Ask A Pelvic Health Physiotherapist

We ask health and wellness professionals the same six questions we always ask. This week, TWO DOULAS talks to pelvic health physiotherapist Amadea Kezar.

Amadea Kezar is a certified physiotherapist and member of the Ordre professionnel de la physiothérapie du Québec (OPPQ) who has been working in rehabilitation for 11 years and practising pelvic floor physiotherapy for the past five. She earned a Master’s degree in physiotherapy from McGill University and went on to specialize in Pelvi-Perineal Re-education for men and women. Travel is Amadea’s second passion and she pursues it in earnest. When in the city, she enjoys dinner parties (where she can talk travel), long urban hikes, and having a good laugh with friends and family. 

How would you describe your job in just one sentence?

I help people identify and improve the function of the pelvic floor and its accompanying structures in order to maximize urinary, anorectal and sexual function, as well as to control pain.

What made you want to be a pelvic health physiotherapist? 

I have always had a love of anatomy and physiology. Physiotherapy is a helping profession that allows me to use my interest in these areas to positively impact someone’s quality of life. As I started looking specifically into pelvic health it quickly became clear that pelvic floor dysfunction was an under treated and somewhat “taboo” issue that could seriously disrupt a person’s quality of life. As a clinician the draw was that the cases were unique and stimulating but it was the people that locked me into the work. Pelvic floor dysfunction is intimate and can be very stressful for the person experiencing it thus developing patient-therapist trust is integral to successful treatment. Building that bond while educating my patients is something I genuinely enjoy and I feel resonates throughout the work.

How can new parents or expectant parents benefit from your services?

Come early during pregnancy and postpartum and ask loads of questions! Knowledge is power! Treatments are an hour and the goal is to demystify what is happening to the patient’s body and what to expect. Often patients are surprised by how small functional changes in how we move, toilet or have sex can make tremendously impact comfort, birthing, recovery or reconditioning. After leaving the office patients should have a significantly improved understanding about what is normal, what is not normal and what they can help control in order to get the best out of their bodies for the new work it must support.

What happens at your first meeting with a new or expectant parent?

First, we do a thorough history including medical, birthing, symptom history which includes questions about urinary, anorectal, sexual function and pain. Next, we do the physical exam which includes a global assessment (posture, movement patterns, breathing, and abdominals) and an internal pelvic exam. During the internal pelvic exam (no speculum ladies) I am looking at pelvic floor strength, endurance, speed and anything that may be negatively affecting these (tension, scar tissue, and nerve irritation). The patient’s symptoms and goals guide the exam some and this is by no means an exhaustive list of what I evaluate but it’s a good start. Once we’ve looked at the pertinent structures then the patient is given exercises and/or advice based on the most important areas that require attention. This work is a partner project, everyone as homework and we progress the work at consecutive follow-ups.

What’s the biggest misconception people have about your field?

There are two very common misconceptions: First, that “Kegels” are the only thing I do … and that’s false. Pelvic floor exercise is only a small part of my work and the focus is on muscle control, coordination with other muscles, and timing. In a lot of cases the pelvic floor needs to be relaxed not strengthened! I will actually assess and treat anywhere between the ribs and the thighs. The cases I see can vary from pregnancy related urine leakage to chronic vulvo-vaginal pain to bowel dysfunction from pelvic radiation so the treatment tools also vary. Other tools of the trade are manual therapy, internally and externally to improve comfort, tissue mobility or joint alignment; electrical stimulation or biofeedback to help patients locate the pelvic floor; fitting pessaries (silicone forms) that women can wear to support pelvic organ descent or taping techniques to brace or body awareness training. In cases of genital, abdominal or pelvic pain relaxation and pain control strategies are taught alongside the physical work. Posture and functional fully body exercise is important as well. Again this is not an exhaustive list but it’s a good start. For the pelvic floor to work well, the surrounding muscles, nerves and tissues need to be functioning just as well.

The second misconception is that I only treat women … Men have pelvic floor dysfunction too!

What do you love most about working with new and expectant parents?

How engaged this population is! They are interested and motivated to be well and functional because they have or will have a little one to take care of. I really enjoy being a support, easing minds and working together to explore practical solutions to the physical issues they are presenting with.