Pelvic Health Physiotherapy 101

There’s a lot of hype around Pelvic Health Physiotherapy but can it help you?

Pelvis in a heart shape being held by hands

Warning: Source links contain gendered language. 

With ongoing developments in endometriosis research, diagnostics and treatment, we’re constantly learning about new ways to support those with endometriosis. One new way? Pelvic Health Physiotherapy. We dug into this new treatment to learn more about what it is, how it can help, and how you can do it within the comfort of your home.

The College of Family Physicians of Canada defines chronic/persistent pelvic pain as nonmenstrual pain lasting 6 months or more that is severe enough to cause functional disability or require medical or surgical treatment. Past estimates put the economic burden of persistent pelvic pain in Canada around at least $25 million per year – and that only included hospital-related costs, leaving out things like lost quality of life or productivity, and outpatient treatments.

One such outpatient treatment gaining traction with anyone suffering chronic pelvic pain, not just people with endo, is pelvic health physiotherapy (PHP). We talked to Toronto-based pelvic health physiotherapist and owner/instructor at Pelvic Health Solutions Nelly Faghani about the discipline and how it can be beneficial for endo patients.

What is pelvic health physiotherapy?

PHP is an evidence-based, conservative treatment for common conditions or dysfunctions within the pelvis like incontinence, pelvic organ prolapse, and pelvic pain.

The pelvic floor muscles are a group of muscles that attach to the front, back and sides of the pelvis which act like a hammock or sling. They also wrap around your urethra (where pee comes out), rectum, and vagina. The pelvic floor muscles must be able to contract to maintain continence (aka, keep you from leaking) and relax to allow for urination, bowel movements, and sexual penetration.

PHP works by improving awareness of these muscles to find ways to minimize pain and discomfort and maximize relief and relaxation.

What should patients expect at an appointment?

The first visit is typically a little longer, where the physiotherapist does a thorough evaluation to identify any factor that may contribute to your symptoms and come up with a treatment plan.

A subjective evaluation includes reviewing your medical history (a lengthy process for many of us!), including mental health or trauma that may seem unrelated like accidents or injuries. This includes questions relating to pain, bladder and bowel function, sexual activity and more.

An objective evaluation looks at factors like breathing, posture and alignment, movement patterns, overall strength and conditioning, the lumbar and thoracic spine, and the pelvic floor muscle function.

Depending on the patient, the physiotherapist and time constraints, at some point an internal manual exam is done so the practitioner can assess how the muscles are functioning directly at the source. This has been shown to be one of the most highly successful interventions for both pelvic pain and incontinence and is an integral part of treatment.

How can PHP help with endo pain?

People with endo are acutely aware of the wide-reaching impacts that chronic pelvic pain has on daily life. Studies have shown that chronic pain physically changes the brain itself–this does not mean the pain isn’t real, it’s very real. Fortunately, the nature of the human brain means that it is possible to change it again.

PHP follows the biopsychosocial model proposed by George Engel in 1977. This approach considers not only the biological but the psychological and social factors, along with their complex interactions in understanding a patient’s health.

Venn Diagram: Biological + Psychological + Social = Health

Using this approach acknowledges that most often a blend of both tissue dysfunction and psychosocial factors contribute to pelvic pain symptoms. Identifying the right driving force behind these symptoms is the key to relieving pelvic pain via physio. The pelvis is often an area where people hold a lot of tension, stress and anxiety, so understanding how the body’s pain system works in relation to these influences is essential in reducing pain.

How can people access it?  

The Canadian Physiotherapy Association has a ‘Find a Physio’ link, but when looking specifically for pelvic floor physiotherapy it’s critical to make sure the physiotherapist has the appropriate post-graduate training to assess and treat pelvic dysfunction.

The Pelvic Health Solutions website has its own ‘Find a Physio’ link that allows you to look for Ontario-based and outside of Ontario pelvic health physiotherapists. There is also a physio finder resource that the Canadian Physiotherapy Association Women’s Health branch provides based on province and territory.

Do you have any tips that people can try at home?

Absolutely! Giving patients tools for self-efficacy so they are not dependent on someone else to manage their symptoms is a crucial part of PHP. Especially now, when in-person appointments are not an option and I can’t provide typical hands-on assessment and treatment. Focusing on bringing the basics home is great for virtual appointments because pain is worse when stress is high.

Pelvic Physio at Home

Home illustration

Deep Breathing

This one may feel like it’s not doing much, but deep breathing is the best way to calm the nervous system. The diaphragm and the pelvic floor muscles relax, giving them a juicy stretch and facilitating relaxation in your entire body.

Try it: 

  1. Sit or lie in a comfortable position.
  2. If it helps, place one hand on your belly and one on your chest, or simply rest your hands in your lap.
  3. Softly and slowly breathe in through your nose and feel your belly expand in every direction.
  4. Breathe out gently through your mouth, emptying every last morsel of air.
  5. Repeat 3 to 10 times.

Calves on a stool

This is an excellent pose for anyone experiencing pain in the lower back, pelvis, hips and upper thighs, as well as for digestive issues. It allows all of the pelvic floor muscles to relax completely and relieves pressure in the area.

Try it:

  1. Find something at home about the height of a dining chair – those work great, or you can use a couch or bed depending on the height.
  2. Lie on your back, placing the calves on the stool (or object). Your thighs and calves should be perpendicular to each other.
  3. You may want to have a small blanket or pillow nearby to place under your lower back.
  4. Stay here for 5-10 minutes, or for however long your time allows.
  5. BONUS: You can do Deep Breathing while in this pose! Double duty!
  6. There’s no real graceful way to come out of this, just make sure you do so gently by turning onto your side or scooching your bum back.
Person on yoga mat in cat/cow posture

Restorative yoga

Gentle yoga exercises are excellent for activating the parasympathetic nervous system, which is another essential part of relieving pain. It also incorporates deep breathing and meditation which are both proven to improve pain symptoms.

Try it: Cat/Cow

  1. Come to hands and knees with hands under the shoulders, knees under the hips. If it’s hard on your knees you can place a folded towel or blanket underneath to cushion them.
  2. Inhale deeply through your nose, arching the back slowly and gently by dropping the stomach towards the floor. Be careful not to throw the head back – keep your spine long.
  3. On the exhale, slowly drop the head and round the back towards the ceiling like a cat.
  4. Repeat 5-10 times to improve hip and spinal mobility.


Good nutrition makes a huge difference to bowel and bladder health, and getting enough water is the foundation. On top of being mindful of what we eat and potential pain triggers, a hydrated body has more energy and sleeps better. How do you know if you’re well-hydrated? Your pee should be a pale yellow colour, but keep in mind that certain vitamins can change the colour (we’re looking at you, vitamin D).

Try it:

  1. Set yourself a few hydrate reminders.
  2. Stick a piece of paper up on the fridge that forces you to check off when you’ve had a glass.

Get out of your head

It’s very easy and understandable for people with endo or persistent pelvic pain to give in to the pain and catastrophize because of the infinite ways this disease impacts daily life. The biopsychosocial model teaches us the importance of the mind-body connection and the power that thoughts can have over how we feel.

Try it:

  1. Grab some post-its or scraps of paper, write positive affirmations on them and stick them up to your mirror or wherever you’ll see them every day.
  2. Take a moment to write down just 1 thing that brought you joy each day, even if it’s just the relief of crawling into bed under a weighted blanket.
  3. Instead of googling endo symptoms, pop on a comedian or your favourite funny show and LAUGH. Laughter goes a long way in boosting our mood and helps us relax.

Notice: These tools are all excellent for people with endo to have in their back pocket as a way to have some control over an unpredictable disease.