Female Urinary Incontinence

Urinary incontinence is a common problem that affects millions of women worldwide. It is a condition where there is involuntary leakage of urine, which can be embarrassing and inconvenient. This problem can occur in women of all ages, but it is more common in women who are over 50 years old. In this blog post, we will discuss female urinary incontinence in detail, including its causes, symptoms, and treatment options.

Causes of Female Urinary Incontinence

There are many causes of female urinary incontinence, and these can be divided into two main categories: temporary and long-term. Temporary urinary incontinence can be caused by a variety of factors, including:

  1. Urinary tract infections (UTIs)
  2. Constipation
  3. Certain medications
  4. Alcohol and caffeine consumption
  5. Pregnancy and childbirth
  6. Menopause

Long-term urinary incontinence, on the other hand, is usually caused by a more serious underlying medical condition, such as:

  1. Overactive bladder (OAB)
  2. Stress urinary incontinence (SUI)
  3. Neurological disorders, such as multiple sclerosis (MS) or Parkinson’s disease
  4. Pelvic organ prolapse (POP)
  5. Bladder cancer

Symptoms of Female Urinary Incontinence

The symptoms of female urinary incontinence can vary depending on the type of incontinence a woman is experiencing. The main types of urinary incontinence are:

  1. Stress incontinence: This type of incontinence occurs when a woman experiences urine leakage during activities that put pressure on the bladder, such as coughing, sneezing, or laughing.
  2. Urge incontinence: This type of incontinence occurs when a woman experiences a sudden urge to urinate and cannot make it to the bathroom in time.
  3. Overflow incontinence: This type of incontinence occurs when the bladder is not able to empty completely, causing urine to leak out.

Treatment of Female Urinary Incontinence

The treatment of female urinary incontinence will depend on the type of incontinence a woman is experiencing and the underlying cause of the problem. Some common treatment options include:

  • Pelvic floor exercises: These exercises can help strengthen the muscles that control the bladder and improve bladder control.
  • GWHA can give you the full picture when it comes to Pelvic Floor exercises.   Its more than Kegels! 
  • Kegels are an important strategy if the goal is strengthening the pelvic floor.  Like any other muscle the pelvic floor muscles need to start with a healthy and pain-free foundation.
  • SOME CLIENTS SHOULD NOT KEGEL!  Our physiotherapy team will assess each client for their individual needs.  Many clients need to create a healthy pelvic floor foundation through relaxation exercises, implement strategies to reduce pain and address any environmental or emotional triggers BEFORE they start strengthening. 

One way to appreciate if your pelvic floor rests in a healthy relaxed state is to practice deep diaphragmatic or tummy breathing.   As you breath in you should see your belly expand outwards with the movement of your diaphragm but you should also feel like your pelvic floor is gently expanding downwards.  Then on the exhale you should feel and see your abdominal wall tighten and get a sense for your pelvic floor lifting or contracting.  A great place to practice and feel this sensation is sitting on hard chair or stability ball.  The pressure of the seat of the chair or stability ball should increase your pelvic floor awareness.  As you inhale you should feel more pressure into the seat-pan of the chair or stability ball and when you exhale you should feel a gentle lightening feel or lift.  Got it?  You may be ready to add on strengthening!

  1. Medications: There are several medications that can be used to treat different types of urinary incontinence, including anticholinergics, beta-3 agonists, and estrogen.
  2. Surgery: In some cases, surgery may be necessary to correct a problem that is causing urinary incontinence, such as pelvic organ prolapse or bladder obstruction.
  3. Lifestyle changes: Making changes to your diet and lifestyle can also help improve bladder control. For example, avoiding alcohol and caffeine, staying active,  and quitting smoking can all help reduce the risk of urinary incontinence.


Female urinary incontinence is a COMMON problem that affects millions of women worldwide BUT lets NOT NORMALIZE it!

It can be embarrassing, inconvenient and push women into a sedentary and isolated lifestyle.  There are many treatment options available to help manage the problem. If you are experiencing urinary incontinence, a Pelvic Physiotherapist can help you determine the underlying cause of the problem and develop a treatment plan that is right for you. With the right treatment, you can regain control of your bladder and improve your quality of life.

Pelvic Pain

Pelvic pain is a common complaint that affects many individuals, including men and women of all ages. Pelvic pain can be caused by a variety of factors, including injury, surgery, pregnancy, childbirth, and underlying medical conditions. Pelvic physiotherapy is a specialized form of physical therapy that can help alleviate pelvic pain and improve overall pelvic health.

Pelvic Floor Dysfunction

Pelvic floor dysfunction refers to a condition in which the muscles of the pelvic floor become weak, tight, or spasmed. This can cause a variety of symptoms, including pelvic pain, urinary or fecal incontinence, and sexual dysfunction. Pelvic physiotherapy can help strengthen and relax the pelvic floor muscles through exercises, manual therapy, and biofeedback.


Vulvodynia is a chronic pain condition that affects the vulva, which is the external genital area in women. Symptoms of vulvodynia can include burning, itching, or sharp pain in the vulva, as well as pain during intercourse or when sitting for long periods. Pelvic physiotherapy can help alleviate vulvodynia symptoms through the use of manual therapy, relaxation techniques, and exercises to improve pelvic muscle coordination and function.


Endometriosis is a condition in which the tissue that lines the uterus grows outside of it, often on the ovaries, fallopian tubes, or other pelvic organs. This can cause severe pelvic pain, especially during menstruation, and can also lead to infertility. Pelvic physiotherapy can help alleviate endometriosis symptoms by improving pelvic muscle coordination and reducing pain through the use of manual therapy and relaxation techniques.

Interstitial Cystitis

Interstitial cystitis is a chronic condition that causes bladder pain and frequent urination. It can also cause pelvic pain, especially during sexual intercourse. Pelvic physiotherapy can help alleviate interstitial cystitis symptoms by improving pelvic muscle coordination and reducing pain through the use of manual therapy and relaxation techniques.

Pelvic Girdle Pain

Pelvic girdle pain refers to pain that is felt in the pelvic area, including the hips, groin, and lower back. It is often associated with pregnancy or childbirth, but can also be caused by injury or underlying medical conditions. Pelvic physiotherapy can help alleviate pelvic girdle pain through the use of exercises to improve pelvic muscle strength and coordination, as well as manual therapy to reduce pain and improve mobility.

Pelvic physiotherapy can be a highly effective treatment for many types of pelvic pain. By improving pelvic muscle strength and coordination, reducing pain, and improving mobility, pelvic physiotherapy can help individuals regain their quality of life and improve their overall pelvic health. If you are experiencing pelvic pain, it is important to talk to your healthcare provider to determine if pelvic physiotherapy may be an appropriate treatment option for you.

ISM & Pelvic Health Physiotherapy

“I have tried pelvic floor exercises and practice them regularly. My pelvic health /abdominal muscle concerns feel a bit better but not completely or they keep coming back and recurring.”

Has this been your experience?

Well, it is not always just about the pelvic floor.

The pelvic floor muscles do not work alone. They are part of a team that involves your breathing muscle – the diaphragm, the abdominal muscles as well as your back muscles. Our trunk and pelvis are the links between the upper and lower body. When we move load is transferred through our trunk, back and pelvis. The ways or strategies we use for this load transfer can vary. Sometimes, our strategies may contribute to pain, and pelvic pressure and also affect our continence mechanism.

The pelvic floor may not always be the ‘driver’(cause) of your symptoms/pain. It could be just a ‘reactor’ that is compensating or reacting to the ‘driver’. Finding and treating the source of the problem from the start can help achieve positive results. The Integrated Systems Model (ISM) approach helps in doing just that.

The Integrated Systems Model (ISM)

ISM is a whole-body approach that considers the whole person (body and mind) rather than single injuries or individual body parts. The ISM approach is an evidence-based framework developed by world-renowned physiotherapists and educators Diane Lee and Linda Joy Lee. It guides the treating therapist to find the driving cause of pain and/ or symptoms. ISM-trained therapists do not just assess the body part affected. They use special ways to determine which problem areas are ‘drivers’ and which ones are ‘compensators’.

An ISM assessment starts with listening to your unique story to help identify your main concern (meaningful complaint). Then you and your therapist determine a meaningful task. Specific movements and/or postures related to your meaningful task are then assessed. In the ISM approach, the movement tasks that are chosen to be assessed are not necessarily related to the location of pain and/or symptoms, but they are relevant to your functional goals.

From this assessment, an individualized treatment plan is developed. Your treatment session may involve components of RACM (Release, Align, Connect and control, Move). ISM treatment initially focuses on using techniques, manual therapy, exercises and education to ‘release’ and ‘align’ the ‘driver or drivers’. Following the release, muscles are trained if needed ‘connect and control’. The final step is training to ‘move,’ aiming to build and use new and better ‘brain maps’ for improving function and performance. ISM-trained therapists integrate their unique and individual professional training and skills into this treatment approach.

Your story and the relationship between your symptoms/pain and the rest of your body can be assessed by our ISM-trained pelvic health physiotherapist Eliza Pereira-Karve. To learn more and see if you may benefit from an ISM-based assessment and treatment approach call our office at 519-780-0606.



Diane Lee ISM series (2021)  https://learnwithdianelee.com/

Diane Lee Lecture: New ISM perspectives for treating women with PGP, UI, POP and DRA

Diane Lee book: The thorax: an integrated approach

Diane Lee book: Diastasis Rectus Abdominis: A clinical guide for those who are split down the middle

Diane Lee Course: Diastasis Rectus Abdominis & the Implications for Low back & Pelvic Health

Listen to your body…. Orthopaedic Care @ GWHA


The human body is very smart. It has the capability of understanding when something isn’t right. It will send you signals and if you ignore these signals, it will try harder the next time. These signals can come in the form of pain, dizziness, vertigo, burning sensations, fatigue, and stiffness, among others. Before these signals affect your ability to enjoy everyday life, listen to them and take action.

At Guelph Women’s Health Associates, our experienced team works collectively, combining their years of experience to help find a solution to your unique condition. We make sure we accommodate your busy schedule, your comfort levels, your needs, and the uniqueness of your body before we assess or treat you, to make sure you have a positive experience with physiotherapy. Because here at GWHA, we only have one motto:




You might have already heard about our various pelvic health physiotherapy programs that help patients with incontinence, pelvic pain, sexual dysfunction, prolapse, pregnancy and beyond.

But this blog post will focus on highlighting the other conditions we work with.

Are you concerned about your shoulder pain affecting your ability to perform simple tasks?

The shoulder is one of the top treated joints amongst our clientele, as it is one of the most mobile joints in the human body. As a result, we are frequently using it to perform day-to-day tasks. This constant wear and tear can lead to swelling, damage, or bone changes within this joint complex. When you come to see one of our physiotherapists, they perform a detailed manual examination to gain a better understanding of your muscles, ligaments and nerves to deduce the root cause of your functional and structural limitations, creating a unique treatment plan for you. So, book an appointment today to ensure your shoulder is no longer preventing you from fulfilling your daily responsibilities.


Are migraines or headaches affecting your daily life?

We can understand how constant throbbing and pressure in your head can negatively impact your functioning both at home and at work. As physiotherapists, we can help reduce the intensity of your headaches by releasing the tension affecting your muscles and joints and helping strengthen the weaker muscles to restore your mobility and reduce the chance of symptom recurrence. We can also provide you with helpful techniques to improve your sleep and work with you to ensure your workplace is set up efficiently to prevent any neck pain, jaw pain, or unwanted injuries due to faulty techniques and postures. We can also help provide you with some mindfulness tips and tricks to help with stress management as many headaches are often stress-related.


Do you hear a sudden clicking sound in your jaw while chewing, talking or yawning?

These sounds in your jaw, alongside having sharp pain, or experiencing stiffness and aching are all symptoms of Tempero – Mandibular Joint (TMJ) dysfunction. The muscles that surround your TMJ are rich in blood supply and nerves. These muscles and joints can often weaken as a result of improper head and neck posture, degeneration of cartilage, or due to injuries to the surrounding structures. As physiotherapists, we can work towards increasing your knowledge and help you learn more about your own TMJ. We can also provide you with some self-management techniques to ensure relief. When needed, your therapist will also perform manual therapy to help improve your joint mobility and reduce stiffness. Your sessions might also include learning exercises that help with postural correction which in turn helps relax the muscles associated with your TMJ.


Is your knee pain preventing you from returning to your favourite activity?

We use our knees to perform several tasks in our life, such as walking, sitting, climbing stairs, squatting, kneeling, driving, etc. Having pain and discomfort in the knee can prevent us from doing many activities that are necessary. Knee pain can get very frustrating. We understand the importance of your knee and the role it plays in allowing you to participate in activities that you love. As physiotherapists, it is our role to help you understand what factors can be leading to and aggravating your knee pain. We can also help strengthen or relieve tense muscles to ensure your knee is both stable and mobile. Whether it is an occupational job or sport you play, working with us will allow you to learn new techniques and strategies to protect your knee, and prevent injuries.


Are you experiencing any burning, numbness, or tingling sensations in your arms and/ or your legs?

Are you finding yourself losing balance due to extreme knee pain, that often starts from your lower back, or dropping objects regularly? This could be a result of an irritated or compressed nerve.

Nerves are fibers that send signals from your brain and your spinal cord to the rest of your body. When they do not function adequately, you can experience numbness or tingle in your extremities, which can often be associated with weak muscles and sharp pain. But the good news is that damage to nerves can be repaired. However, they need to be treated as a priority. As physiotherapists, we work on calming down your irritated nerve, and can even help dislodge a compressed nerve to prevent irreparable damage. Once your nerve has calmed down, we can also help bring back your sensation along with your strength to help you return to your daily activities. So, if you suspect you have an issue with your nerves, come see us right away.


When many think of physiotherapy, they often imagine an elite athlete working alongside a physiotherapist. If you never looked at yourself through that lens, you may have not considered seeking physiotherapy to either treat or prevent your injuries. However, as physiotherapists, we treat a wide range of problems and are trained and licensed to treat any areas of concern you might have to ensure and prevent the development of any serious problems.

Pregnancy & Infant Loss

Content Warning: this blog post highlights baby loss and infant death while discussing ways to support oneself and others through loss. Please proceed with caution if this topic is sensitive for you. 

October is Pregnancy and Infant Loss Awareness month and we at GWHA want to highlight some support options for bereaved parents. This is a brief introduction to the many ways that you can support your mind, body, and heart through the unique grief that only comes through the loss of a pregnancy or infant child. 


Pregnancy and Infant Loss, or PAIL, captures the myriad of ways that pregnancy can end in death – miscarriage, chemical pregnancy, ectopic pregnancy, termination for medical reasons, stillbirth, neonatal loss, infant loss (including SIDS), loss of a multiple, loss through adoption, loss through surrogacy, and any other loss that a birthing person identifies. The loss of a pregnancy or infant has reverberating impacts on the birthing parent as well as their partners, other children, family, friends, colleagues, and other valuable relationships. It can occur at any time during pregnancy or the first year of the life of a child. It’s the dark side of pregnancy, the antithesis of the hope, joy, and excitement we all associate with pregnancy. Open discussion about PAIL-related grief is growing and we welcome the destigmatization and ever-evolving support that bereaved parents can and should receive from all of the people that touch their lives. 


Bereaved parents may feel left adrift with few reliable places to turn for high-quality, trauma-informed support. We encourage everyone to consider these options if they feel right for you or to reach out to the clinic for more detailed options as needed. 


Have you drank any water today? What about a nourishing meal? Taken a shower? Gotten outside for a breath of fresh air? These may sound like simple tasks, but if you find yourself here as a loss parent, you know they are full of complexities. We cannot grieve and heal without properly caring for our bodies, so when you have an opportunity, check in with yourself and address your basic needs. If that is all you do today, good for you – you did something that you didn’t think you could do. 

Allow your wounds to heal. If you birthed your child, you will still require 6-8 weeks of physical recovery time, just as you would if your baby survived. Loved Momma Fitness and Two Peas Wellness offer beautiful online options for honouring your physical journey and returning to fitness. A trauma-informed health care practitioner, such as a pelvic health physiotherapist, osteopath, acupuncturist, massage therapist, or somatic/energy healer (Reiki, etc) can be helpful for birth and trauma recovery when you feel ready. 

Lastly, create healthy boundaries when you need to. Need more time off of work? Take it if you can. Need some alone time from your partner, living children, or well-meaning family members? Let them know. Want to stop talking about your loss for a bit? Be honest with those who ask. Want to hear your baby’s name more often? Make that request from those who also loved your baby already. Many bereaved parents report feeling multiple and conflicting emotions about their loss, often on the same day. Try your best to communicate your needs, and if that is too difficult (hello, more work for the griever is NEVER a good idea!), then gently ask for space, a change of words/phrases, and/or remove yourself from any situation that doesn’t feel safe for you. You are allowed to grieve in any way you need to and others will grow to respect that in time. 


Grief is a complex journey and requires mindful approaches to gently ease yourself back into the world of the living. When it feels like your world has been upended, but the rest of the world carries on, what can a person do? We suggest the following:

– Reach out to a trusted, gentle friend or family member for a good cry, a firm hug, or a quiet listening ear.

– Find your people – consider joining a peer support group. Our most frequent recommendations include the Pregnancy and Infant Loss Support Centrethe PAIL Network, and Bereaved Families of Ontario – Midwestern Region for comprehensive, in-person and virtual peer support options for families and losses of all kinds.

– Consider individualized or couples therapy – any practicing social worker, psychologist, or counsellor licensed in Ontario can be accessed through virtual care now. If you prefer in-person therapy services, many practitioners have re-opened their doors to support grieving families. A grief coach is another option too for those looking for something similar to therapy, usually at a reduced cost.  

– Use social media at your discretion – there are MANY amazing online support networks in the world of social media. You can start by accessing our list of Supportive Social Media on the website and continue as far as the algorithm will take you. Be mindful of your energy and what feels right for you and only consume the social media that brings you to resolve, rather than more heartache. Do you feel seen when reading that person’s posts or do they make you feel worse? It’s ok to only intake what feels right for you at this time (and that may vary daily).

– Read a good book, if you can. If you prefer to avoid grief literature, consider picking up your favourite novel to re-read, your preferred religious scripture, or something new to create a brief escape. If you’re looking to deep dive into the multitude of grief-related writing available, check out our Reading List for PAIL, or consider making a small purchase from Melissa Sulley, Certified PAIL Coach and accessing her PDF Resource Guide

We’re sorry you have found yourself here as a bereaved parent, a new member in what many call the worst club in the world. We see you and honour your journey and your baby. They will be missed in this world. We hope you can find your way in the dark to the place where grief and joy meet again.

Welcome to GWHA

Welcome to the first GWHA blog post! This has been a long time coming. Our hope is to offer you monthly educational posts to help you understand your body, your diagnosis, and an opportunity to learn more about what pelvic health physiotherapy is and how it can help you on your Path to Improved Health. But, first, a quick review about who WE are and what we offer to Guelph and the surrounding community.



Do you know we’re renovating?! We’ve started revamping and expanding our space to better serve YOU and our community. Everyone at GWHA wants you to feel comfortable coming into clinic and seeing our familiar faces and brand new space, so let us welcome you with a sneak peek at Guelph Women’s Health Associates.

We can’t wait to show you our new space and hope to have the dust settled by the end of 2022.



Our team has grown and changed a lot since we opened in 2017 so here’s a quick reintroduction of the most frequent faces at GWHA.


Aishwarya Desai, PT Resident

Aish graduated in 2020 and has been navigating the pandemic-afflicted national exam process that has been on hiatus since the spring of 2020. As a Physiotherapy Resident, Aish can perform all of the same assessment and treatment skills as a Registered Physiotherapist and brings thousands of hours of experience to our clinic. Her clinical interests are broad and she brings fresh blood to our pelvic and orthopedic programs. She is especially interested in neural and fascial treatment techniques and always provides the team with innovative ways to manage their more difficult cases.

Aish has experience treating urinary, fecal and urge incontinence, pelvic organ prolapse, and postpartum recovery. She is up-to-date with the latest recovery techniques for caesarean birth and enjoys helping women get back to “feeling like themselves” after labour and delivery.

When Aish isn’t in the clinic, you can find her planning her next travel adventure, cooking up a new recipe, or deep diving into the latest historical fiction TV series!


Eliza Karve-Pereira, PT

Eliza is our newest team member and brings a wealth of knowledge to our clinic to support peri-natal and peri-menopausal women. The rest of the team was excited to welcome her after her yearlong mentorship under one of her favourite physiotherapy gurus, Diane Lee.

Eliza excels in patient-centred goal setting and treatment planning. She strongly believes that optimal health is a combination of a healthy body, and a resilient spirit and mind. She uses a whole-person treatment approach that involves sensitive communication, education, manual therapy, and individualized exercise prescription and modalities.

Eliza loves to explore the world with her spouse and is a self-proclaimed foodie.


Janet MacKinnon, PT

Janet is the OG physiotherapist who opened GWHA in 2017. Her passion for supporting women through pregnancy, post-partum, and beyond is evident in her ever-growing list of continued education courses and certifications. An avid runner and athlete herself, her special interest is helping women remain active through their lifeline while helping them navigate any concerns they have about their pelvic health during sport.

Janet treats a gender-diverse clientele and is always expanding her knowledge to better support the 2SLGBTQIA+ community.

Maintaining her own active lifestyle throughout her motherhood journey has laid the groundwork for her three daughters to become active members of their athletic communities and Janet is frequently returning to clinic on Monday mornings with a hoarse voice as she cheers on her girls in arenas, fields, and pools across Ontario!


Shannon Clutton Carr, PT

Shannon has been at GWHA since 2018 and is our resident Pilates instructor, having introduced Clinical Pilates to EPA in 2011. She has many years of orthopedic and pelvic health experience, offering authentic connection and educational empowerment to help you navigate your physiotherapy concerns.

Having two living children of her own, she recently developed an interest in supporting people through their infant feeding journeys and pediatric motor development. Shannon works closely with multiple team members locally to assist parents navigating treatment for issues like tongue tie, torticollis, latching issues, and head shape concerns.

Shannon grew up dancing ballet in Guelph and still has a soft spot for treating dancers of all ages. She still loves a good kitchen dance party with her family and tries to set a good example for her kids by semi-regularly hopping on her Peloton.


Dr. Robin Urekar, ND

We can’t forget about our resident Naturopathic Medicine Doctor, Dr. Robin, who recently welcomed her first daughter. Although Dr. Robin is on maternity leave until 2023, her locum, Dr. Christina DeGiuli, is available for virtual appointments.

Dr. Christina’s clinical practice is focused on women’s health and hormones, including treating those with thyroid disorders, PCOS, and fertility challenges. Her ultimate goal is to empower women to feel their absolute best so they can achieve everything they always wanted. You can connect with Dr. Christina here and continue to learn from Dr. Robin on Instagram.


Jessica Dorado, Administrator Extraordinaire

Jessica is our head administrator and sees to the day-to-day smooth operation of our clinic. She’s your team member for any questions you may have about billing, insurance, scheduling conflicts, and general inquiries. Jess personally trains all of our staff to navigate our booking and billing system and we would be lost without her!

When not at the clinic, Jessica enjoys finding gluten-free gems in and around Guelph, hiking, and yoga.



More in-depth profiles can be found under the GWHA Team tab on the main page, and you can always call the clinic to talk with a clinician prior to booking with them to ensure they are the best fit for your journey towards pelvic health and beyond. We can’t wait to meet you!