All You Need to Know

Frequently Asked Questions

What should I expect on my first pelvic floor therapy visit?

Prior to your visit you will be asked to fill out paperwork which allows us to get to know you better. On your initial visit the therapist will take time to listen to your story and review your history. She will begin an objective exam to look at your breathing, posture, low back, sacroiliac and hip joints as well as general mobility to determine if these are contributing to your issue. An internal assessment may be done on the first visit or may be postponed until the second visit. An explanation of the exam and consent are obtained before this happens. Education is a constant throughout all sessions and a treatment plan will be discussed to determine what works best for you. You are encouraged to ask questions throughout and if at anytime you are not comfortable there is no pressure to continue.

What is a pelvic floor internal exam and do I have to have one?

The pelvic floor is a group of muscles that run from your pubic bone to your tailbone. Just like any other muscle in the body the best way to assess them is through palpation (feeling the muscle).

An internal exam consists of digital palpation (1 or 2 fingers) of these muscles, through the vagina and/or the rectum, that allows us to get a better idea of what is happening with these muscles. To best help you, it is vital that we perform a detailed assessment of the perineum and pelvic floor movement, strength and tension.

If you aren't comfortable with an internal exam, that's okay. We can still help. Alternative options can be discussed with your therapist.

How should I prepare for my pelvic floor therapy appointment?

Dress in comfortable clothing that you can easily move in and get ready to discover more about how your body works.

Prior to your appointment, questionnaires will be sent via email. It is best to have online paperwork filled out prior to your appointment.

What kind of pelvic floor treatments can I expect?

Education - Education is vital in all sessions to help you understand what is happening with your body. Discussion on how the pelvic floor works and how it contributes to bladder and bowel function, importance of breathing and posture are just a few examples.

Manual therapy - The use of hands-on techniques to help stretch, release and mobilize soft tissue of the pelvic floor or surrounding muscles.

Exercise - Clients will always be recommended some form of exercise specific to their issue. These can include breathing, strengthening and stretching exercises, specifically directed at the pelvic floor or surrounding muscles as well as general exercise like walking, strength training or yoga to help manage symptoms.

Retraining the brain and nervous system - A sensitive nervous system is often a large contributor to pelvic floor issues. Treatments to target the nervous system include breathing techniques, meditation, relaxation strategies and specific exercise program.

Acupuncture -A treatment technique using fine needles can help to alleviate pain and improve function in the pelvic floor and other orthopedic conditions.

Is a pelvic floor internal exam safe while pregnant?

Yes, an internal exam is safe to have done during pregnancy as long as you have no precautions/restrictions from your doctor. If you are cleared for intercourse, an internal exam is safe for you and your baby. That being said, we tend to avoid exams during the first trimester out of an abundance of caution. If you have any concerns, please speak to your doctor or midwife prior to your appointment.

Should I cancel my pelvic floor appointment if I am on my period?

It always comes at the most inconvenient times! But that's okay, menstruation does not affect pelvic floor treatment and it may decrease the discomfort you feel during your period (bonus!). If you are not comfortable having an internal treatment done at this time, let us know and we can discuss other treatment options.

Can't I just do Kegels at home?

Well, you could...but the trouble is often the pelvic floor muscles are already overactive, which means the muscles are short and tight and Kegels could make your symptoms worse.

It has also been shown that simple instruction (or reading off the internet) is not adequate training for a Kegel program (Bump et all, 1991). The 2008 clinical guidelines published by the Society of Obstetricians and Gynecologists of Canada recommends that "proper performance of Kegel exercises should be confirmed by digital internal exam or biofeedback".

What should I expect with the Freedom+ Kegel Chair?

For this treatment you will sit fully-clothed on the Vitality Plus Seat.

We will set the machine to a setting that is right for you.

For 30 minutes you will experience waves of muscle contractions that feel like mild tingling.

You will need to wear comfortable clothing and remove all jewelry, belts, wallet and coins from your pockets.

Cell phone use is not permitted around the machine so bring a book or magazine and enjoy a peaceful 30 minute break from technology.

Is it safe for me to use the chair?

This modality is not right for everyone. It is contraindicated to use the chair if you have any of the following:

Pacemaker
Defibrilator
Electronic implants
Metal plates (anywhere)
A total hip replacement
Copper IUD (plastic is okay)
Malignant tumor
Graves’ disease (an autoimmune disorder that causes an overactive thyroid) or active bleeding disorder
While pregnant or lactating

What is functional magnetic stimulation (FMS)?

Functional magnetic stimulation produces a high intensity electromagnetic field. This induces an electric current that depolarizes neuron's resulting in concentric contractions.

This directly modifies the muscle structure, inducing a more efficient growth of myofibrils (hypertrophy), the creation of new protein strands and muscle fibres (hyperplasia).

It simultaneously stimulates type one slow twitch and type two fast twitch muscle fibres enhancing both muscle strength and functional endurance.

How does FMS work?

Functional magnetic stimulation treatments result in:

Muscle Strengthening through 28,000 supramaximal contractions each session creating muscle hypertrophy.

Neuromodulation by stimulating the sensory, pudendal and autonomic nerves to improve neural communication and coordination of the pelvic floor muscles.

Circulation with repeated contractions improve blood flow to the tissues to help reduce inflammation and support healing .

Myofascial relaxation is produced with low intensity setting helps to improve blood flow and relax tight muscles to help reduce tension and discomfort.

What are the side effects?

The side effects may include, but are not limited to:

Muscular pain,
Temporary muscle spasm,
Temporary joint or tendon pain,

Temporary redness or stiffness or irritation at the treatment area which usually dissipates within hours of the treatment.

Why do I need to have an initial assessment?

It is important to have an initial assessment with the physiotherapist in order to determine if this treatment is appropriate for you, as well as determine other factors that may be contributing to the pelvic floor dysfunction, and to provide you with a home program to make sure you are getting all the benefits of this treatment.

This assessment may include an internal exam but may not be necessary. This will be determined by the client and therapist together.

Why do I need the follow-up visit?

The final visit allows for you and your therapist to follow-up on goals that were discussed at the first meeting as well as determine a maintenance plan that works best for you. If you are able to continue a home program on your own you will see improved and longer lasting results.

How often do I come and what if I miss a session?

The general protocol is 6 sessions about 4-5 days apart. This means two 30 minutes sessions per week for 3 weeks.

This protocol can vary depending on what is contributing to your disfunction and when developing a program to meet your goals.

The sessions will be booked after your initial assessment.

Missed sessions due to illness or weather will be made up on the next available day.

How does this work for weak pelvic floor muscles?

For weak pelvic floor muscles, a high intensity treatment produces supramaximal muscle contractions improving pelvic floor strength, muscle hypertrophy and improved coordination.

How does this work for pelvic pain or tense muscles?

For pelvic floor muscles that are too tense, a low intensity treatment works to improve blood flow to the tissues, reduce pain and inflammation and promote healing.

Are there any clinical studies to support this modality?

“HIFEM technology is able to safely and effectively treat a wide range of patients suffering from urinary incontinence. After six treatments, an improvement in ICIQ-SF score and reduction in absorbent pads usage was observed… these changes positively influenced quality of life”

JB Samuels · 2019

https://pmc.ncbi.nlm.nih.gov/articles/PMC6851770/

“Post treatment results suggest that HIFEM technology is suitable for treatment of PFMs weakening and showed to be more effective when compared with electrostimulation in short-term. Therefore, we recommend HIFEM as treatment option for weakened PFMs and UI.”

E Silantyeva · 2021

https://pubmed.ncbi.nlm.nih.gov/31860567/

"The present trial is designed to investigate the effects of a conjunct physiotherapy program for urinary incontinence in women…this strategy is more effective than pelvic floor muscle training alone, and high-frequency electromagnetic stimulation will be superior to the low-frequency magnetic stimulation group.”

C Chen · 2024

https://pmc.ncbi.nlm.nih.gov/articles/PMC8016513/

“Study results showed that the proposed treatment strategy led to a significant improvement in Pelvic Floor Muscle (PFM) tone and strength in patients with UI and pelvic floor disorders, without discomfort or side effects”

M Filippini · 2023

https://pubmed.ncbi.nlm.nih.gov/37241111/

“This study documented that the HIFEM procedure was significantly more effective than electrical stimulation in treatment of PFD in postpartum women.”

S Elena · 2020

https://pmc.ncbi.nlm.nih.gov/articles/PMC7261686/

Do I need a referral?

The clinic does not require a physician referral to book but your benefit company may require one to submit to them.

Will my insurance/benefits cover pelvic floor physiotherapy?

Yes, pelvic floor therapy is a type of physiotherapy so it will be covered if you have physiotherapy benefits. In this clinic, acupuncture is also considered a physiotherapy treatment and is therefore covered under physiotherapy benefits. Specific coverage under acupuncture will not be covered when submitting for this clinic as we are physiotherapists who perform acupuncture for musculoskeletal benefits and are not considered acupuncturists. Unfortunately we do not directly bill insurance companies at this time.

Will my insurance/benefits cover the Freedom+ Kegel Chair?

Yes, this is a treatment prescribed and monitored by a registered physiotherapist with an expertise in pelvic floor dysfunction. If you have physiotherapy benefits it should be partially or fully covered depending on your plan.