Frequently Asked Questions

The Bloom Team answers your frequently asked questions about what to expect at your first pelvic floor physiotherapy appointment! 

What can be expected at your first visit?

At your first visit, you can expect a thorough health history.  Each concern you have will be addressed. A physical exam will be conducted including a postural and movement exam as well as a gentle abdominal examination. If you are comfortable, an internal evaluation will be completed. For all clients it is recommended to bring shorts and a loose fitting top to allow for ease of assessment and movement during treatment.

Following the assessment, the findings of the exam will be discussed. You will be provided with a home exercise program and a treatment plan will be created.

How long does the assessment take?

Each initial visit is scheduled for 60 minutes as there is a lot of cover. There will be ample time to answer all questions and address all concerns you may have.

What if I need to cancel my appointment?

It is understandable that some appointments may need to be rescheduled or cancelled. However, we ask that you provide 1 business day notice by phone to cancel or reschedule any appointments as we set aside significant time for your treatment and care, and without prior notice any missed appointment time cannot be filled by other patients. Patients who do not provide 1 business days notice will be charged their full treatment fee.

What does the internal exam entail?

A physiotherapy pelvic exam is more detailed (and gentle) than a medical one. It will include an observation of the external anatomy to identify any imbalances, irritation, scarring or connective tissue dysfunction. Sensation and reflexes will be tested to ensure proper neurological function. 

A manual internal (vaginal and/or ano-rectal) assessment will identify imbalances, scarring or connective tissue issues, and muscle tension, strength, and coordination. Lastly, internal organs will be manually assessed to determine proper positioning and mobility. Our PTs will guide you through the process instructing you to perform certain movements and will let you know what they are doing at all times. If you are not comfortable with an internal evaluation, we will work around this to design a treatment plan that is right for you. 

My doctor already did a pelvic exam. Why do I need to have another one?

While doctors complete pelvic exams regularly, they are not the same as the ones carried out by Pelvic Floor Physiotherapists. While some medical doctors may prescribe pelvic floor physiotherapy, they only assess for life threatening issues (e.g. infection, malignancy, etc. ) and identify areas where medicine or surgery may be the best course of action. Alternatively, pelvic floor physiotherapists assess for visible infection/irritation, bony alignment and mobility, muscle tension, strength, and coordination, pelvic organ positioning and mobility, and scar tissue adhesions.

This will allow your therapist to observe how your body is functioning in all aspects which provides the basis of your diagnosis, treatment plan, and overall care. Without it we would be missing crucial information which would only give you very limited results.

What is pelvic floor physiotherapy?

Pelvic floor physiotherapy is an orthopedic specialization in physiotherapy which requires post-graduate training. It is the urogenital, urogynecological, obstetrical/gynecological equivalent in physiotherapy as it treats conditions of the pelvic basin, for both men and women, including urinary or fecal frequency, urgency, and or incontinence, pelvic organ prolapse, pelvic pain including coccyx pain, pubic bone separation and pain, pain with intercourse, Cesarean section or episiotomy scarring and pain, ano-rectal dysfunction like chronic constipation, pain with elimination, and chronic non-bacterial prostatitis. The pelvic floor can also be very interrelated to other conditions including low back pain, sacroiliac joint pain, hip and lower limb issues, as well as head, neck, and jaw dysfunction.

Treatment employs a combination of education, positioning, strength, coordination, and functional exercises (many different types beyond typical Kegels), stretching, myofascial release, manual therapy, pelvic alignment, and visualization via biofeedback. Pelvic floor physiotherapists will use a combination of these techniques and will treat both internally (vaginal, ano-rectal) and externally.

I’m on my cycle. Can I still come in for a pelvic floor assessment or treatment?

Yes, you can still receive an internal pelvic assessment or treatment while menstruating. Proper hygienic protocols are used and being on your cycle does not interfere with assessment or treatment.

Can I receive pelvic floor physio while I am pregnant?

Yes. Pelvic floor physiotherapy has been shown to be very helpful during pregnancy to help limit and remove pelvic girdle, pubic bone, groin, coccyx and low back pain, as well as aiding to open the pelvic floor and prepare it for labour and delivery, limiting the possibility of tearing or the need for an episiotomy.

There are no risks to the mother or baby with an internal pelvic assessment or treatment with a healthy and normal pregnancy. If however you are a high risk pregnancy and have been placed under medical precautions such as abstaining from intercourse, bed rest, etc. then an internal pelvic floor assessment or treatment would not be advisable. However, you would be at no risk of receiving general physiotherapy externally.

How soon can I receive pelvic floor physio postpartum?
As soon as possible is best, but depending on your concerns as well as the type of birth (vaginal vs Caesarian) a few weeks wait after birth may be necessary to allow for healing in areas needing treatment. If a Caesarian was performed, you may want to wait until the incision has healed (approx 4-6 weeks) before having abdominal or scar work done. If you had an episiotomy, again you may want to wait a few weeks to allow for incision healing before having internal pelvic floor work done. But, if pain is significant, it is wiser to be treated immediately as there are numerous things that can be helped without disturbing incision sites to ease pain and return to function.

How can physiotherapy help fertility issues?

While hormone imbalances, reproductive cell (sperm, ovum) dysfunction, or other medical conditions are outside the scope of physiotherapy, structural issues such as abnormal inflammatory responses, adhesions, cysts, and poor cervial/ uterine alignment and circulation can all be treated manually.

The reproductive organs, as with all tissue in the body, are supported, enveloped, and infiltrated by connective tissue (aka fascia). Working directly on this tissue can help to improve conception and carrying to term. Learn more in the published scientific article by Wurn and colleagues (2008): “Treating Fallopian Tube Occlusion with Manual Pelvic Physical Therapy.”

Do I need a physicians referral?

No physician’s referral is needed to access physiotherapy care.

However, some private insurance companies require a physician’s referral to be compensated for treatment. Please check with your private insurer for their requirements.

Is pelvic floor physiotherapy covered by OHIP or private insurance?

Unfortunately pelvic floor physiotherapy is not covered under OHIP (Ontario government). However, if you have private insurance, pelvic floor physiotherapy is covered by extended health benefits, it falls under your physiotherapy benefit.

How many treatments will be required?

Everyone will respond to treatment differently. We will typically have follow up visits every 2-4 weeks, ranging from 30, 45, or 60 minutes depending on the complexity of the condition(s). Typical number of treatments varies between 4 and 12. This will be discussed with you at your first visit following the assessment.

I am making a motor vehicle accident claim. What do I need to do?

It is important to come in as soon after a car accident as possible, even if you are not feeling any symptoms. It is very common for symptoms to show up a few days to weeks after an accident and research shows improved outcomes and less chance for long term issues with those who received early intervention and treatment.

Once you have called and reported the accident to your insurance company, you can call the clinic to book your assessment. Make sure to let the reception staff know it will be for a car insurance claim so they can make sure you bring the appropriate paperwork from your insurance provider. We no longer deal directly with your insurance, so you are expected to pay at each visit. 

I am making a workplace injury (WSIB) claim. What do I need to do?

Unfortunately, we do not provide services for WSIB insurance claims. There are, however, many reputable physiotherapy, massage therapy, and alternative healthcare practitioners who do.