Did you know there is a specific type of physical therapy that solely addresses conditions within the pelvic region? It is called pelvic floor physical therapy, or you may also hear it referred to as women’s and men’s health physical therapy. Pelvic floor physical therapy addresses conditions within the pelvis, which is the area between the lower abdomen and the thighs. It can be appropriate for women, men, and children of all ages. The pelvic floor is made up of a group of muscles that function to maintain urinary and fecal incontinence, provide support to our organs, and serve an important role in our sexual function. It is not uncommon for a woman to suffer from urinary incontinence after childbirth or to suffer from painful intercourse at some point in her life. The good news is both of these examples can be resolved with pelvic floor physical therapy. However, due to the perceived embarrassment a woman may feel discussing these sensitive areas coupled with the lack of knowledge that this specialty area of physical therapy even exists, it is not uncommon for women to go years or even a lifetime suffering in silence. There are many conditions of the pelvic floor that impact women and pelvic floor physical therapy should be part of a conservative treatment strategy.
What conditions are appropriate for pelvic floor physical therapy?
Pelvic floor physical therapists are trained to treat conditions related to the bladder, bowel, and pelvic organs causing pain and other problems. Below are examples of some of the more common conditions.
• Bladder conditions including urinary incontinence (any involuntary loss of urine), urinary urgency and/or frequency, difficulty initiating the flow of urine, and difficulty completely emptying the bladder.
• Bowel conditions including constipation, fecal incontinence (any involuntary loss of stool), and incomplete bowel emptying.
• Pelvic Organ Prolapse, which is considered any slippage of the pelvic organs into the vagina.
• Pelvic pain can be felt externally within the pelvic region from the area of your belly button to your mid-thighs on the front and/or back part of the body. Additionally, it can be felt internally vaginally or rectally. This can include any pain felt upon sitting, pain or difficulty with intercourse, pain or difficulty with tampon insertion or gynecological exams, bladder pain, tail bone pain, menstrual pain, and vulvar pain that could prevent you from wearing certain types of clothing.
How does a woman develop symptoms within their pelvic floor?
This is a tricky question. Some women are able to pinpoint the reason for their pelvic floor symptoms, while others are not. Pelvic floor symptoms can develop for a variety of reasons and may be the result of a single factor or of multiple factors. Any type of trauma, which can include pregnancy and childbirth, surgery in or around the pelvic region, an infection such as a urinary tract or yeast, sexual abuse, or a direct fall can cause the muscles in and around the pelvic region to tighten, to weaken, or both. This can result in pelvic floor symptoms. Additionally, a woman’s lifestyle can contribute. Years of poor posture, poor diet, poor sleep habits, and genetics might be a reason for the development of pelvic floor symptoms.
What physical therapy treatments are available?
• Manual therapy is a type of hands-on treatment. It can include checking and correcting pelvic alignment, hip and spinal manipulations and mobilizations, and soft tissue work including trigger point release, connective tissue manipulation, myofascial release, and visceral mobilizations. Manual therapy can be performed both externally and internally. These techniques can help to decrease tension and pain and to increase blood flow. Manual therapy is typically the primary treatment for pelvic pain conditions.
• Therapeutic exercise can range from relaxation and stretching exercises to strengthening exercises. Stretching of the muscles that surround the pelvic floor, such as the abdominal and hip muscles, can be beneficial for pelvic pain conditions. Stretching of the internal pelvic floor muscles can be done via dilators. There are many different brands and sizes of dilators and your physical therapist will be able to instruct you in a program that is specific and appropriate for you.
Relaxation exercises are also indicated for pelvic pain conditions. Performing deep belly breathing and discovering positions that allow the pelvic floor to be in a relaxed position can help to decrease pain. Strengthening exercises, on the other hand, are often indicated for conditions associated with weakness, such as incontinence and prolapse. Strengthening of the pelvic floor is done via Kegels, which is a pelvic floor muscle contraction. A proper contraction is done by contracting the entire pelvic floor as if you were holding back urine and gas at the same time. This is done while maintaining a normal breathing pattern and not engaging the surrounding external muscles. Additionally, strengthening of the surrounding core musculature can be beneficial. Strengthening exercises should be tailored to each individual, therefore, the length of time you should hold a contraction, the number of repetitions to perform, and the position in which to perform can vary greatly from one woman to the next.
• Neuromuscular re-education is indicated when you have difficulty coordinating your muscles. For example, the pelvic floor muscles might “think” they are relaxing when in fact they are contracting. Or, they might “think” they are contracting when they are actually relaxing. Proper coordination of the muscles is important in order for the muscles to function properly.
• Modalities such as biofeedback and electrical stimulation may also be considered as part of the treatment plan. Biofeedback is a way you can have a visual and/or auditory cue to better understand the muscle activity that is occurring within the pelvic floor. Electrical stimulation can be helpful to control pain as well as to help strengthen pelvic floor muscles that are extremely weak. Both biofeedback and electrical stimulation can be used externally or internally.
How to locate a pelvic floor physical therapist?
Since pelvic floor physical therapy is a unique specialty area, it can be difficult to find a physical therapist with the proper training to treat your condition. I would first recommend discussing your concerns with your physician and ask if they feel pelvic floor is appropriate, and if so, if they are familiar with anyone in your area that is a pelvic floor physical therapist. Additionally, there are websites such as http://www.womenshealthapta.org/pt-locator/ and https://pelvicrehab.com/ that have a “PT Locator” function.
By: Angela Dobinsky, PT, DPT
Please email Angela Dobinsky at firstname.lastname@example.org with questions.