Pelvic floor physiotherapy treats the muscles, nerves and connective tissue that sit at the base of your pelvis and control bladder, bowel and sexual function. People come to us for leaking when they cough or run, urgency they cannot ignore, a heavy or dragging feeling after childbirth, pain with intimacy, tailbone pain, or pelvic pain that has been investigated and cleared but never resolved. Assessment is one-on-one in a private room, and every part of it, including whether an internal examination happens at all, is your choice. Most people are treating a coordination problem rather than a strength problem, which is why generic exercises so often fail before this care begins.
Every pelvic health appointment is a private, one-on-one room with the same physiotherapist for the full session, so you are not repeating your history to a new person each visit.
The pelvic floor is a layered sling of muscle, mainly the levator ani group, running from the pubic bone to the tailbone. It closes the urethra and anus, supports the bladder, bowel and uterus or prostate from below, contributes to sexual function, and works with the diaphragm and deep abdominals to manage pressure every time you lift, cough or laugh.
Pelvic floor physiotherapy assesses how that system actually behaves, then retrains it. Supervised training is the first-line treatment for stress and mixed urinary incontinence, and guidance sets the minimum programme at three months rather than a handout of exercises [+]. Pooled trial data show women with stress incontinence who complete a supervised programme are around eight times more likely to report cure than those who receive no active treatment [+].
What it is not:
Symptoms are grouped by the system they affect, because that is what determines the treatment plan.
For symptomatic prolapse that has not descended past the vaginal opening, guidance supports a supervised pelvic floor programme of at least sixteen weeks before considering surgical options [+].
Most pelvic symptoms are not dangerous and can be booked directly. A small number need medical assessment ahead of physiotherapy, and delaying them is the one real risk on this list.
| Symptom | What to do |
|---|---|
| Cannot pass urine at all, with a painful full bladder | Go to the emergency department now |
| New numbness in the saddle area, new loss of bladder or bowel control, with back pain or leg weakness | Go to the emergency department now, this needs same-day imaging |
| Visible blood in urine or stool | See your doctor before booking |
| Fever with pelvic or flank pain | See your doctor before booking, this may be infection |
| Any vaginal bleeding after menopause | See your doctor before booking |
| New pelvic mass, or unexplained weight loss with pelvic pain | See your doctor before booking |
| Leaking, urgency, heaviness, pain with intimacy, constipation, postpartum symptoms | Book pelvic floor physiotherapy directly, no referral needed in Ontario |
Two people can describe the same leaking and need opposite treatment. A weak or poorly coordinated floor fails to close under pressure, and responds to graded strengthening with correct timing. An overactive floor is already held at high resting tone, cannot relax fully, and produces urgency, pain with penetration, straining to empty and leaking that gets worse the more the person squeezes.
This is the reason so much self-directed work stalls. A tight floor given Kegels gets tighter. Treatment for that pattern is down-training: manual release of trigger points, breathing and positional work to lengthen the muscle, and desensitisation, since learning to release when pain starts is what interrupts the pain and guarding cycle [+]. We establish which pattern you have at the first visit, before any exercise is prescribed.
The assessment runs about 45 to 60 minutes.
Symptom pattern and triggers, bladder and bowel habits, birth or surgical history, medications, pain map and what you want to get back to doing.
Posture, breathing mechanics, abdominal wall and diastasis, hips, lower back and sacroiliac joint, and how you brace under load.
This is how we measure tone, strength and coordination. A more detailed hands-on assessment is offered as an option, with your written consent, and you can pause or decline at any point.
You leave with the working diagnosis, two or three prescribed exercises, and specific bladder, bowel or load-management changes to start immediately.
Follow-up sessions combine progressive muscle training, manual therapy, biofeedback, bladder retraining with a diary, dilator or desensitisation work where relevant, and return-to-activity loading.
Pelvic health appointments are booked with a specific physiotherapist, and you stay with that person for your full course of care. Tell us your main symptom when you book and we will match you.
Most people notice a change in four to six weeks and complete a course in three to four months, which matches the minimum supervised duration used in the guideline evidence. Sessions are usually weekly or biweekly at the start, then spaced out as your home programme carries more of the work. Prolapse and persistent pelvic pain generally sit at the longer end. Because the gains come from muscle adaptation, they hold as long as the maintenance programme continues, and the exit plan is a short routine you can keep indefinitely.
Pelvic floor physiotherapy in a private clinic is not covered by OHIP. It is covered by most extended health benefit plans under physiotherapy, and we direct bill the major insurers where your plan allows it. Motor vehicle accident and WSIB claims are handled directly. No physician referral is required to book, though some insurance plans ask for one to release funds, so it is worth checking your policy before your first visit. All treatment is provided by physiotherapists registered with the College of Physiotherapists of Ontario.
We treat pelvic health patients at two locations. Call (416) 443-6895 or request an appointment and tell us your main symptom so we can book the right length of assessment.
951 Wilson Ave, Unit 15, North York, ON M3K 2A7
9555 Yonge St, Unit 307, Richmond Hill, ON L4C 9M5
Related care that often runs alongside pelvic health treatment includes post-surgical rehabilitation, massage therapy and acupuncture.
No. It is offered because it gives the most accurate picture of tone and coordination, but it requires your written consent, can be stopped at any point, and can be declined. Real-time ultrasound and surface biofeedback are used instead when you prefer.
Not to book with us. Some extended health plans require a referral to reimburse you, so check your policy first.
No. Men are treated for leakage after prostate surgery, chronic prostatitis and chronic pelvic pain syndrome, post-void dribbling and bowel symptoms.
Only for some people. If your pelvic floor is already overactive, more squeezing usually worsens urgency, pain and emptying. Which pattern you have is established at the assessment before any exercise is given.
Most people notice a difference within four to six weeks, with a full course running three to four months. Consistency with the home programme matters more than session frequency.
No. The pelvic floor responds to training at any age, including decades after childbirth and after menopause.
