I remember my first mentoring session back when I was starting out as a recently graduated physio. It was with Dr. Sinead Dufour, a pelvic health physiotherapist, researcher, and educator who I had met as a student during my time at McMaster University. Something she said in that session completely changed the trajectory of my career:
"Bhawan, we don't treat just the pelvic floor alone in isolation. We treat holistically; we treat pelvic health"
If you are confused - you are not alone! I remember being so confused thinking to myself - aren’t they the same thing?. I also remember thinking that it was just semantics and that the difference really doesn’t matter.
Like a true researcher :’), I asked ChatGPT recently and this is what it said:
- “Pelvic Floor Physiotherapy focuses specifically on the muscles, ligaments, and tissues of the pelvic floor. It aims to treat issues related to pelvic floor dysfunction, such as incontinence, pelvic organ prolapse, and pelvic pain. The treatment often involves exercises to strengthen or relax the pelvic floor muscles and may include manual therapy, education, and advice on posture or lifestyle changes.”
- “Pelvic Health Physiotherapy is a broader term that includes pelvic floor physiotherapy but also addresses a wider range of conditions affecting the pelvic region. This can include not just pelvic floor muscle issues, but also conditions related to the bladder, bowel, sexual health, and the musculoskeletal system in the pelvic area. Pelvic health physiotherapy might involve treatment for problems like pelvic pain, urinary or bowel issues, sexual dysfunction, or prenatal and postnatal care.”
Here’s the real question: Can anyone fully treat pelvic dysfunction without more broadly addressing bladder, bowel, or sexual health? If yes - how does one only treat the pelvic floor without addressing any of the systems around it?
In my opinion - you simply can't separate pelvic floor physiotherapy from pelvic health physiotherapy.
Anyone who refers to it as pelvic floor physiotherapy likely does not understand how detrimental it can be to treat the pelvic floor in isolation (a very biomechanical approach). One would almost have to ignore all of the sexual health, bladder health, bowel health experiences, trauma experiences, and personal experiences when treating just the muscles, ligaments, and tissues.
It appears that pelvic floor physiotherapy quickly forgets about the human being that came in with the pelvis being treated. This is something I could never do.
I am not interested in being a Pelvic Floor Physiotherapist.
Anyone who has worked with me recognizes my longer intake form, and how much time I spend learning about you. YOU. The person who houses your pelvis and pelvic floor, the one that changes your pelvic floor with each breath and each thought, and the one who experiences all that your pelvic floor can do. Based on your comfort, we take our time talking about sexual health, bladder health, bowel health, birth experiences, how we feel about birth, trauma experiences, lifestyle, sleep, diet, movements - all in the name of creating a more holistic and complete picture of how your symptoms are a product of more than just muscles.
I remember when I first went to pelvic physiotherapy myself. I sat in a room and was briefly asked questions about why I was there before an internal vaginal exam began. For context - I was not comfortable with internal exams and this was one of the reasons I had found myself there. For the next 4 sessions, I continued to show up, get undressed, and my physio would do an internal exam and massage for about 30 minutes while talking to me about her day and her life. I never got long term relief and the things that mattered to me - my goals - were never addressed. This is pelvic floor physiotherapy.
I realized I needed something different, pelvic floor physiotherapy wasn’t working. So I found someone else. This physiotherapist took time to understand what was going on and only performed an internal when I was ready. She educated me on pain, previous experiences, how the pelvic floor was linked to the nervous system (aka stress, gut, etc), and how I had more control over my symptoms than I realized. She addressed my goals and always saw me when I was in that room. This is pelvic health physiotherapy.
There may be some conditions or some people out there who find that pelvic floor physiotherapy and addressing just the body is sufficient for them - which is not a bad thing! We all have a desire to be well and to be symptoms free, regardless of how we get there. However, if you found that pelvic floor physiotherapy didn’t work for you, then I would urge you to re-evaluate what you actually received. You likely needed a more holistic approach, one that doesn't forget about the human being that you are.
We all deserve to be seen, heard, and treated with respect when we are vulnerable. Treating pelvic symptoms or preparing for birth is not a biomechanical physical task alone. Pelvic Health Physiotherapists should always aim to treat the human being.
Because isn't that what all healthcare should AIM to do?
Warmly,
Bhawan Sekhon
