Booking a first pelvic floor physio appointment can feel like a big step, mostly because people are not sure what will happen in the room. This guide explains what to expect at a pelvic floor physio appointment at Forza Physiotherapy in downtown Vancouver, from the questions you will be asked to the parts that are always your choice.

Who pelvic floor physiotherapy is for

Pelvic floor physiotherapy looks at the muscles, joints and connective tissue that support your bladder, bowel and pelvic organs, and how they work with your breathing, core and movement. People book for many reasons. The ones our pelvic health physiotherapist, Teala McEwan, sees most often include:

• Leaking when running, jumping, laughing, coughing or sneezing

• Rushing to the bathroom or going more often than you would like

• A gap or doming down the middle of the tummy (diastasis recti) during or after pregnancy

• Heaviness, pressure or a dragging feeling in the pelvis, which can be a sign of pelvic organ prolapse

• Pelvic girdle pain, low back or hip pain during pregnancy

• Wanting a check-in after birth before returning to running or lifting

You do not need a diagnosis to book, and you do not need to wait until something is wrong. Plenty of people come during pregnancy simply to stay active and strong. At the moment, pelvic health appointments at Forza are available for female patients.

Before you arrive

You will fill in an intake form when you book through Jane, our online booking system. It asks about your health history, pregnancies and births if relevant, and what you would like help with. Be as honest as you can; nothing on it will surprise your physiotherapist.

Wear comfortable clothes you can move in. If you can, keep a simple note for two or three days before your visit of when any leaking or urgency happens and what you were doing. It is one of the most useful things you can bring.

What to expect at a pelvic floor physio appointment

Your first pelvic health appointment at Forza is a 60-minute one-on-one assessment with a registered physiotherapist. It usually runs in this order.

A conversation first. Your physiotherapist asks about your symptoms, when they started, what makes them better or worse, your bladder and bowel habits, pregnancy and birth history if relevant, and your goals. Most of the first appointment is listening.

An external assessment. This looks at your breathing, posture, abdominal wall, hips and back, and how you move, lift and load. If you are pregnant or postpartum, it often includes checking for diastasis recti by feeling along the midline of your tummy.

An explanation and a plan. Your physiotherapist tells you what they found in plain language, answers your questions and builds a plan with you. Treatment can start in the first appointment, so you usually leave with something to work on.

The internal assessment is always optional

This is the part people worry about, so here it is plainly: an internal vaginal or rectal assessment is completely optional, and it is only done with your informed consent. You can say no, say not today, or stop at any point.

When it is done, it gives your physiotherapist extra information about pelvic floor muscle strength, tone, coordination and tenderness. It can be helpful, but it is not required to get useful care. Plenty of people start with an external assessment only and decide later.

What follow-up appointments look like

Follow-ups at Forza are 45 minutes. Your physiotherapist reassesses how things are going and progresses your plan. Depending on what you need, sessions can include:

• Pelvic floor retraining, which can mean learning to relax the muscles as well as strengthen them

• Exercise for your core, hips and legs, building towards the activities you care about

• Breathing and pressure strategies for lifting, running and everyday tasks

• Education about bladder habits and what to expect during pregnancy or postpartum

• Manual therapy where it helps

How many sessions you need depends on what is going on and your goals, and your physiotherapist will talk this through with you rather than promise a number.

The caveat: why "just do Kegels" is not always the answer

Kegel exercises get recommended for almost everything, and for many people they help. HealthLink BC's guide to Kegel exercises notes that some people have pelvic floor muscles that are too tight, and for them Kegels can make things worse. Leaking, pain and urgency can come from muscles that are weak, muscles that cannot relax, or muscles that do not switch on at the right moment. Doing more squeezing will not fix a timing problem.

This is the main reason to get assessed before starting a program from the internet. HealthLink BC's pages on urinary incontinence in women and pelvic organ prolapse are good background reading before your visit.

Costs, billing and booking at Forza

• Pelvic health initial assessment: 60 minutes, $190

• Pelvic health follow-up: 45 minutes, $145

• Free 10-minute discovery call with Teala if you would like to ask questions first

• No referral needed

• Direct billing to most major extended health plans in BC

Teala sees patients from 7am on Mondays and Wednesdays and some evenings until 8pm. Forza is on the 4th floor of The Post at 658 Homer St, inside Evolve Strength. You can read about Teala McEwan, our pelvic health physiotherapist, or see everything on our pelvic health physiotherapy page.

Pelvic floor physio FAQ

Do I need a referral for pelvic floor physio in Vancouver?

No, you can book pelvic floor physiotherapy at Forza without a doctor's referral. Some extended health plans ask for a referral before they reimburse, so it is worth checking your policy. If you are not sure, call the clinic at (604) 359-2919 and the team can help you check.

Is an internal exam required at pelvic floor physio?

No, an internal exam is never required. It is completely optional and only done with your informed consent, and you can change your mind at any point. Your physiotherapist can assess a lot externally, and many people start without one and decide later whether it would be useful.

Can I see a pelvic floor physio while pregnant?

Yes, many people see a pelvic floor physiotherapist during pregnancy. Common reasons are pelvic girdle pain, low back pain, leaking, and wanting to stay active and strong safely. Your physiotherapist will tailor the assessment to your stage of pregnancy and work alongside your midwife or doctor.

When should I see a pelvic floor physio after giving birth?

Many people book a postpartum check-in once they have had their routine check with their midwife or doctor, often around six weeks after birth, but there is no hard rule. Book sooner if you have leaking, heaviness, pain or a noticeable gap in your tummy, and before returning to running or heavy lifting.

How long is a pelvic floor physio appointment?

The first pelvic health appointment at Forza is 60 minutes and costs $190. Follow-up appointments are 45 minutes and cost $145. Every session is one-on-one with a registered physiotherapist for the full appointment.

Next step

If something here sounds familiar, book a pelvic health initial assessment online with Teala at Forza Physiotherapy, or start with her free 10-minute discovery call if you would rather ask a few questions first. Not sure pelvic health is the right fit? Our general physiotherapy services cover hip, back and other pain too.