Pelvic floor physiotherapy focuses on strengthening or relaxing your pelvic floor muscles. This can improve bladder control, reduce urgency, and help with other lower urinary tract symptoms.

Many people need help learning how to do pelvic floor muscle training properly. Seeing a pelvic floor physiotherapist is a great way to get the support you need. Not all pelvic floor physiotherapy treatments are covered by the Alberta Health Care Insurance Plan, so there may be extra costs involved. To find pelvic floor physiotherapy in Alberta:

• Contact a private pelvic floor physiotherapy clinic. If you need help finding a clinic, call the AHS Rehabilitation Advice Line at 1-833-379-0563.
• Search for pelvic floor physiotherapy resources near you on the Adult Community Rehabilitation website.
• Attend a free pelvic health physiotherapy webinar.

Your pelvic floor muscles will only stay strong by exercising them regularly. To do pelvic floor exercises (also called Kegel exercises):

1. Start by sitting or laying down. Keep your knees slightly apart. Relax. (Once you are comfortable with the exercises, you can do them standing up.)
2. Find your pelvic floor muscles by pretending you are trying to hold in your urine and squeezing those muscles. Make sure you are not tightening your stomach or buttocks. You can make sure you have the right muscles by inserting your finger into your vagina while doing the exercise to feel the muscle tightening then relaxing around your finger.
3. Squeeze the pelvic floor muscles. Hold the squeeze for 5 to 10 seconds while breathing normally, then completely relax for a full 10 seconds.
4. Repeat the squeezing, holding, and relaxing 12 to 20 times.

If you have any pain while doing these exercises, stop and talk with your healthcare provider.

Ask your pelvic floor therapist how often you should be doing these exercises. It can take several months for you to see ongoing benefit from pelvic floor exercises, but you could see results after 3 months of daily exercises.

Biofeedback

Biofeedback is a technique where you learn to control a body function that you don’t normally think about controlling.

To use biofeedback to learn how to do pelvic floor muscle exercises correctly, you can use a machine to record and show your muscle contractions. Biofeedback is usually done by a healthcare provider in a healthcare setting, but you can buy or rent a machine to use at home.

Vaginal cones or weights

Vaginal cones or weights are an alternative to biofeedback for doing pelvic floor muscle exercises. Vaginal cones or weights are inserted into your vagina and held in place by squeezing your pelvic floor muscles. You can increase the weight over time, as you become more comfortable and stronger.

Vaginal cones and weights aren’t for everyone. Always talk to your healthcare provider before using any device. Stop using these devices if your symptoms get worse or if you develop new symptoms or pain.

Pelvic floor and biofeedback devices are not covered through the Alberta Health Care Insurance Plan, so there may be extra costs involved. If you have extended health coverage, your plan may help cover the cost.

You may have heard or seen advertisements for special treatments or devices to treat urinary symptoms, like laser therapy or incontinence treatment chairs. If you see an advertisement for a treatment that you are interested in, talk to your doctor first. There is often little to no evidence that these options are effective, and they can be very expensive to try.

If you have symptoms of an overactive bladder or urgency incontinence, bladder training (also called bladder re-training) may help. With bladder training, you slowly increase the length of time that you wait to urinate once you get the urge to go. Different ways to delay urination when you feel the urge to go include:

• Stay still instead of running to the toilet.
• Do pelvic floor muscle exercises (Kegels).
• Focus on something else, like counting backwards.
• Take slow, deep breaths in through your nose and out through your mouth, focusing on relaxing your body.
• Cross your legs.

To help find a bladder training program that will work for you, keep a bladder diary for a few days and bring it to your healthcare provider.

Pessaries

A pessary is a silicone device that is placed in the vagina to hold your bladder and uterus in place. They help decrease pressure on your bladder and bowel, increase the length of your urethra, and gently compress the urethra, which helps stop leaking.

Pessaries can relieve your symptoms right away and have minimal risks compared to surgery. Pessaries are usually very effective and most people are satisfied with their pessary.

Pessaries come in different shapes and sizes. Work with your healthcare provider to find a pessary that fits you properly. A pessary should not cause pain or pressure when it is in place. You can keep the pessary in when you go to the bathroom and most pessaries can be worn while having sex.

Once your healthcare provider has fitted you, you can buy the pessary from a few different places, like the clinic where the fitting occurs, specialized pharmacies, medical supply stores, or online.

When you have a pessary, you should get regular vaginal exams. If you can clean and care for your pessary yourself, it is recommended to have a vaginal exam once a year. If you need support caring for your pessary, like if your healthcare provider helps you clean it, it is recommended to have a vaginal exam every 3 months.

Other medical devices

Other devices for stress incontinence are also available. They are inserted into the vagina and apply light pressure on your urethra to slow or stop the flow of urine during activities like coughing, dancing, and jogging. You can still pee normally while wearing one.

A product currently available in Canada is Uresta. Starter kits are available to help you find the right size for you. Talk to your healthcare provider if you are interested in over-the-counter medical device options.

Your healthcare provider may suggest different medicines based on the type and severity of your symptoms. It’s important to follow your healthcare team’s instructions and discuss any side effects or concerns.

• Alpha-blockers: Often used if you have symptoms like a weak urine stream or difficulty starting to urinate. They work by relaxing the muscles in your urethra and bladder, making it easier to urinate.
• Antimuscarinics: Help symptoms of an overactive bladder by controlling bladder sensations and reducing the urge to go.
• Beta-3 agonists: Help with overactive bladder by reducing the intensity of bladder sensations, allowing your bladder to store more urine and reducing how often you urinate.
• Diuretics: If you get up at night frequently, your healthcare provider may recommend a diuretic in the late afternoon to help your body get rid of excess fluid during the day. This can reduce nighttime urination.
• Menopause hormone therapy: Estrogen plays an important role in maintaining the health, strength, and function of your bladder, urethra, and surrounding pelvic tissues. Menopause hormone therapy may help with lower urinary tract symptoms by reversing tissue weakness caused by declining estrogen levels during menopause.
• Antibiotics: If your symptoms are caused by a urinary tract infection (UTI), your healthcare provider may prescribe antibiotics to treat the infection. These medicines help clear the bacteria causing the infection and usually improve symptoms within a few days. It’s important to take the full course as prescribed, even if you start to feel better.

Some people may want to explore surgery options instead of medicine to avoid potential side effects. Some surgeries may not be covered by the Alberta Health Care Insurance Plan, and you may need to pay for them. In some cases, you may also need to travel outside of Alberta for surgery. Talk with your healthcare team to see what might be best for you.