Why We Do What We Do
We believe that a woman is meant to be healthy, functional, strong, and mobile before conceiving, during pregnancy, and all the way through to her wisdom years. Although our bodies are incredibly designed to bring forth life, pregnancy, postpartum, or the peri-menopause stage can greatly impact how our bodies feel, how they move, and how they work.
Often women believe the myth that these changes are normal, or they have to “just live with it”, or that in time it will heal itself. This couldn’t be further from the truth!
We are here to help you experience what it means to live in a body that works well for you. At your initial consultation, we seek to understand what is meaningful to you. We listen, we complete a physical assessment, and we then propose a roadmap that is designed to help you meet your goals.
Be confident, capable, and content in your body.
What We Treat
Incontinence is the uncontrolled loss of urine, gas or stool in any amount. Urinary incontinence may occur due to to activities that increase pressures in the abdominal canister and on the bladder – such as running, coughing, jumping, lifting or laughing. This is called stress urinary incontinence and is the most common form of incontinence we see.
Incontinence may also result from a strong and sudden urge to void. If that strong urge cannot be controlled, then leakage occurs which is termed urge urinary incontinence. Other types of incontinence exist as well: mixed incontinence, overflow incontinence, functional incontinence or total incontinence.
Although urinary incontinence may be common, it is not normal and can be effectively treated by pelvic physiotherapy.
Faecal incontinence can range from staining to complete loss of bowel control. It can occur following damage to the anal sphincter muscles which are a part of the pelvic floor. This can occur with 3rd or 4th degree tearing following childbirth or sometimes due to other factors.
Want to know more? Read more about incontinence in this informative article.
This category includes problems such as voiding frequency, voiding hesitancy, pain or burning with urination, a sensation of incomplete emptying, frequent night-time voiding, recurrent UTIs, or pain in the bladder. Bowel and gut dysfunction can include chronic constipation, hemorrhoids, IBS, or defecation dyssynergia (when the anal sphincter contracts instead of relaxes during attempted bowel movement – also known as anismus).
Many of these challenges are require a multifactoral approach for successful treatment. It is very important to evaluate the pelvic system and to also consider how other systems, such as the nervous system, myofascial, or visceral systems, contribute to woman’s presentation.
One of the most common bladder conditions is known as overactive bladder or OAB. Read more about urinary urgency and frequency and how you can regain control.
Pelvic organ prolapse (POP) occurs when there is a shift in the optimal position of the pelvic organs (uterus, rectum, bladder, urethera). Fascia and ligaments that suspend the organs in place may become lax, suddenly torn, or lose integrity over time. This causes the pelvic organs to lose suspensory support from above. If the pelvic floor muscles are also compromised or weak, it can result in lack of pelvic support from below.
These factors, coupled with poorly managed pressures in the abdominal canister result in a downward descent of the pelvic organs. They will lean into the vaginal walls which will then descend towards the vaginal entrance and possibly bulge or protrude.
POP is a condition which can be effectively managed with strategies taught by a pelvic health physiotherapist. It is a subjective experience which may or may not be accompanied by any symptoms. For women who are symptomatic and who are bothered by their prolapse, it is very possible to become completely symptom free and lead an active lifestyle, even if the prolapse itself does not disappear.
Return to a pain free life is possible! To heal from pain, physiotherapy treatment focuses on the body’s tissues and also importantly, on the central nervous system/brain since it is ultimately responsible for modulating the pain experience. Persistent pain in the pelvic region is pain that has been present for over 3 months. Official diagnoses or terms include:
- dyspareunia (painful intercourse)
- vaginismus (involuntary spasm of pelvic floor muscles with penetration attempts)
- vulvodynia (generalized pain in the vulvar region)
- vestibulodynia (specific pain in the vestibule region of the vulva – also known as vulvar vestibulitis)
- clitroidynia (pain in the clitoral region)
- coccydynia (pain in coccyx or tailbone)
- endometriosis (pain caused by inflamed endometrial tissue outside of the uterus)
- painful bladder syndrome (hypersensitivity and inflammation of the lining of the bladder wall – similar presentation to interstitial cystitis)
- levator ani syndrome or proctalgia fugax (tension or spasm in one major group of muscles that make up the pelvic floor)
- pudendal neuralgia or pudendal nerve entrapment (irritation or compression of a major nerve supplying the pelvic floor muscles)
- persistent genital arousal disorder (unwanted and painful arousal of the genitals triggered by sexual or non sexual stimuli)
- other types of pain due to hormonal changes, menopause, abdominal or pelvic surgery, internal scar tissue, gut or bladder dysfunction, pelvic girdle pain, hip labral tears, myofascial or connective tissue dysfunction, trauma, or hypertonicity of pelvic floor muscles
Regardless of the location or nature of the pain, a bio-psycho-social approach is necessary for the effective treatment and ultimate elimination of pain. We focus on the whole person, not just one part. When our clients buy into a more holistic model of care (body, heart, mind, spirit), we have great success in helping them have a completely different experience with persistent pain – one where they ultimately overcome the problem of pain and return to a healthy and active lifestyle.
You may be interested in reading:
- Your Pelvis Is a House – A blog about the effects of pain, threat, and trauma on the pelvic floor and entire nervous system.
Diastasis Rectus Abdominis (DRA) is technically defined as a separation of the rectus abdominis (6 pack) muscle. However, the most current research indicates that a DRA is less about a separation (or gap) and more about the integrity of the connective tissue that lies at the midline of the abdominal wall.
This tissue is called the linea alba and it should have a certain amount of tension to it. It should be able to transmit forces from our upper body to our lower body and across our abdomen. It helps to counteract pressures generated in the abdominal cavity.
Imagine a suspension bridge strung across a deep canyon. This is the linea alba. In order to walk across the bridge, it will need to have a certain amount of tension so you can safely transfer your weight from one end to the other. If the bridge is super lax and droopy, you will not feel safe walking across! So the problem is not the canyon itself at that point, but rather the integrity of the suspension bridge and ability to do it’s job.
During pregnancy the abdominal wall expands, the rectus muscles move apart to make room for the baby, and the linea alba softens, stretches, and gets thinned out. These adaptations are normal. However, for a variety of reasons in some people, the linea alba does not return to its usual state after pregnancy is over. The tissue remains lax and may be unable to generate tension. This decrease in abdominal wall integrity, coupled with non-optimal alignment and inability to manage intra-abdominal pressures, can compromise the entire function of the inner core unit. Issues may “show up” anywhere in the body – with aches and injuries, pelvic health challenges, altered movement patterns, decreased athletic performance, or with a distended “looking-pregnent-but-not-actually-pregnant” belly (which is a common complaint among postpartum moms who have DRA).
The inner core unit is comprised of four main muscle groups that work synergistically: the transversus abdominis, the diaphragm, the multifidus, and the pelvic floor. These muscles turn on in advance of movement to provide a stable and controlled platform for movement. Correct core training involves engaging all these muscles in the right sequence, to the right degree, and in anticipation of movement.
Hormonal changes that take place around menopause can have a significant impact on pelvic health. Woman may find themselves facing changes in vaginal tissue appearance or texture, and changes to bladder/bowel health. Pelvic pain or pelvic organ prolapse may seemingly arise out of no-where and high-risk surgeries, such as hysterectomy or a sling procedure may suddenly be on the table.
At this stage in life, many women are motivated to seek pelvic floor physiotherapy for three reasons: 1) They finally have time to care for themselves. 2) They want to avoid surgical procedures and are very open to alternative solutions. And 3) They want to remain active as they age, without having to constantly be worried about their bladder, bowel, or pelvic function.
The beautiful thing about our bodies is that they are adaptable. It’s never too late to start improving one’s pelvic health. Even though we are called “The Mama’s Physio”, we LOVE working with older women and a large part of our practice is made up of women in the peri-menopausal stage of life. It’s amazing to see how quickly changes can take place once women connect to their inner system and get some proper training.
Abdominal or pelvic surgery may be necessary or it may be elective. It includes surgery to address incontinence, pelvic organ prolapse, or removal of cysts, fibroids, other growths, or adhesions. It may be an endometrial ablation or to surgically repair a diastasis recti.
Interestingly, hysterectomy is one of the top 5 performed surgeries in Ontario (C-sections being number 1). When it comes to irreversible procedures, the risks, benefits, alternatives, success and failure rates, and general outcomes of surgery must be carefully evaluated before making the decision. If you are considering surgery to correct a pelvic floor problem, please be sure you are well informed. Sometimes it is not the quick fix many women imagine it will be and they may experience new and unwanted health pelvic symptoms following a procedure.
Pelvic floor physiotherapy treatment prior to surgery may help to delay or even prevent surgery all together. Just as in any other situation (such as an ACL repair or knee replacement) going into pelvic surgery with as robust of a system as possible will lead to better post-surgical outcomes. Pre-operative physiotherapy is therefore recommended to maximize the state of the pelvic region prior to surgery. Post-operative physio is equally important for regaining optimal function, mobilizing scar tissue, learning practical strategies for maintenance, and to ideally prevent the need for future repeat surgeries.
The pelvic girdle consists of 3 joints – the left sacro-iliac joint, the right sacro-iliac joint and the pubic symphysis. Imbalances or asymmetry of the bony pelvis (usually due to imbalanced muscular forces or tensions) can lead to pain at one, two or all three joints. Generally speaking, this is called pelvic girdle pain. It can be experienced during pregnancy, after childbirth or following an injury. While biomechanical factors are important to consider, there is another even more significant driver for pelvic girdle pain and that is the central nervous system.
It is important to understand all the elements contributing to PGP so that treatment is effective. Often tension in the system needs to be addressed and let go of before any attempt to add “more stability” to the system, be that in the form of “core stability exercises” or some sort of compression belt.
Your physiotherapist will carefully examine all the factors affecting YOUR specific body, and she will then teach you strategies to help you move better and manage limiting pelvic girdle pain.
The pelvic girdle, pelvic floor, uterine muscle, and inner core are all intimately involved with childbirth. The pelvis is baby’s first cradle and it’s orientation during pregnancy and childbirth can impact outcomes during labour and delivery. We teach exercises and strategies to help mom create more space and help baby position optimally for birth.
The job of the pelvic floor is to gently yield and open during labour. Therefore a flexible and compliant pelvic floor, along with a strong one, is ideal. Because many pelvic health conditions (such as incontinence, prolapse, or diastasis recti) can result from pregnancy and childbirth, prevention of dysfunction is a huge goal of pelvic floor physiotherapy prenatally. The ultimate goal is to decrease excessive strain and manage pressures on the pelvic floor during labour and delivery. Minimizing perineal tears and preventing pelvic floor avulsions is also a key focus of prenatal physiotherapy.
We offer a unique prenatal classes for women that focuses on preparing the pelvic floor for childbirth and postpartum recovery. If you’re pregnant, especially for the first time, this is not to be missed!
A caesarean section is major abdominal surgery that can take additional time to recover from postpartum. Returning to normal mobility and strength, restoring optimal abdominal wall function, promoting a well healed and mobile scar, optimizing the health of the deeper layers of connective tissue, normalizing sensation in the lower abdominal wall – these are some of the goals of physiotherapy post c-section.
Changes to the abdominal canister, increases in maternal weight, shifts in the centre of gravity, increased volume of blood – these are just a few factors that can cause muscular aches and pains during pregnancy as the body tries to find a new way of orientating itself against gravity.
Upper or lower back pain, sciatica, restless legs, varicose veins, increased pelvic pressure, vulvar varicosities, pain in the tailbone, groin, hip or pubic pain, changes to walking pattern, general feeling of muscle fatigue – these challenges can all occur during pregnancy.
It is important to get any musculoskeletal dysfunction treated so that the body does not continue to adopt an unhelpful pattern of alignment and movement. Often compensatory patterns that are present during pregnancy continue postpartum and into later years. Working with our physiotherapists can help women become more aware of holding patterns that are potentially aggravating a condition, and ultimately resolve it.
Breastfeeding is something many women want to do and that some women truly struggle with. We highly recommend working with a lactation consultation both pre and postnatally to help support you during your breastfeeding journey. If you experience blocked milk ducts, we offer therapeutic ultrasound treatment as a highly effective strategy to quickly unclog ducts, abolish pain, and re-establish a positive breastfeeding experience.
Articles you may find interesting:
Men, women, and children can have pelvic floor dysfunction. Unfortunately children’s pelvic health challenges are often dismissed as part of being a child. However, if left untreated, poor childhood bowel and bladder habits can persist into adulthood and impact the ability to function normally. When parents do pay attention to symptoms, they may feel frustrated, unsure of how to assist their child, or inadvertently convey unhelpful messages and attitudes to their children. Children can suffer embarrassment and feel defeated or inadequate. Their pelvic floor problems can greatly impact social interactions.
Pelvic Health Physiotherapy for children helps families (both the parents and kids) to overcome all the physical and emotional challenges that accompany various conditions such as:
- Day time leaking due to sneezing, laughing, giggling, or holding pee in too long
- Urinary frequency or urgency
- Night time bedwetting (Enuresis)
- Constipation or stool retention
- Fecal incontinence
- Under-active bladder or urinary retention
- Painful bowel or bladder movements
- Pain in the perineal or rectal region
- Non-optimal toileting habits and behaviours
Find out more about our approach to treating the paediatric pelvic floor – and discover if this could be exactly what your child needs to become more capable and confident in his or her body.
Who We Are
It’s rare to find a workplace where everyone loves being present and gels so well together. Not only are we passionate about our work, we also have over 50 years of combined experience to provide you with the best care. We work with our heads, hearts and hands. We love what we do and we’re here to serve you.
Fun fact: collectively we have lived in or visited multiple countries on every continent (except Antarctica). We speak English, French, Spanish, Hindi, and a few other languages!
If you are looking to join an incredible team where you make a difference, see our careers page for current opportunities.
Did you know that in France it is standard protocol for every woman who has had a baby to have up to 20 visits from a pelvic health physiotherapist? And it’s covered by their government! Why? Because they value the health and well being of their families! While there is sadly much less support here in Canada, YOU can be the one to value yourself and invest in your own health both now and for the future. Every woman, whether young, expecting, an experience mother, or seasoned lady will benefit from working with our team at The Mama’s Physio.
The goal is to optimize your pelvic or maternal health by equipping you with knowledge that can make a world of difference. Preventing pelvic dysfunction is much easier when you know what to do and how to do it, and simply getting checked can save you a lot of future heartache.
Pelvic health physiotherapists are trained to assess and treat the pelvic floor as it works syngeristically with the rest of your system. We have the unique skills to assess and treat areas that other health providers may miss or are outside of their scope of practice.
Unfortunately, kegels is what many people think of when they hear the words “pelvic floor”. But it’s so much more than that. It is about training the entire core (the pelvic floor is just one part of it) and integrating its function into your daily life activities. It’s about whole body alignment, and connecting to your various systems which all play off each other. It’s about optimization of the neural and myofascial systems, about mobility, endurance, strength, efficiency, breathing, re-learning optimal movement patterns, motor control and coordination. It’s about the brain-body dynamic and looking at the bigger picture of YOU. It’s about finding the driver for dysfunction (which may not be the pelvic floor muscles), eliminating pain, and being comfortable, confident and in control of one’s body…
Basically, we don’t believe in a cookie cutter approach for every woman. Instead we carefully listen, asses, evaluate, and then together, we act to help you attain your goals.
You will be sent a welcome email prior to the first visit. That email will contain all the information you will need to prepare.
The first visit is the initial consultation which typically lasts around 75 minutes and takes place in a comfortable and private office with closed doors. You share your story, let us know your goals, and then we complete a physical assessment.
The physical assessment may focus on a number of different areas depending on what your concerns are. We may evaluate alignment, functional movement patterns, breathing, your abdominal wall, orthopaedic tests, lumbar-pelvic balance, your central nervous system, pressure system, or something else that’s an important feature in your story. Also, the physical assessment may include an internal pelvic floor muscle evaluation, with your consent. Time permitting, we aim to give you one or two treatment strategies to get started on.
After completing the physical portion of the consultation, we share our findings, answers any questions, and outline a plan of care. If it all sounds good to you and you’re ready to proceed, then you’ll book out your all of your treatment sessions so it’s in your calendar. We find that our clients better when they are committed, are consistent, and have accountability.
Follow up sessions are typically booked for 45 or 30 minutes. They may also be booked for 60 minutes especially if you’re coming from out of town. Treatment sessions may focus on: education, mind-body awareness, optimizing your alignment and biomechanics, improving flexibility and mobility, increasing endurance and functional strength, training your pelvic floor and core, bladder and bowel (and brain) re-training, manual therapy techniques, breath training, learning to tune into and relax your body, lifestyle evaluation, pain management strategies, acupuncture or dry needling, pressure management, and more.
Certain tools, products, books, or other services (for example, naturopathic medicine or counselling) may be recommended to you as well. You will be provided with a home program to practice and integrate what you learn into your daily life. The goal is to keep it practical because women are busy people! We encourage and expect you to take ownership of your program and your overall health, because it really is the key to long-term success.
You are welcome to bring a trusted person to any appointment with you.
No, you do not. However, if you plan on using your extended health benefits, your insurance company may need to see a referral for physiotherapy from a physician in order for you to be reimbursed. You should call your insurance company to find out.
Yes, absolutely! Issues caused by one or more pregnancies, childbirth, chronically poor ways of moving or menopause often don’t get better on their own. They typically get worse or can manifest later in life. It’s never too late to get checked and we urge you to do so.
If you have never gone through pregnancy or childbirth yet you find yourself facing various health issues related to pelvic health, such as diastasis recti, incontinence, prolapse, vaginismus or other types of pelvic pain, please do not hesitate to contact us. We work with women in all stages of life and are here to serve you.
We really like to be thorough on the first visit – so our recommended consultation block is 75 minutes and that typically includes a pelvic health evaluation. It costs $160 and at this visit, we aim to give you some strategies to get started right away. We also offer a slightly shorter consultation block of 60 minutes at the rate of $135. Other fees vary based on length of time you spend with your therapist or the workshop you are interested in. Please contact us for more details.
Most private insurance companies provide coverage for physiotherapy. Since pelvic physiotherapy is under the umbrella of physiotherapy, coverage should be no problem. If in any doubt, please call your insurance company. You may also be able to claim physiotherapy treatment as part of your medical expenses on your year end tax return. Speak with an accountant to verify if it applies to you.
No, we are not currently set up to bill directly. However, you will be provided with a receipt for services after payment has been made. You can then send that receipt to your insurance company. It will have all the information they require to process your claim. We unfortunately cannot accept OHIP because our office is not an OHIP funded physiotherapy clinic. To find out more about OHIP funded physiotherapy clinics in our area, please click here.
Internal examination is the gold standard to properly assess the status and function of the pelvic floor. Pelvic floor physiotherapists are specially trained to assess muscle tone, spasm, strength, structure, function, position, compliance, tissue quality, and more by using manual assessment skills. By completing an internal pelvic exam, we gain a wealth of information which we would otherwise have to guess at.
If you provide your informed consent for a pelvic examination, you will be asked to lie down on a physiotherapy table and you will be draped comfortably with a sheet. The process will be explained step by step using an anatomical pelvis model as a visual.
The internal examination is a gentle and clean technique (using non-latex gloves) and does not involve a speculum or stirrups. One or two gloved fingers are inserted into the vaginal canal, or one finger is inserted into the rectum in order to access the pelvic floor muscles. We walk you through each component of the internal examination so you understand what we are assessing for and can also offer us feedback.
It is very important that you feel comfortable and in control at all times. Please know that you can revoke your consent to an internal examination at any time and for any reason – no questions asked.
Some women prefer to defer the internal examination until a future appointment and that is completely fine with us as well.
Yes. Your period is no reason to cancel! We simply work on external strategies at that session (which are just as important, if not more so, than internal strategies).
Your children are most certainly welcome. We love little people! We have a room full of toys for them and our receptionist and student volunteers are are great at cuddling babies. You’re also welcome to bring a friend along who can watch your baby while you are in with your therapist.
If your little one comes into the session with you, we suggest that you have something that will keep him or her occupied and happy so that you can focus on you and get the most from your time with The Mama’s Physio. If you need to attend to a fussing baby, feel free to do so! (We are breastfeeding friendly). However we are unfortunately unable to extend the length of your visit as other clients are booked in and we need to respect their time.
This question is asked often! A passion for women’s health and advocacy was born when the owner of The Mama’s Physio, Ibukun Afolabi, was a physiotherapy student completing an international rotation at this hospital back in 2006. The experience planted a seed which ultimately grew into The Mama’s Physio! Each of our therapists have a different story that led her down this path – so feel free to ask when you meet your physio in person. She would love to share!