Lisa Flanders, Registered Physiotherapist

Connecting you with your Pelvic Floor

It’s Not TMI – Episode 5: All About Poop (in less than 5 minutes)

I had a chance to sit down and chat with the wonderful Dr. Erin Kasparek, Naturopathic Doctor here in Ottawa and get the scoop on our poop.

All about Poop, constipation help, bowel movement, gut health

The Scoop On Poop

She gave some great insight on;

  1. What defines constipation
  2. How often we should have a bowel movement
  3. What our movements should look like
  4. How to choose a probiotic for gut health
  5. The different types of fibre
  6. How fluid plays a role in constipation and normal bowel function

Episode 5: All About Poop

Click on the link below to learn all about poop in less than 5 minutes!


It’s Not TMI – Episode 4: How Should I Wash My Vulva For Optimal Hygiene?

Vulva Care, Wash My Vulva,  Vulva Hygiene

What if I told you that your vulva and vagina are self-cleaning and that you don’t have to wash with soap? I’ve created a new video below to address vulva care and hygiene. Plus it means another video with my Vulva puppet!

Episode 4: How Should I Wash My Vulva For Optimal Hygiene?

Click on the link below to learn more, and remember, It’s Not TMI!


It’s Not TMI – Episode 3: Does Stopping the Flow of Urine Strengthen Your Pelvic Floor?

I am fortunate enough that I get to do what I love. Right now I am LOVING filming these videos (so much so that I filmed this one at 6 in the morning)!


Stopping the Flow of Urine, It's Not TMI, Pelvic Floor


Does stopping the flow of urine strengthen your pelvic floor?

  1. Not everyone needs to strength
    en their pelvic floor (see episode two)
  2. It may increase your risk for urinary tract infections
  3. This action is likely not specific to your dysfunction

Episode 3: Does Stopping the Flow of Urine Strengthen Your Pelvic Floor?

Click on the link to find out more. If you have a question that you think is “too much information” feel free to send me a message and I will answer it on an upcoming episode.

It’s Not TMI – Episode 2: All About Kegels

This week on “It’s Not TMI” I am talking all about kegels!


5 reasons kegel exercises may not be appropriate for your pelvic floor:

  1. Kegels are not specific
  2. If you have a tight pelvic floor, doing kegels may make your dysfunction worse
  3. Most women do not do kegels effectively
  4. Kegels are typically not done dynamically or applied to functional exercise
  5. The pelvic floor is only ONE aspect of our deep core (working together with our diaphragm, deep abdominals and low back muscles)

Episode 2: All About Kegels

Click on the video link below to learn more about kegels and if they are a good exercise for you.

And yes….I did reference a T-rex, I just watched Jurassic World on Netflix.

It’s Not TMI – Episode 1: The Vulva vs. Vagina

It’s Valentines Day! V is for Valentine but it is also for Vulva (and Vagina)!

Have you ever said to your healthcare practitioner “This might be too much information…”, If so, I have just the just the series for you!

It's Not TMI - Episode 1: The Vulva vs. Vagina

I’ve started a series on Youtube called “It’s Not TMI” where each week, I will be addressing the questions that you might be too embarrassed to ask. In Episode 1, we address the difference between the vulva and the vagina. Click on the link below to access the video via YouTube. And yes, that is a picture of me with my FAVOURITE educational tool, The Wondrous Vulva Puppet

Episode 1: The Vulva vs. Vagina


Research Study – University of Ottawa

Are you pregnant with your first child? If so, you may be interested in the study below at the University of Ottawa regarding the natural course of recovery of the truck and pelvic floor musculature after delivery.

Research like this is so important to the field of physiotherapy and pelvic health. It allows myself and my colleagues to continue serving our patients with the the most current information and best practices.


Pelvic Floor Physiotherapy – What to Expect at Your First Visit: Part 1

Pelvic floor physiotherapy is a branch of orthopaedic physiotherapy with the focus being on the muscles, joints, tendons, bones and organs found in and around the vagina and rectum.


I encounter so many wonderful questions regarding the first visit with a pelvic floor physiotherapist and what to expect, that I compiled them into one place.


Below is a list of frequently asked questions about your first visit.


  1. What can be expected at my first visit?


At your first visit, you can expect a thorough health history.  Each concern you have will be addressed. A physical exam will be conducted including a postural and movement exam as well as a gentle abdominal examination. If you are comfortable, an internal evaluation will be completed.


Following the assessment, the findings of the exam will be discussed. You will be provided with a home exercise program and a treatment plan will be created.


  1. How long does the assessment take?


Each initial visit is scheduled for 60 minutes as there is a lot of cover. There will be ample time to answer all questions and address all concerns you may have.


  1. Will there be an internal evaluation?


Typically there is an internal exam at your first appointment as this is considered the gold standard for evaluating the pelvic floor. If you are not comfortable with an internal evaluation, we will work around this to design a treatment plan that is right for you.


  1. Is pelvic floor physiotherapy covered by OHIP or private insurance?


Unfortunately pelvic floor physiotherapy is not covered under OHIP (Ontario government). However, if you have private insurance, pelvic floor physiotherapy is covered by extended health benefits, it falls under your physiotherapy benefit.


  1. How many treatments will be required?


Everyone will respond to treatment differently. We will typically have follow up visits every 2-4 weeks. Typical number of treatments varies between 4 and 12. This will be discussed with you at your first visit following the assessment.


Stay tuned for part 2……

Singing and the Pelvic Floor

I love to sing! Only when no one can hear me, which often involves a solo party with my iPod or belting out tunes to a song on the car radio (yes I am that person at the red-light). When asked what type of music I like, my answer is whatever I can sing along with.

I am not a good singer and I am okay with that, however I started taking singing lessons with the goal of having confidence to get up on stage at a karaoke night. I won’t be quitting my day job anytime soon because I am mediocre at best (though my singing teacher is much more complimentary).


I am a physiotherapist with an area of focus on the pelvic floor. I pride myself in my body awareness. I can contract individual muscles on cue and relax them just the same. I can flawlessly demonstrate an exercise and I have perfect sitting posture. What has been fascinating through my singing lessons and what inspired me to write this post is how much more I am learning about my body and connecting with areas where I hold tension.

I have learned that I hold my pelvic floor tightly in standing and consciously have to relax the muscles to allow a diaphragmatic breath before the notes come from my mouth. I have learned how to take fuller and longer breaths and command noise from my diaphragm. I have also learned that I am not tone-deaf and can actually hit some pretty high notes (I can hit them, but the sound is not nearly as pretty as what I hear on the radio). I leave every lesson feeling open, relaxed and slightly more connected with my body.


An effective diaphragmatic breathing technique is essential to singing. Sadly I find that many people do not know how to breathe effectively. In our modern era, we have become a sedentary population who spend a third of each day sitting at desks. Desk-jobs and compression of the abdomen through poor posture is non-optimal for an effective breath. Further, and this applies especially to women, we suck our stomachs in or wear compressive garments to give the appearance of a flatter stomach, think of how difficult breathing becomes to inhale fully when we have compression across our bellies.

The Diaphragm and Pelvic Floor Role in Singing

As we inhale (long, slow and smooth breaths) our diaphragm contracts and descends to allow air to fill the lungs. This increases the pressure through the abdomen and that pressure has to go somewhere, hence a belly breath. Ideally, the pelvic floor will relax slightly to allow for this pressure as well. The long and full breath is what is needed to create beautiful sound out of the vocal chords and to hold notes without running out of air.

Initially I teach my clients breath work in a supine position (lying on the back). We focus on long, slow and smooth breaths. The focus is to imagine breathing into the pelvic floor.

For our muscles to be functional, they must be able to contract AND relax. Muscles that hold too much tension are not functional muscles. This can lead to pelvic pain, painful intercourse, hip dysfunction and stress urinary incontinence. If we learn to breathe more consciously, not only will pelvic pain decrease but overall stress levels will decrease as well.

I think I am going to start incorporating singing as a treatment technique into my physiotherapy practice.

A little side note: On my first lesson, my teacher asked me to think of a word that ends in ”ah” (based on Italianate vowels), without blinking I responded with “vagina”, I really am meant to be a pelvic floor physiotherapist.

A Pelvic Floor Physiotherapy Exam is NOT a Pap Test

I believe a big deterring factor from women seeking treatment from a pelvic floor physiotherapist is fear of the internal exam.


Nobody enjoys going for regular Pap test and though it is a necessary piece to overall health it is my least favorite part of the physical.


Pelvic floor physiotherapy is different and when I explain the differences to my patients I hear things like “oh that sounds so much better”.

Pelvic Exam vs. Pap Test

Below are some of the main differences between a Pap test and an internal exam by your pelvic floor physiotherapist

Pelvic Exam vs. Pap Test

  1. You will not have your feet in stirrups.


It is awkward lying on your back, legs up in stirrups with your bum at the edge of the table. Traditionally called lithotomy position, it has been used in the medical world since early times. There are obviously benefits to being in this position from the doctor or medical teams perspective (good visual and physical access) however I find it leaves a level of vulnerability.


During your pelvic floor physiotherapy exam, there are no stirrups, the exam can be completed on your back or on your side (in the position that you are most comfortable) and I will be next to you at the table so I can see your face, explain each step in the process and watch for any facial cues to let me know you are not comfortable.


  1. Pelvic floor physiotherapists do not use speculums


The speculum is the plastic instrument (or if you remember the metal….) that is used to open the vagina to get a clear path to the cervix. Use of a speculum is never comfortable, however, they are a necessary part of the Pap test to allow a swab to taken without contamination from the vaginal wall.


During your physiotherapy exam this is not necessary (hooray!), as I want to be able to evaluate the walls of the vagina, the muscles and connective tissues what the tone feels like and the strength, endurance and symmetry of your contraction, the speculum would get in the way.


  1. You will not be asked to wear an awkward paper gown


The paper gown never fits, and I always lose the plastic belt that is provided to tie it around. When I move it shifts, leaving me feeling exposed.


I provide my patients with a soft flannel sheet to cover the lower body, allowing you to stay covered, comfortable and warm.


  1. You will not have to lie on table paper


The piece of paper designed to cover the exam table that is never wide enough. When I try to get up onto the table I shift it and it usually tears, leaving my bum exposed to the vinyl tabletop (which is cold).


During your visit to my clinic, I cover the exam table with a fitted sheet (soft flannel) that is removed and washed after each patient.


  1. You will remain in complete control


You always have the right to remove consent during any examination completed by your medical doctor or other health care professional. However many women will grin and bare the full Pap test, even if they are in pain or discomfort. Worse, some women will avoid them all together knowing the discomfort they feel.


At your pelvic floor physiotherapy exam, we will only complete what you are comfortable with on that day. This may mean only an external visual or it may be the full internal exam. I will talk to you during your visit to ensure you remain in complete control and feel comfortable for the duration of the visit.


Take home message

If you do need pelvic floor physiotherapy, know that it is not the same as a Pap test; don’t let fear, embarrassment or discomfort deter you from the treatment you require. Additionally, if you have not had a recent Pap test, I encourage you to make an appointment with your doctor, as it is a necessary part of your regular health checkup.











The Postnatal Pelvic Floor – Frequently Asked Questions: Part 1

Frequently Asked Questions

I have been encountering some great questions about the postnatal pelvic floor. Below is a list of the most common questions.


Q: How long after delivery should I wait to see a pelvic floor physiotherapist?


I generally recommend waiting 6 weeks before having an internal vaginal examination; your body requires time to heal. However if you are experiencing low back or pelvic pain, seeing a physiotherapist sooner will be beneficial.

Q: I have Diastasis Recti, can pelvic floor physiotherapy help?

Diastasis Recti (or DRA for short) is a separation of the connective tissue that joins on the abdominal muscles. It typically occurs along the linea alba (connective tissue line attaching the ribs to the pubic bone). It is due to stretching of the abdominal tissue to accommodate your growing baby, however the tissue can remain stretched well after delivery.


The goal is support the connective tissue through control of transversus abdominus (deep abs). The transversus abdominus is part of the deep core system along with the diaphragm, pelvic floor and multifidus (deep back muscles); the whole system must work together to be functional.


Until you have been evaluated by a trained professional and it is determined that you have adequate deep core control, avoid abdominal exercises including planks, crunches and double leg lifts.


Q: Which exercises are best during the early postpartum period?


Everybody will respond differently in the early postpartum period (first 6-8 weeks) and you should return to physical activity at a pace that is right for your body. It is advisable to have an evaluation with a pelvic floor physiotherapist to ensure it is safe to return to activity, together you will discuss your goals and develop a plan that is right for you.


Generally low impact activities like walking and swimming are safe for the body in the early postpartum period.


Q: I had a Cesarean Section, yet I am still experiencing urinary leakage when I cough, I thought my pelvic floor would be okay?


During a cesarean section, the abdominal muscles, including transversus abdominus are cut to allow access to the uterus. Our deep core system must work together to be functional, therefore a dysfunction in one area can lead to a dysfunction in another, in this case in the pelvic floor.


Secondly, following a cesarean section, scar tissue is created as the incision heals. This may create restrictions in the deep core system, creating dysfunction to the system as a whole.


Q: When will I feel like myself again?


The immediate post partum period is considered to be 6-8 weeks. However, keep in mind that your body underwent a beautiful change over a 9-10 month period where your abdominal and pelvic floor organs shifted to accommodate your growing baby. It can take at least as long for you body to make the transition back.


Be patient, it’s hard work to grow and nurture a child. Working with a pelvic floor physiotherapist in your area that you connect with will help you reach your goals.


Stay tuned for part 2……



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