PELVIC HEALTH CONDITIONS

Pelvic Health Related Conditions

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Pelvic health and dysfunction can come in many forms.  Please click on one of the conditions/symptoms below to learn more about the topic and how a pelvic floor physiotherapist can help.

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

PELVIC HEALTH PHYSIOTHERAPISTS

Meet our team of pelvic health physiotherapists from both our Vancouver Physiotherapy clinic locations.

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Allison Evers
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Dikla Barer
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Anna Hudon-Kaide
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*Contact us if you have any more questions regarding Pelvic Health Physiotherapy

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.

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.

     

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.

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. 

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!

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.

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.

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.

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!

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.

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.

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!

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 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.

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.