For clinicians. McMaster Women's Health Review, October 16, 2026
The evidence from Kristen's ten minutes, the four words worth a referral, and how to send a patient to us. Everything on this page is cited and the citations are linked.
See the evidence Refer a patient
Everybody has a pelvic floor. At midlife it shows up in the history as peeing, pooping, pain or pleasure, and most patients will not raise it unless you do. One question in each lane is enough.
"Do you leak with a cough, a sneeze or a run? Do you plan your day around bathrooms?"
"Do you strain? Do you feel finished?" Most people who say they are not constipated change their answer after those two questions.
"Is sex painful, or have you stopped?"
"Has arousal or orgasm changed?"
Every number Kristen used on stage, with its source. Nothing here is from memory.
| Finding | What it means |
|---|---|
| 56% vs 6% | Women with stress incontinence who did supervised pelvic floor muscle training reported cure, compared with 6% of controls. Cured or improved: 74% vs 11%. For any type of incontinence, cured or improved 67% vs 29%.Dumoulin C, Cacciari LP, Hay-Smith EJC. Cochrane Database Syst Rev 2018. 31 trials, 1,817 women. PMID 30288727 |
| First-line | A three-month supervised, progressive pelvic floor muscle training program, taught by a health professional, is first-line treatment for stress urinary incontinence. Strong recommendation, high quality evidence (Recommendation 11).Carlson K, et al. Canadian Urological Association guideline on female stress urinary incontinence. CUAJ 2024. PMID 38648655 |
| 17.8 per 100 | New urinary incontinence is most likely to begin in early perimenopause (17.8 new cases per 100 women per year) rather than after menopause (8.2 per 100). Frequent leaking tracked with weight gain, anxiety and diabetes more than with menopause stage.Waetjen LE, et al. Study of Women's Health Across the Nation (SWAN). Obstet Gynecol 2009. PMID 20168098 |
| 81% vs 69% vs 39% | For urge incontinence in women aged 55 to 92, behavioural training reduced incontinence episodes by 80.7%, compared with 68.5% on oxybutynin and 39.4% on placebo. 74% rated themselves much better. Bladder training is a Grade A "offer to all" statement in the 2024 AUA/SUFU overactive bladder guideline (Statement 11).Burgio KL, et al. JAMA 1998. PMID 9863850. Cameron AP, et al. J Urol 2024. PMID 38651651 |
| 447 women | One-to-one pelvic floor muscle training reduced prolapse symptoms at 12 months compared with a lifestyle advice leaflet (adjusted difference 1.52 points on the POP-SS, p=0.005).Hagen S, et al. POPPY trial. Lancet 2014. PMID 24290404 |
| Pessary = training | Pessary and pelvic floor training gave the same overall symptom improvement at two years for prolapse, and the pessary cost less. Adding a pessary to training beat training alone in a separate 276-woman trial.Panman CM, et al. Menopause 2016. PMID 27504918. Cheung RYK, et al. Obstet Gynecol 2016. PMID 27275798 |
| 80% vs 22% | Biofeedback for dyssynergic defecation produced major improvement in 80% of patients compared with 22% on laxatives, sustained at 12 and 24 months.Chiarioni G, et al. Gastroenterology 2006. PMID 16530506 |
| 12 weeks | In postmenopausal women with GSM and incontinence, 12 weeks of pelvic floor muscle training reduced GSM symptoms and signs and improved blood flow in the internal pudendal and dorsal clitoral arteries, pelvic floor relaxation and vulvovaginal tissue elasticity. These are single-arm studies. The randomized comparison with vaginal estrogen is registered and not yet published, so the honest line is that physiotherapy treats the tissue and sits beside estrogen, not instead of it.Mercier J, et al. Maturitas 2019. PMID 31133219. Mercier J, et al. Climacteric 2020. PMID 32105155 |
| Pain down | Physiotherapy techniques reduce pain and improve quality of life in dyspareunia (pain SMD -4.43). In deep endometriosis with superficial dyspareunia, five pelvic floor physiotherapy sessions cut pain with sex by a median of 3 points out of 10 and improved levator relaxation.Fernández-Pérez P, et al. BMC Women's Health 2023. PMID 37482613. Del Forno S, et al. Ultrasound Obstet Gynecol 2021. PMID 33428320 |
| Early evidence | Vibrator use improved sexual function over three months in a 53-woman pilot, with trends toward less urge incontinence and less prolapse bother. In women unable to contract the pelvic floor, vibration increased muscle strength more than electrical stimulation. Blood flow and nerve effects are proposed mechanisms, not yet measured.Dubinskaya A, et al. Int Urogynecol J 2024. PMID 38668760. Rodrigues MP, et al. Eur J Obstet Gynecol Reprod Biol X 2019. PMID 31403114 |
| 1 in 4 | Of 1,366 women with urinary incontinence, 25% sought care and 12% reached a specialist. In the midlife SWAN cohort, 61% never sought treatment.Minassian VA, et al. Int Urogynecol J 2012. PMID 22527544. Waetjen LE, et al. Menopause 2018. PMID 28763399 |
| 46% | Of 4,556 women with pelvic floor symptoms, 46% had stopped an exercise they used to do because of those symptoms.Dakic JG, et al. J Sci Med Sport 2021. PMID 34244084 |
| Position matters | Resting pelvic floor activity is higher with the ankle in dorsiflexion than plantarflexion, and pelvic floor EMG rises from lying (16%) to standing (30%) to a parallel squat (41%). This is why we assess standing and train in the positions where leaking happens.Chen HL, et al. Urology 2005. PMID 16040089. Rodríguez-López ES, et al. Life 2025. PMC11766776 |
Say it in one sentence. "Leaking, heaviness and pain with sex are common at midlife and never normal. Pelvic floor physiotherapy is the first-line treatment, and I would like you to see one."
A warm hand-off matters. In urogynecology clinic cohorts about a third of referred women never attend and fewer than half complete, so name the clinic and the first step before she leaves the room (Brown 2020, Shannon 2018).5 Things Nobody Tells You About Your Pelvic Floor and Sex. Written by Kristen for patients, in plain language. She enters her email and the PDF arrives in minutes.
pelvicfloorguide.blueberrytherapy.caThe Hole Shebang (H-O-L-E) is Kristen's pelvic health podcast. Over a hundred episodes with the researchers and clinicians behind this evidence, including Stuart Phillips on muscle in menopause, Michelle Lyons on the musculoskeletal syndrome of menopause, and Sarah Shaw on vaginal estrogen safety.
podcast.blueberrytherapy.caBlueberry Therapy Pelvic Health and Pediatrics is a multidisciplinary clinic in Dundas, Ontario, founded in 2017 by Kristen Parise. We treat people of every age and gender with bladder, bowel and sexual dysfunction, and we talk about pee, poop, pain and sex without shame, because the only awkward conversation is the one we are not having.
The name comes from the contraction cue we teach every day: draw a blueberry up and in.
14 Cross Street, Unit B, Dundas, Ontario
blueberrytherapy.ca | 289-238-8383 | hello@blueberrytherapy.ca
refer.blueberrytherapy.ca
