Designed with women of all ages in mind, Shelbourne Physiotherapy's Women's Health program works with you to restore confidence and function for a variety of issues ranging from pregnancy to pelvic dysfunctions. There are many health conditions that are unique to women and the various challenges in their life. The most obvious are the effects of pregnancy and childbirth. Other issues that can affect women in particular relate to the fear and avoidance to exercise due to issues with incontinence.
At Shelbourne Physiotherapy we have highly trained Pelvic Floor Physiotherapists Miriam Haustein, Eimear Brogan, Sarah Hubbs and Laura Werner who are specially trained to help assess and manage these challenges and help get you exercising in a safe and effective way without risking further damage to your pelvic floor.
Some common issues related to Women’s Health include:
•Pelvic instability ante/post natal
•Chronic Pelvic Pain
•Vulvar and Vaginal Pain
•Postural changes post pregnancy
•Coccyx (tailbone) Pain
•Complications due to childbirth, pregnancy
•Breast Cancer and exercise
•Deconditioning during and after childbearing
How to get started?
You start with an initial assessment to determine your needs. From there we help you to get back on track with movement and exercise. Call our main clinic at 250-598-9828 to book an appointment with Miriam Haustein, Laura Werner, Sarah Hubbs, Faraley Vander Schilden and Eimear Brogan. Call our Cook Street Clinic at 250-381-9828 to book an appointment with Osteoporosis Physiotherapist Meena Sran.
Real-time Ultrasound for your Pelvic Floor
At Shelbourne Physiotherapy we can provide you with a consultation using our real time ultrasound unit. This machine can accurately visualise muscles like your pelvic floor, deep abdominals and hip tendons, via pictures taken through a sound head that we place on your abdomen or pelvis (like when you see a baby in the womb). It can allow us to determine if you are able to switch on the muscles when you think you are and also to help provide live feedback to help retrain recruitment if you are not.
Who can benefit from the use of real-time ultrasound?
•Incontinence- both men and women
•Difficulties with understanding the concept of how to switch on the pelvic floor
•Difficulties maintaining a pelvic floor contraction for any length of time without holding your breath
•Hip pain and tendinopath
Different Names for Pelvic Floor Dysfunction
- Chronic pelvic pain
- Chronic pelvic pain syndrome
- Levator ani syndrome
- Prostatitis or chronic prostatitis
- Prostatodynia (prostadynia)
- Non-bacterial (abacterial), prostatitis
- Coccydynia or coccygodynia (tail bone pain)
- Myofascial pain symptoms often associated with Interstitial Cystitis
Women’s Health Matters Treated By our Physiotherapists
From the Canadian Physiotherapy Association
Some chronic health conditions, including breast cancer, pelvic pain and urinary incontinence, are important concerns for women. These conditions can significantly affect a woman’s physical and mental well-being, participation in daily activities, and even her identity as a woman.
Benefits For Specific Conditions Affecting Women
Physiotherapy can offer valuable benefits in chronic health conditions that are predominantly seen in women. Physical training can help women cope with the effects of breast cancer and its treatment. Also, specific therapeutic exercises can noticeably improve pelvic pain and urinary incontinence, whether the symptoms occur secondary to labour and delivery or occur earlier or later in life. Your physiotherapist will assess your problem, discuss your concerns, and develop a treatment plan that can help you return to an active life.
Fatigue, a common side effect of chemotherapy and radiation, can linger even after treatment is finished. An exercise prescription from your physiotherapist can reduce fatigue and improve physical functioning, cardiorespiratory fitness and well-being, even during treatment.(1,2) Specific physiotherapy techniques can also reduce post-mastectomy pain and swelling (lymphedema) and improve lost range of motion and strength that may occur in the arm on the side of the surgery.(3) Your physiotherapist can assess your overall fitness, identify specific problems resulting from surgery and/or radiation, and design an individual program that can support you during treatment and recovery, and help you cope with chronic symptoms that persist after medical recovery.
Chronic Pelvic Pain
Pelvic pain is chronic if it lasts at least six months. Living with chronic pelvic pain is draining, and can interfere with sexual intercourse, good sleep, hygiene and daily functioning. Although no specific cause can be identified in many women, pelvic muscle or nerve inflammation, pelvic muscle spasm, or postural problems affecting pelvic muscles and joints may be implicated.(4) Your physiotherapist can assess your pain and develop an appropriate treatment program. Specific therapeutic exercises can stretch painfully contracted muscles, strengthen weakened muscles, and address postural problems that may be contributing to your pain.(5) Physiotherapy can produce a substantial and lasting reduction in pelvic pain and let you focus on enjoying your life again.(3)
Urinary incontinence (the involuntary leakage of urine) is common in women, affecting up to 30% of women by 65 years of age.(6) It should not, however, be dismissed as a normal sign of aging or long term effect of labour and delivery. In addition to reducing well-being and activity levels, urinary incontinence can cause secondary health problems, such as urinary tract infections and skin ulceration(7), and may lead to reduced fitness, quality of life and depression. Bladder and pelvic floor muscle training are proven treatments for improving symptoms of urinary incontinence, recommended by the International Continence Society as the first line treatment for this condition. Clinical studies have found that targeted exercise therapy can resolve or improve most types of incontinence.(6,7) Age is no barrier in this condition, as women over 75 years of age can also benefit from physiotherapy.(8) If you are experiencing urinary incontinence, talk to your physiotherapist about exercise therapy to eliminate or reduce your symptoms.
1. McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006;175:34–41.
2. Markes M, Brockow T, Resch, KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev2006 Oct 18;(4):CD005001.
3. Gomide LB, Matheus JP, Candido dos Reis FJ. Morbidity after breast cancer treatment and physiotherapeutic performance. Int J Clin Pract 2007;61:972–82.
4. Montenegro ML, Vasconcelos EC, Candido Dos Reis FJ, Nogueira AA, Poli-Neto OB. Physical therapy in the management of women with chronic pelvic pain. Int J Clin Pract , 2008;62:263–9.
5. Hall J, Cleland JA, Palmer JA. The effects of manual physical therapy and therapeutic exercise on peripartum posterior pelvic pain: two case reports. J Man Manip Ther 2005;13:94–102.
6. Shamliyan TA, Kane RL, Wyman J, Wilt TJ. Systematic review: randomized, controlled trials of nonsurgical treatments for urinary incontinence in women. Ann Intern Med 2008;148: 459–73.
7. Dumoulin C, Hay-Smith J. Pelvic floor muscle training versus no treatment for urinary incontinence in women. A Cochrane systematic review. European J Phys Rehabil Med 2008;44:47–63.
8. Perrin L, Dauphinée SW, Corcos J, Hanley JA, Kuchel GA. Pelvic floor muscle training with biofeedback and bladder training in elderly women. A feasibility study. J Wound Ostomy Continence Nurs 2005;32:186–99.
Women's Health Research & Articles
Hodges P W, Kaigle Holm A, Holm S et al 2003 Intervertebral stiffness of the spine is increased by evoked contraction of transversus abdominis and the diaphragm: in vivo porcine studies. Spine 28(23):2594
Hungerford B, Gilleard W, Lee D 2004 Alteration of pelvic bone motion determined in subjects with posterior pelvic pain using skin markers. Clinical Biomechanics (19):456
Hungerford B, Gilleard W, Moran M & Emmerson C, 2007 Evaluation of the reliability of therapists to palpate intra-pelvic motion using the stork test on the support side. J Phys Therapy (87):7 879
Lee D G 2004 The Pelvic Girdle 3rd edn. Elsevier SyntaxError
Lee D G 2007 Clinical Reasoning and Pelvic Girdle Pain: Show me the Patient! In: Proceedings of the 6th World Congress on Low Back and Pelvic Girdle Pain, Barcelona, Spain, p 27
Lee D G, Lee LJ 2004a An Integrated Approach to the Assessment and Treatment of the Lumbopelvic-hip Region â€“ DVD. www.dianelee.ca or www.discoverphysio.ca
Lee DG, Lee LJ 2007 Bridging the Gap: The role of the pelvic floor in musculoskeletal and urogynecological function. Proceedings of the World Physical Therapy Conference, Vancouver, Canada
Lee D G, Lee LJ, McLaughlin L 2008 Stability, continence and breathing - The role of fascia in both function and dysfunction and the potential consequences following pregnancy and delivery. Journal of Bodywork and Movement Therapies 12, 333-348
Mens J M A, Vleeming A, Snijders C J, Stam H J, Ginai A Z 1999 The active straight leg raising test and mobility of the pelvic joints. European Spine 8:468
Ostgaard H C, Andersson GBJ, Karisson K 1991 Prevalence of back pain in pregnancy. Spine 16:49-52
Ostgaard HC, Andersson 1992 Postpartum Low back pain. Spine 17(1):53-55
Pool-Goudzwaard A, Slieker ten Hove M C, Vierhout M E, Mulder P H, Pool J J, Snijders C J et al. 2005 Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. Int Urogynecol J Pelvic Floor Dysfunt 16(6): 468-474
Rath A M, Attali P, Dumas J L, et al 1996 The abdominal linea alba: an anatomo-radiologic and biomechanical study. Surgical Radiologic Anatomy 18:281-288
Richardson C A, Snijders C J, Hides J A, Damen L, Pas M S, Storm J 2002 The relationship between the transversely oriented abdominal muscles, sacroiliac joint mechanics and low back pain. Spine 27(4):399
Smith MD, Russell, A, Hodges PW 2007a Is there a relationship between parity, pregnancy, back pain and incontinence? Int Urogynecol J Pelvic Floor Dysfunction [Epub ahead of print] July 31
Spitznagle TM, Leong FC, van Dillen LR 2007 Prevalence of diastasis recti abdominis in a urogynecological patient population. Int Urogynecology J 18:3
Wu W H, Meijer O G, Uegaki K, Mens J M, Van Dieen J H, Wuisman P I et al 2004 Pregnancy-related pelvic girdle pain (PPP), I: Terminology, clinical presentation, and prevalence. Eur Spine J 13(7):575-589
Smith KB, Basson R, Sadownik LA, Isaacson J, Brotto LA. (2018). Antenatal vulvar pain management, labour management, and postpartum care of women with vulvodynia: A survey of physicians and midwives. Journal of Obstetrics and Gynaecology of Canada. 40(5):579-587. doi: 10.1016/j.jogc.2017.09.014.
Sadownik LA, Yong PJ, Smith KB (2018). Systematic review of treatment outcome measures for vulvodynia. Journal of lower genital tract disease. 22(3):251-259. doi: 10.1097/LGT.0000000000000406.
Sadownik, L. A., Smith, K. B., Hui, A., & Brotto, L. A. (2016). The impact of a woman’s dyspareunia and its treatment on her intimate partner: A qualitative analysis. Journal of Sex & Marital Therapy.
Smith KB, Sadownik LA, Basson R, Isaacson J, Brotto LA. (2016) Clinicians’ Perspectives and Experiences Regarding Maternity Care in Women With Vulvodynia.
J Obstet Gynaecol Can. 2016 Sep;38(9):811-819. doi: 10.1016/j.jogc.2016.04.008.
Lester, R. A., Brotto, L. A., Sadownik, L. A. (2015). Provoked vestibulodynia and the health care implications of comorbid pain conditions. Journal of Obstetrics & Gynaecology Canada, 37(11), 995-1005.
Yong, P., Sadownik, L. A. & Brotto, L. A. (2015). Concurrent deep-superficial dyspareunia: prevalence, associations, and outcomes in a multidisciplinary vulvodynia program. Journal of Sexual Medicine, 1, 219-227.
Brotto, L. A., Yong, P., Smith, K. B. & Sadownik, L. A. (2015). Impact of a multidisciplinary vulvodynia program on sexual functioning and dyspareunia. Journal of Sexual Medicine, 12(1), 238-247.
Sadownik, L. A. (2014). Etiology, diagnosis, and clinical management of vulvodynia. International Journal of Women’s Health, 6, 437–449. http://doi.org/10.2147/IJWH.S37660
Brotto, L. A., Sadownik, L., Thomson, S., Dayan, M., Smith, K. B., Seal, B. N., Moses, M., & Zhang, A. (2014). A comparison of demographic and psychosexual characteristics of women with primary versus secondary provoked vestibulodynia. Clinical Journal of Pain, 30(5), 428-435.
Sadownik, L. A., Seal, B. N., & Brotto, L. A. (2012). Provoked Vestibulodynia—Women’s experience of participating in a Multidisciplinary Vulvodynia Program. Journal of Sexual Medicine. 9, 1086–1093.
Sadownik, L. A., Seal, B. N., & Brotto, L. A. (2012). Provoked Vestibulodynia: A qualitative exploration of women’s experiences. BC Medical Journal, 54, 22-28.