Pelvic Health Program

NHRC Pelvic Health Program 


We would like to take this opportunity to provide information about Niagara Health & Rehab Centre (NHRC) Pelvic Health Program. We want to increase awareness of various pelvic floor dysfunctions affecting women and men, and how they impact their quality of life. Pain during sex, urinary leakage, organ prolapse, pelvic pain, and pelvic girdle problems are all topics which need to be discussed. Talking to your Doctor about these symptoms is the first step, and often the hardest step. Don’t let embarrassment keep you from seeking help. The multidisciplinary team at NHRC offers prenatal therapy, pelvic floor muscle training, naturopathic medicine, and progressive exercise programs. 


Female and Male Urinary Incontinence

Just how common is this problem? Here are the facts on prevalence of urinary incontinence in Canada: 20-30% in young women, 30-40% in middle aged women and 30-50% in elderly women. In men, 1 in 9 will experience urinary leakage.


There are different types of incontinence. Pelvic floor rehab can help with:

  • Stress Incontinence: Occurs when urine leaks from the bladder when pressure is applied to it suddenly. High impact activities, coughing, sneezing, obesity and constipation can put pressure and stress on the pelvic floor muscles.
  • Urge Incontinence: Occurs when there is an inability to control urine leakage from the bladder when the “urge” to urinate occurs.
  • Mixed Incontinence: Occurs when both stress and urge incontinence are experienced


Vaginal Organ Prolapse


The pelvic floor functions as a hammock of muscles lining the pelvis girdle in order to support the organs. Patients affected will often describe an annoying bulge at or near the vaginal opening which may or may not be accompanied by pressure. This pressure is aggravated by standing or relieved by lying down.


Different organs can prolapse

There are 4 different grades of prolapse

Cystocele : bladder

1st degree : Into vaginal space

Uterine prolapse : uterus

2nd degree : To the vaginal opening

Urethrocele : urethra

3rd degree : Past the vaginal opening

Rectocele : rectal wall

4th degree : Total inversion

Enterocele : intestines



Treatment recommendations:


Grade 1& 2: Recommendation is pelvic floor muscle training; Prolapse can often be reversed


Grade 3&4: Recommendation is surgical intervention. Pelvic floor muscle training should be done pre-operation and post-operation to reduce the likelihood of future surgeries.



What to expect in physiotherapy?


Research is establishing that specialized pelvic physiotherapy is an excellent first-line of defense against incontinence.


Pelvic floor dysfunction may be caused by:


  • HYPOTONICITY: contributing to Stress Incontinence and Pelvic Organ Prolapse
  • HYPERTONICITY: contributing to Urgency, Urge Incontinence, Chronic Pelvic Pain, Dyspareunia, Vaginismus, Vulvodynia, Pudendal Neuralgia, Interstitial Cystitis and Chronic Prostatitis

A pelvic floor specialist will do a full physiotherapy assessment as well as an internal palpation exam, to assess the strength of the pelvic floor muscles, severity of the incontinence, muscle tone and prolapse grade. We will identify treatment goals and discuss individualized treatment recommendations.


Treatment plans may include:

  • Muscle re-education
  • Bladder retraining
  • Strengthening of pelvic floor muscle (Kegel exercises)
  • Manual Therapy
  • Myofascial techniques
  • Electric stimulation of the pelvic floor muscles, with rental and home exercise program
  • Lifestyle changes
  • Progressive exercise program for return to sport and daily life activities


Research and Medical Guidelines


Financially, incontinence is a costly problem for patients, with up to $1000 a year spent on products alone. Research has shown that therapists qualified in pelvic floor muscle training promote continence in patients with stress and mixed incontinence, and reduce the severity of urgency incontinence. These results are often gained in as few as 5 sessions.


Note that the Society of Obstetricians and Gynecologists of Canada recommend that Kegel exercises should be confirmed by internal palpation. Simple written or verbal cueing is NOT sufficient for a Kegel exercise program.


Kegels are NOT always indicated for pelvic floor problems. Sometimes they do more harm than good and often they are NOT performed correctly.


If you have any questions, or would like more information about our other services, please do not hesitate to contact us at 289.362.3600.


Pelvic floor




Marie-Eve Nackers                                         Stefania Tiveron                                 

Registered Physiotherapist                              Naturopathic Doctor