What is pelvic floor physical therapy?

Pelvic Floor Physical Therapy is specialized physical therapy aimed to treat pelvic dysfunction and promote optimal pelvic health for both women and men. Pelvic floor dysfunction refers to a wide range of diagnoses pertaining to the pelvic muscles and the pelvis, including urinary/bowel incontinence, pelvic pain, pelvic organ prolapse, and postpartum pelvic girdle dysfunction to name a few. At least 1 out of every 5 Americans will suffer from a pelvic floor dysfunction at some time during their life.

Why would I need pelvic floor physical therapy?

There are a multitude of reasons one may need pelvic floor physical therapy. Pelvic dysfunction occurs when pelvic muscles become weak, tight, or when there is an imbalance within the surrounding joints including, lower back, hips, and coccyx. The pelvic floor is an integral part of your core stabilization system, which works intimately with your organs, bones and joints in the region. It is always working throughout the day and is often overlooked as the cause of many issues related to pelvic pain, urinary and bowel incontinence and lower back pain.

Specialized pelvic floor physical therapists help men and women across the lifespan continuum, including young athletes, childbearing aged women, peri-menopausal women and men with pelvic health complications.

What is the pelvic floor?

The pelvic floor is a group of muscles that attach to the pelvis. Their function is to support your organs, allow for elimination, stabilize your pelvis and hips, and promote sexual function. Remember pelvic floor muscles are just like any other muscles in the body. They contract, relax and function like a bicep muscle would. Because our daily pelvic functions, include urination, elimination and sexual function; it is important to remember your pelvic floor can be influenced by your organs, abdominal muscles and skeletal system and vice versa. For example, urinary incontinence is not “just a weak bladder” as thought by popular belief. But incontinence occurs because of pelvic muscle weakness, altered coordination of bladder, brain and pelvic muscles, as well as poor toileting habits.

Do men have pelvic floors too?

Of course! Even though men do not carry children or go through menopause, men have a pelvic floor which functions similarly to a woman’s pelvic floor. Men with pelvic floor dysfunctions will report a slower urine stream, difficulty or pain with erection, tailbone/lower back pain, constipation, or bowel or bladder incontinence. It is not uncommon for a man to have an increase in these symptoms after having any kind of prostate surgery or hernia repairs.

What can I expect during Pelvic Floor PT Evaluation?

Your first evaluation includes a one-on-one visit discussing your concerns and symptoms related to your pelvis and daily activities. You will have the opportunity to share your past medical history, including pregnancies, abdominal or back surgeries, and gynecological/urinary history. Your exam may include general movement like bending forward and backward, observing your body mechanics and strength testing. A comprehensive review of the pelvic floor musculature, pelvic organ function and normal bladder/bowel habits will also be discussed.

During the follow up visit, an external and internal assessment of your pelvic muscles (through the vaginal or rectal canal) may be valuable, however you have the option to choose or refuse any part of the process with which you don't feel comfortable.

An external pelvic floor assessment includes a visual assessment of the skin, symmetry and color of tissues, and observation of muscles performing a contraction.

An internal pelvic floor muscle assessment includes checking all layers of pelvic floor for strength, mobility, pain, symmetry and control. Therapist will also palpate muscles in all three layers of the pelvic floor to assess the coordination for functional activities like coughing, lifting and relaxation.

What is biofeedback? Does it hurt?

Some physical therapists synthesize more information by performing a biofeedback assessment. Biofeedback assessments are performed by inserting a sensor either vaginally/rectally or by placing electrodes near perineum. The sensor is then connected to a computer program which will guide you through a series of tests. The sensors are used to measure the electrical activity of the pelvic floor muscles at rest and when contracted. From the biofeedback information, the therapist can see if the patient has good muscle activity or an uncoordinated muscle pattern. The therapist can also determine if the patient needs to work on slow or fast twitch muscle contractions or both. This assessment should not be painful or uncomfortable, but is helpful to developing an overall picture of your pelvic floor health.

What happens at additional treatments?

The therapist designs individualized programs depending on the findings from the evaluation. The PT may prescribe breathing and core stability exercises to improve the coordination of all muscles in the pelvis, back and core. They may also recommend relaxation and behavior modifications to improve pain or learn control for your daily toileting habits. Initially, you may require assisted neuromuscular training such as manual feedback via the internal pelvic muscles to improve muscle tone, activation and coordination.

You will be given daily homework to assist your healing and pelvic control.

Do I need a prescription?

Yes! Just like traditional physical therapy you will need a prescription for the treatments to be covered under your insurance. However, the prescription must say “Pelvic Floor PT.” Your primary care provider, gynecologist or urogynecologist may write this type of prescription. Many pelvic conditions have multiple causes and may require a specialist to rule out more serious conditions. Therefore, it is necessary to have your medical provider to help coordinate care.

My gynecologist told me to do “Kegels”. I do them every day, but I am not sure if they help to improve my leakage? What is going on?

Kegels or a pelvic floor contraction are important to strengthen and maintain good function of the pelvic floor including improving incontinence. However, research shows 40% of women perform Kegels incorrectly and can promote more leakage! Many women who have leakage with coughing, laughing, sneezing have an altered pattern of contracting their pelvic floor muscles. Pelvic floor PT can teach you to re-train your pelvic muscles to properly coordinate a contraction to eliminate or minimize most types of urinary incontinence.

How does the Pelvic Floor work with the core?

Remember, your pelvic floor is one aspect of the core. Our core is made up of the diaphragm (breathing muscle), transverse abdominals, multifidus (small spine muscles) and pelvic floor. These four muscles make up the core! They must work together and manage your everyday movements and daily eliminations. They cannot, and should not be addressed independently from each other. The diaphragm and pelvic floor synchronize to monitor the pressure in your abdomen. Think of the pressure that occurs in your belly when you sneeze. Oh gosh! This is scary for some…just thinking of it makes you think, “Squeeze the knees.” If the diaphragm and pelvic floor do not coordinate well, leakage and other pelvic related dysfunction can occur.


Dr. Amanda Heritage, DPT

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