needs to help restore your function to help meet your goals.

Meet the Pelvic Health Physiotherapy Team

Our five pelvic floor physiotherapists have an approach that is rooted in the knowledge and teachings of pioneer Marcy Dayan, and they each bring their own experience and continuing education to their practice.  Dayan Physiotherapy & Pelvic Floor Clinic merged with Envision in 2020 and continues to work as a team supported by our broader services like Clinical Pilates, Kinesiology, Dietitians and other specially focused Physiotherapy. 

 

Please click on each physio’s name below to read their bio and determine who you think might be the best fit to help you.

PELVIC FLOOR PHYSIOTHERAPISTS

Click on Name for Bio
Click on Name for Bio
Dikla Barer
Click on Name for Bio
Click on Name for Bio
Allison Evers
Click on Name for Bio
Click on Name for Bio
Anna Hudon-Kaide
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How to Make an Appointment

If you have questions or concerns about booking an appointment for pelvic floor physio, you can call our reception staff at either office:

 

South Granville 604-737-7309 or False Creek 604-876-2344

 

If you would like to book online, you can do so by clicking on the Booking Link above and pick which clinic and which physio you would like to see.  

Learn More

Please click on any of the links below to learn more about our pelvic floor services and common conditions that we can help with:

Physiotherapy Services

Pelvic Health Education
Pessary Fitting
Core Muscle Activation and Training
Physical Assessment with Internal Exam
Manual Therapy
EMG Biofeedback
Real-Time Ultrasound

Pelvic Health Related Conditions

Abdominal Separation / DRA
Bladder Control - Incontinence
Bowel Control - Incontinence
Coccydynia / Tailbone Pain
Constipation
Pelvic Organ Prolapse
Low Back & Pelvic Girdle
Painful Intercourse
Pelvic Dysfunction (SI joint, pubic symphysis)
Pudendal Neuralgia
Prostate Problems
Prostate Cancer / Prostatectomy Health
Vulvar Pain
Vaginal Pain

*Contact us if you have any more questions regarding Pelvic Health Physiotherapy

Core Muscle Activation & Training

The timing and coordination of muscles and movement is important for painfree, healthy function. The deep muscles of your pelvis and abdomen (the pelvic floor, transversus abdominus, multifidus and the diaphragm) turn on milliseconds before you move your arms or legs in order to stabilize your trunk, also referred to as your core. This stabilization forms a stable base from which your arms and legs can move.  Poor motor control and the poor timing or sequencing of certain muscles can be the result of injury or can cause injury to our bodies.

 

We provide one on one attention as we carefully assess your movement patterns, coordination and balance, along with your strength, to ensure optimal movement strategies for painfree, healthy function.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the bladder, uterus or rectum slips out of place down into the vagina. 

 

Bladder prolapse, also called a cystocele or anterior vaginal wall prolapse, is when the bladder loses its support, slips down and bulges into the front wall of the vagina, pushing it down. 

 

Uterine prolapse is when the uterus looses support and slips down into the vagina. 

 

A rectocele, also called a posterior vaginal wall prolapse, is when the rectum loses its support, slips down and bulges into the back wall of the vagina, pushing it down. It then forms a pocket that stool can get trapped in.

 

Symptoms can include:

  • Incomplete bladder or bowel emptying
  • A sensation of vaginal or rectal heaviness or pressure
  • Something bulging at the vagina or perineum

 

Correctly performed pelvic floor muscle (Kegel) exercises can help prolapse. Research shows that based on verbal and written instruction, 75% of women are doing these exercises incorrectly. Research also demonstrates that supervised, correctly performed pelvic floor exercises (Kegel’s) result in a higher resting position of the bladder, bowel and pelvic floor! At Dayan Physiotherapy, we use both biofeedback and real-time ultrasound to assess your ability to contract and to teach you how to contract and strengthen your pelvic floor (Kegels). Once you can do this and have enough strength in your pelvic floor, we help you learn how to use your pelvic floor to return to activities that caused your prolapse to be bothersome. 

 

At times pelvic floor exercises (Kegel’s) do not completely alleviate the prolapse. As an alternative to surgery, many women choose to use a pessary; an internal assistive device that supports your prolapse. These can be used just for activities when the prolapse is bothersome, such as running or jumping, or kept in all day long if needed. The pessary cannot be felt when using it and is easy to insert and remove. At Dayan Physiotherapy, we fit and prescribe pessaries.

Abdominal Separation - Diastasis Rectus Abdominus (DRA)

Many women are concerned that they will not regain their waistline after pregnancy. Sometimes, the right and left abdominal wall separates during pregnancy. This is called a diastasis rectus abdominus. You might notice a bulge down the centre of your abdominals when you move or that you can sink your fingers into the space between your abdominals across the midline of your tummy. When your abdominals are stretched and separated, they are no longer able to adequately stabilize your low back and pelvis. There are a lot of misconceptions regarding a diastasis. It is possible to do abdominal exercises, BUT they need to be done in a way that draws the separation together and back, rather than apart and bulging. We will do a comprehensive assessment and use real-time ultrasound to determine an individualized treatment program for your specific needs, helping you flatten your tummy and regain stability of your low back and pelvis.

Pelvic Health Education

Your physiotherapist will explain all the relevant anatomy around the pelvis and how it relates to the rest of your body to help give you context to understand what you are experiencing.  You will have the opportunity to ask questions in a safe environment with a health professional that has knowledge and experience helping people with sensitive and personal health matters.

EMG Biofeedback

Biofeedback is an important tool for both accurate physiotherapy diagnosis and client learning. It senses how much tension is in a muscle. The technology works the same as a heart monitor. When the heart is monitored, electrodes on the chest detect heart (a muscle) activity and the information is displayed on a graph on the heart monitor screen. The person only feels the electrodes being placed and removed.
 

Pelvic floor biofeedback works much the same way. During pelvic floor biofeedback three electrodes are placed on the skin, two on either side of the anus very close to the opening, while the third electrode is placed on the inner thigh. For women, the electrodes do not go in or touch the area immediately around the vagina. The biofeedback doesn’t provide any electrical output to the patient (It doesn’t zap you!). It simply reads the amount of muscle activity occurring in any given moment. The computer processes this information and a graph is displayed demonstrating the muscle activity.
 
Biofeedback is a helpful tool in learning to control both contracting and relaxing your pelvic floor muscles. Electrodes can also be used that go in the vagina or anus. We rarely use these, as they can be uncomfortable, they change the sensation of contraction and cost the client more.

Prostatitis / Prostadynia

Also know as prostatitis, pelvic pain syndrome, chronic nonbacterial prostatitis, chronic genitourinary pain, pudendal neuralgia, painful bladder syndrome or interstitial cystitis.  Prostatodynia or Chronic Pelvic Pain Syndrome (CPPS) is a pelvic pain condition in men.

 

Symptoms may include a few or all of the following:

 

  • Pain in the testicles, or tip, shaft or base of the penis
  • Pain at the perineum (the area between the testicles and penis)
  • Pain on urination
  • Increased pain in sitting
  • Pain or discomfort with sexual arousal, or during or after ejaculation
  • Pain or discomfort above the pubic bone
  • Urinary frequency
  • Urinary urgency
  • Pain before, during or after a bowel movement
  • Decreased interest in sex
  • It is often found along with interstitial cystitis, painful bladder syndrome and IBS (irritable
    bowel syndrome)

 

Investigations for bacteria and yeast are negative. Physical examination does not usually show anything unusual, although the prostate may be swollen, soft or firm, warm and tender. What can make the problem even more confusing is that often young, otherwise healthy men develop this condition. Antibiotics, pain-killers, and medications prescribed in attempt to relax the muscles of the prostate are often not effective. Many men have been told that they must learn to live with the symptoms because a cure is not available.

 

This condition is now understood as a pain condition and it is highly doubtful that problem lies solely in the prostate. Treatment interventions include pain education and ensuring an understanding of the multiple factors contributing to the condition; ensuring there is no reactive pelvic floor spasm and if so, teaching men skill in relaxing their pelvic floor; bladder management techniques; and cognitive, behavioural and dietary interventions to address bladder and bowel symptoms. Using these interventions, concepts of pacing and grading are included to enable men to return to activities (sitting, cycling, sexual) that have become too painful to enjoy. Our clinic is fully equipped with biofeedback and imaging ultrasound to ensure the best in technology to support excellence in assessment and treatment. Our philosophy is to teach clients what they need to know and do in order to be able to manage their condition and minimize or eliminate pain and other symptoms.

     

Pessary Fitting

A pessary is an internal assistive device that is worn in the vagina to stop incontinence or support pelvic organ prolapse.   It can be easily inserted and removed by the wearer and should not be felt when using it. It can be used just for activities when the prolapse is bothersome, such as running or jumping, or kept in all day long if needed. It helps the user to become symptom free and return to the activities they want to do without leaking urine or experiencing the symptoms of prolapse. 

 

Envision Physiotherapy's pelvic floor physios can assess, prescribe and fit pessaries.

Prostate Cancer / Prostatectomy Health

Many men find that they are incontinent (involuntarily leaking urine) following a prostatectomy. Although we do not have the statistics for men, research shows that based on verbal and written instruction, 75% of women are unable to contract and relax their pelvic floor muscle correctly. Our clinical experience shows it to be about the same for men. At Dayan Physiotherapy we use biofeedback to assess your ability to contract your pelvic floor (Kegel’s) and if needed, to teach you how to contract and strengthen the muscle. Once you can do this and have enough strength in your pelvic floor, we help you learn how to use your pelvic floor to return to activities without leaking urine. This assessment can be done before the operation, giving you confidence in your skill postoperatively.

Low Back Pain / Pelvic Girdle Pain

Research shows that our deep muscles (core stabilizers) automatically contract milliseconds before we move, stabilizing our low back and pelvis. This creates a stable platform from which we can move our arms and legs. When there is low back pain, this automatic contraction does not occur, resulting in excess movement of the vertebrae and pelvis. Pain can worsen and further injuries can occur. At Envision Physiotherapy we have the skill, knowledge and tools (real-time ultrasound) to assess your movement patterns. We create an individualized treatment program to enable you to return to activities and function painfree.

Anna Hudon-Kaide - BSc, MPT

Anna Hudon-Kaide is a registered physiotherapist with a passion for helping people with pelvic floor dysfunction. She assesses and treats pelvic health conditions such as bladder and bowel control problems, pelvic organ prolapse, painful intercourse, and other genital pain conditions. She is equally passionate about treating perinatal pelvic pain such as pubic symphysis, SI joint and back pain and coccydynia (tailbone pain). 

 

Anna obtained a Master of Health Sciences in Physiotherapy from the University of Ottawa in 2018, and has completed post-graduate training in pelvic floor rehabilitation. Prior to this, she attended the University of Alberta, where she earned a Bachelor of Sciences degree.

 

As an orthopedic practitioner, Anna came to realize how many patients have common concerns related to pelvic health. She also noticed that patients were often too embarrassed to seek advice, or simply unaware that treatment is available. Anna has since joined Dayan Physiotherapy and Pelvic Floor Clinic. She feels an important part of her work is to help shed the stigma of pelvic health concerns and assist people in optimizing the health and function of their pelvic floor, enabling them to fully engage in all aspects of their lives with comfort and joy.

 

Anna is also fluent in French and Japanese!

 

In her personal time Anna enjoys running and camping. She’s new to Vancouver and excited to learn how to sail.

Bladder Control - Incontinence

Bladder incontinence is the involuntary loss of urine. It is not a disease, but a symptom of a physical or neurological problem. It is estimated that up to 25% of adults have urinary incontinence and that women are affected twice as often as men. Although the chance of becoming incontinent increases with age, it happens to people of all ages and is NOT a natural part of aging.

 

Symptoms can include:

* Leaking urine or stool when you sneeze, run, exercise, laugh, cough… (Stress urinary incontinence)

* Problems getting to the bathroom in time (urgency)

* Constipation

* Frequent need to urinate

 

The bladder is a hollow muscular organ that collects urine. Urine leaves the bladder through the urethra, a narrow tube-like structure extending from the bladder to the outside of the body. The bladder has two functions. It either stores urine or empties urine. During the storage phase the bladder muscle remains relaxed, while the sphincters and muscles that block off the urethra and bladder stay contracted, thus preventing any urine from escaping. If urine escapes during the storage phase, it is called a leak.

 

Urine leakage, or incontinence, can have many causes.. Stress and urge are two common types of urinary incontinence. Many people have more than one type of incontinence at the same time.

 

STRESS INCONTINENCE

 

Many people leak urine when they cough, sneeze, walk, run or otherwise exert themselves. This is called stress urinary incontinence. These actions increase the pressure within the abdomen. This increased pressure squeezes the bladder. If the pressure squeezing the bladder is greater than the closure pressure of the sphincters sealing the urethra, urine is forced out and a leak occurs. Correctly performed pelvic floor muscle (Kegel) exercises can help stop this leakage. Research shows that based on verbal and written instruction, 75% of women are doing these exercises incorrectly.

 

URGE INCONTINENCE

 

A strong, sudden need to empty the bladder is called urgency. When it is associated with leakage it is called urge incontinence. Remember, the bladder is a muscle. The strong urge is caused by an overactive contraction of the bladder muscle. The problem is compounded if the pelvic floor muscles that close the urethra and bladder are weak. Several things can cause your bladder to become overactive. Small bladder capacity, nerve damage, caffeine, and anxiety are a few of the contributors to an overactive bladder. It is not uncommon for someone to have both stress and urge incontinence. The individual can learn to suppress the urges, increase their bladder capacity and the amount of time between emptying their bladder, and strengthen their pelvic floor muscles. There are also medications that can help the bladder to be less active.

 

Treatment varies depending on the problem. We use both Real-Time Ultrasound and Biofeedback to help you learn how to contract and strengthen your pelvic floor (Kegels). Research shows that up to 75% of women, based on verbal and written instruction alone, are doing Kegels (contracting their pelvic floor) incorrectly. We do not have the research for men, but our clinical experience shows it to be about the same. We also help you learn behavioural changes involving diet and toileting patterns and, prescribe the use of internal assistive devices (pessaries) to help you regain control of your bladder.

Physical Assessment with Internal Exam

A pelvic floor physiotherapist will first talk through your story with you to determine what type of assessment is most appropriate to help you.  She will look at your global posture and movement patterns and try to determine what role your pelvic anatomy may be playing in your issues.  An internal exam can help the therapist assess the integrity of the pelvic floor muscles in supporting your organs and the structure of your pelvis.  Internal exams can be vaginal or rectal and can help assess if muscles are over or under-active which can then help guide the course of treatment and exercises going forward.  

Allison Evers - MScPT, BSc

Allison completed her education at the University of British Columbia’s Vancouver campus, where she obtained a Bachelor of Science (BSc) in Biology and Master in Physical Therapy (MPT). Allison holds her Level 1 Orthopedic Manual Therapy certification and has advanced training in the assessment and treatment of pelvic floor dysfunction, including urinary and bowel control, and pelvic organ prolapse.

Allison recognizes that clients may feel self-conscious discussing the nature of their visit. She brings a sensitivity to her practice, where she promotes a respectful environment that is responsive to her clients’ individual preferences, needs, and values.

One of Allison’s goals as a physiotherapist is to empower clients by giving them the education and tools needed to manage their condition independently overtime with confidence and success!

A proud Vancouverite, when Allison isn’t at work, she enjoys running, camping, and team sports. She also enjoys time spent with her family and friends. 

Dikla (Dee) Barer - MScPT, BHK (ExSc), IMS

Dikla’s treatment philosophy of client empowerment through education, body awareness, and
customized rehabilitation exercise has led her to her interest in pelvic health. Drawing on over a decade of experience in an orthopaedic clinical setting, she brings a client centred, whole-body, hands-on therapy approach. This approach draws from her depth of knowledge in anatomy and physiology and her breadth and depth of experience in private practice.

 

Dikla has been a practicing physiotherapist in Vancouver for over 10 years. She holds a Masters degree in Physical Therapy from Queen’s University (2008), a Bachelor of Human Kinetics (Exercise Science) from UBC (2005), and is a Certified Gunn Intramuscular Stimulation practitioner (CGIMS). She has additional training in male and female pelvic floor dysfunction including incontinence, pelvic organ prolapse, painful intercourse, perinatal low back and pelvic pain, and abdominal separation, as well as certifications in advanced orthopaedic manual therapy and manipulation therapy.

 

Dikla lives in Vancouver with her husband and two daughters. Outside of work, you can find them on various adventures throughout the lower mainland.

Real Time (imaging) Ultrasound

Real-time ultrasound images your pelvic floor, transversus abdominus (lower abdominals) and multifidus (deep lower back muscles). Research shows that if you have low back or pelvic girdle pain or dysfunction (incontinence, vaginal, perineal or anal pain) or have been pregnant, these muscles stop working effectively. These muscles are very important for stabilizing your back, maintaining bladder and bowel control, and supporting you pelvic organs (bladder, uterus and rectum). As these muscles work effectively at a low amount of contraction, it can be difficult for people to learn the correct technique. The ultrasound gives you a picture of the muscle at rest and contracting, so you can actually see when you are contracting correctly.

Vulvodynia / Vulvar Pain

Some women suffer from a pain condition called vulvodynia. Pain is not only isolated to the opening of the vagina, as in vestibuldynia, but can be felt anywhere in the vulva, perineum and vagina. Pain is usually constant, but can be intermittent and triggered or worsened by contact such as intercourse or other sexual touch, tampon use, a medical exam, riding a bike, sitting, or wearing tight clothing. Considering that vulvodynia is often misdiagnosed, it is important that women are informed about this condition – the causes, treatment and supports – enabling women to make informed decisions regarding their health care. 

 

Although pain can be present with or without physical contact, it is often exacerbated by contact and can vary in intensity and frequency, from very occasional to constant and unrelenting. The type of discomfort can also vary, ranging from mild burning to knife-like pain. Many women experience increased pain at a specific point in their menstrual cycle. Approximately 40% of women also experience simultaneous bladder and bowel conditions and other pain conditions. 

 

Often misdiagnosed as a yeast infection or psychological issue, the cause of this condition is unknown. Medical examinations and laboratory test results are negative for bacterial and fungal infections and skin conditions. The medical community believes that vulvodynia may be caused by injury or irritation of the pain nerves in response to trauma, infection, or sensitivity to environmental factors. Most women with vulvodynia have increased tension or spasm of the pelvic floor (the muscles that support the pelvic organs and surround the vaginal opening). 

 

Several different treatment options are available. Physical therapy, medications, dietary modifications, stress and pain management, counselling and exercise are common treatment approaches. 

 

Physical therapy treatment has many aspects, ranging from learning how to control both the contraction and relaxation of the muscles surrounding the vagina, desensitizing the painful areas to touch, the use of vaginal inserts and information regarding dietary modifications. 

 

At Dayan Physiotherapy, we use biofeedback to help women learn how to relax these muscles (the pelvic floor), and if there is pain, what to do to minimize or eliminate the discomfort. In this way, anxiety can be eliminated as women take back control of their vaginas! Information regarding nonpainful sexual activity and the physiology of pain and of the male and female sexual response are also important treatment components. As several different treatment options can be helpful, we can help direct you to other healthcare professionals knowledgeable about this condition. If you already have other supports, we commit to working as part of your team. 

 

Educate yourself. Women often find a holistic, multi-faceted approach to management of vulvar pain works best. Information, support and treatment options are available; the path is individual. At Dayan Physiotherapy, we help you learn about your options and make informed choices. Remember, the problem is in your vagina – not in your head!

Painful Intercourse

Vaginal pain – it’s not in your head! Many women suffer from a common and often misunderstood vaginal pain condition called vulvar vestibulodynia, also know as vulvar vestibulitis syndrome (VVS) or vulvodynia. Pain can be experienced with intercourse or other sexual contact, tampon use, a medical exam, riding a bike, sitting, or wearing tight pants. A study published in the Journal of the American Medical Women’s Association [2003] demonstrated that 16% of the female population experienced vaginal pain at some point in their life. Many women chose not to seek treatment, of those that did, 60% saw 3 or more doctors, many of whom could not diagnose the condition. The study also showed that women who have pain the first time they use a tampon are 7% more likely to have chronic vulvar pain later in life. Considering that vestibulodynia (vestibulitis) is believed to be quite prevalent and is often misdiagnosed, it is important that women are informed about this condition – the causes, treatment and supports – enabling women to make informed decisions regarding their health care.
 

Although pain can be present with or without physical contact, it is often made worse by contact and can vary in intensity and frequency, from very occasional to constant and unrelenting. The type of discomfort can also vary, ranging from mild burning to knife-like pain. Many women experience increased pain at a specific point in their menstrual cycle. Approximately 40% of women also experience simultaneous bladder and bowel conditions and other pain conditions. The onset of pain varies. Some women have had vaginal pain since their first experience of vaginal contact when trying a tampon or intercourse for the first time. Others develop vestibulodynia after many years of painfree vaginal contact.
 

Often misdiagnosed as a yeast infection or psychological issue, the cause of this condition is unknown. Medical examinations and laboratory test results are negative for bacterial and fungal infections and skin conditions. The medical community believes that vestibulodynia, or vestibulitis, may be caused by injury or irritation of the local pain nerves in response to trauma, infection, or sensitivity to environmental factors. Most women with vestibulodynia have increased tension or spasm (vaginismus) of the pelvic floor (the muscles that support the pelvic organs and surround the vaginal opening).
 

Several different treatment options are available. Physical therapy, medications, dietary modifications, stress and pain management, counselling and exercise are common treatment approaches. In some situations, surgery may be an option. Physical therapy treatment has many aspects, ranging from learning how to control both the contraction and relaxation of the muscles surrounding the vagina, desensitizing the painful areas to touch, the use of vaginal inserts and information regarding dietary modifications.
 

At Dayan Physiotherapy, we use biofeedback to help women learn how to relax these muscles (the pelvic floor), and if there is pain, what to do to minimize or eliminate the discomfort. In this way, anxiety can be eliminated as women take back control of their vaginas! Information regarding nonpainful sexual activity and the physiology of pain and of the male and female sexual response are also important treatment components. As several different treatment options can be helpful, we can help direct you to other healthcare professionals knowledgeable about this condition. If you already have other supports, we commit to working as part of your team.
 

Educate yourself. Women often find a holistic, multi-faceted approach to management of vulvar pain works best. Information, support and treatment options are available; the path is individual. At Dayan Physiotherapy, we help you learn about your options and make informed choices. Remember, the problem is in your vagina – not in your head!

Bowel Control - Incontinence

Bowel or fecal incontinence is the involuntary loss of stool or gas. It is not a disease, but a symptom of a physical or neurological problem.
 

Symptoms can include:

 

  • Leaking stool when you sneeze, run, exercise, laugh, cough… (Stress incontinence)
  • Problems getting to the bathroom in time (urgency)
  • Constipation
  • “skid marks” on underwear
  • inability to control passage of gas

 

Correctly performed pelvic floor muscle (Kegel) exercises can help stop this leakage and/or control the urgency. Research shows that based on verbal and written instruction, 75% of women are doing these exercises incorrectly. We do not have the research for men, but our clinical experience shows it to be about the same.

 

Treatment varies depending on the problem. At Dayan Physiotherapy, we use both real-time ultrasound and biofeedback to help you learn how to contract and strengthen your pelvic floor (Kegels). We also help you learn behavioural changes involving diet and toileting patterns to help you regain control of your bowels.

Manual Therapy

Manual Therapy involves hands on physiotherapy that uses a variety of techniques with the aim to restore normal movement to the various tissues of the body, including joints, muscles, fascia and nerves.  All Envision physiotherapists use this in conjunction with postural education, exercise, and movement re-training.

Coccydynia - Tailbone Pain

Tailbone pain, or coccydynia, can make it difficult to sit, lie flat or go from sit to standing. The joint where the tailbone (coccyx) joins the sacrum can become strained leading to both joint problems and problems in the surrounding pelvic floor muscle. We have the clinical knowledge, experience and tools (biofeedback and real-time ultrasound) to fully assess and treat both the joint and surrounding muscles.

Pelvic Dysfunction (sacroiliac joint, pubic symphysis)

      Mechanical dysfunction of the pelvis can result in a few different problems, including SI (sacroliac) joint pain or pubic symphysis pain or separation.  

 

SI joint problems can occur during pregnancy but also can occur during other stages of life and affect both men and women.  Determining what tissues are affected, what biomechanical faults may be contributing to the pain, and determining the root of the problem is the main focus of therapy.  The faults may lie in a combination of poor stability or hypo-mobility (stiffness).

 

During pregnancy and after delivery some women experience pain at their pubic bone or groin. The amount of pain can very, but it can often be excruciating and difficult to manage. Activities that put weight on one leg more than the other, such as climbing stairs, putting on pants while standing, standing on one leg, lifting, getting out of the car or rolling are some of the common concerns. We will do a comprehensive assessment to determine the muscular and joint components of your condition, teach you movement strategies to decrease pain and if needed, can use real-time ultrasound to help determine an individualized treatment program that addresses both your pelvic floor and transversus abdominus (deep abdominal muscles) to help you stabilize your symphysis pubis (pubic bones). If you have not yet delivered your baby, we will review strategies to protect your symphysis during labour and delivery.

Vaginal Pain / Vestibulitis / Vestibulodynia

Vaginal pain – it’s not in your head! Many women suffer from a common and often misunderstood vaginal pain condition called vulvar vestibulodynia, also know as vulvar vestibulitis syndrome (VVS). Pain can be experienced on penetration with intercourse or other sexual contact, tampon use, a medical exam, riding a bike, sitting, or wearing tight pants. A study published in the Journal of the American Medical Women’s Association [2003] demonstrated that 16% of the female population experienced vaginal pain at some point in their life. Many women chose not to seek treatment. Of those that did, 60% saw 3 or more doctors, many of whom could not diagnose the condition. The study also showed that women who have pain the first time they use a tampon are 7% more likely to have chronic vulvar pain later in life. Considering that vestibulodynia (vestibulitis) is believed to be quite prevalent and is often misdiagnosed, it is important that women are informed about this condition – the causes, treatment and supports – enabling women to make informed decisions regarding their health care.
 

Although pain can be present with or without physical contact, it is often exacerbated by contact and can vary in intensity and frequency, from very occasional to constant and unrelenting. The type of discomfort can also vary, ranging from mild burning to knife-like pain. Many women experience increased pain at a specific point in their menstrual cycle. Approximately 40% of women also experience simultaneous bladder and bowel conditions and other pain conditions. The onset of pain varies. Some women have had vaginal pain since their first experience of vaginal contact when trying a tampon or intercourse for the first time. Others develop vestibulodynia after many years of painfree vaginal contact.
 

Often misdiagnosed as a yeast infection or psychological issue, the cause of this condition is unknown. Medical examinations and laboratory test results are negative for bacterial and fungal infections and skin conditions. The medical community believes that vestibulodynia, or vestibulitis, may be caused by injury or irritation of the local pain nerves in response to trauma, infection, or sensitivity to environmental factors. Most women with vestibulodynia have increased tension or spasm of the pelvic floor (the muscles that support the pelvic organs and surround the vaginal opening).
 

Several different treatment options are available. Physical therapy, medications, dietary modifications, stress and pain management, counselling and exercise are common treatment approaches. In some situations, surgery may be an option. Physical therapy treatment has many aspects, ranging from learning how to control both the contraction and relaxation of the muscles surrounding the vagina, desensitizing the painful areas to touch, the use of vaginal inserts and information regarding dietary modifications.
 

At Dayan Physiotherapy, we use biofeedback to help women learn how to relax these muscles (the pelvic floor), and if there is pain, what to do to minimize or eliminate the discomfort. In this way, anxiety can be eliminated as women take back control of their vaginas! Information regarding nonpainful sexual activity and the physiology of pain and of the male and female sexual response are also important treatment components. As several different treatment options can be helpful, we can help direct you to other healthcare professionals knowledgeable about this condition. If you already have other supports, we commit to working as part of your team.
 

Educate yourself. Women often find a holistic, multi-faceted approach to management of vulvar pain works best. Information, support and treatment options are available; the path is individual. At Dayan Physiotherapy, we help you learn about your options and make informed choices. Remember, the problem is in your vagina – not in your head!

Constipation

Irregular, infrequent or difficult elimination of stool that does not have an underlying medical disorder can often be addressed by physiotherapy.

 

Many people with constipation have anismus and are unknowingly contracting their sphincters when they are trying to have a bowel movement. Research shows that based on verbal and written instruction, 75% of women are unable to contract and relax their pelvic floor muscle correctly. We do not have the research for men, but our clinical experience shows it to be about the same.  Biofeedback is a useful tool for both diagnosis and treatment.

 

Treatment may include pelvic floor muscle exercises (Kegels) for both contraction and relaxation of the pelvic floor, biofeedback, real-time ultrasound, and behavioural changes involving diet and toileting

Pudendal Neuralgia

Info coming soon.