Pelvic floor dysfunction is far more common than it seems. Studies show that 25% of adult US women suffer from one or more pelvic floor disorders. Many, however, are reluctant to talk to their healthcare provider because they feel uncomfortable or embarrassed to discuss their symptoms.
Pelvic floor issues arise when the pelvic floor muscles are weakened, stretched, or too tight. Pelvic floor therapy works by either strengthening or re-training your pelvic muscles. Acquiring an individualized training program for every individual with a pelvic dysfunction issue is crucial to achieving the best results.
Pelvic floor disorders can have a significant impact on a person’s quality of life. Pelvic floor therapy can help improve or reverse these conditions and other symptoms associated with pelvic floor dysfunction, getting you back to normal functioning. Read on to learn more about pelvic floor dysfunction and how pelvic floor therapy can help, as well as what to expect during a pelvic floor evaluation and therapy.
First, what is the Pelvic Floor?
The pelvic floor refers to a group of muscles at the base of the pelvis, which supports the pelvis system. It separates the interior of the body from the lowest part of your pelvis structure where the urethra, external genitalia, vagina, and anus can be found.
The pelvic floor muscles span from the coccyx (the tailbone) to the rectum and the sides of the pelvic bone. The funnel-shaped musculature structure forms a “hammock” to support and protect the pelvic organs. Made of thick skeletal muscles, the openings confine within the pelvic floor, including the anus, urethra, and vagina, rely on the pelvic floor muscles for normal functioning.
Common Causes of Pelvic Floor Dysfunction
In women, pregnancy and childbirth pose the main risks of pelvic floor disorders. The pelvic floor muscles can become strained, particularly if the baby is big and the labor was long or difficult.
Other factors that can lead to pelvic floor dysfunction include the following:
- Stress or direct trauma to the pelvic floor muscles
- Excessive strenuous exercises
- Recurrent cough
- Chronic constipation or straining to poop
Pelvic floor disorders also tend to become more common as a woman ages. Mothers who give birth to their first baby at a mature age, as well as family history, are also found to increase the possibility of developing pelvic floor issues.
Pelvic Floor Dysfunction: Common Symptoms
Pelvic floor dysfunction is a common condition marked by the inability of a person to correctly relax and coordinate the muscles in the pelvic floor to urinate or to have a bowel movement.
There are different types of pelvic floor dysfunctions. In most cases, the issues occur along with other symptoms and may cause overlapping effects. Some of the symptoms associated with pelvic floor dysfunction include:
- Lower back pain
- Leakage of urine or stool
- Lack of sexual sensation in women and trouble reaching orgasm
- Pain during sexual intercourse
- Urinary issues including painful urination or frequent need to pee
- Constipation or straining to evacuate (release) a bowel movement
- An incomplete bowel movement
If you have any of the symptoms mentioned above, know that help is available. By understanding the risks and symptoms, and taking appropriate action, pelvic floor dysfunctions can be corrected and possibly avoided altogether.
What Is Pelvic Floor Therapy
Pelvic floor physical therapy is a treatment approach to help address weakness, pain, and dysfunction in the pelvic floor muscles. Pelvic floor therapy uses the principles of physical therapy to provide a structured, effective, and safe reconditioning of pelvic floor muscles.
During your initial appointment, your therapist will typically make an assessment, which may include an evaluation of both external and internal muscles. The type of treatment your therapist may prescribe you will largely depend upon the symptoms you are experiencing.
When to See a Pelvic Floor Therapist
The pelvic organs consist of the urinary bladder, uterus and cervix, vagina, and rectum. These are the organs that assist in urinary and bowel continence, as well as sex and overall stability.
If you have weakened pelvic floor muscles, you may experience bladder or bowel incontinence, pelvic and/or lower back pain, sexual dysfunction, or pelvic organ prolapse (when one or more of your organs in the pelvis slip down from their normal position, causing them to protrude into the vagina).
If the muscles of the pelvic floor are tight, you may experience myofascial pain (chronic muscle pain), constipation, difficulty urinating, or pain during sexual intercourse.
Many of these pelvic issues can be treated or managed without the need for surgery. Below are some of the common pelvic conditions that can often be treated with pelvic floor therapy:
- Endometriosis – when the tissue that lines the inside of the uterus or womb, called the endometrium, grows outside of the uterus. Endometriosis is most often found on the ovaries, fallopian tubes, and the outer surface of the uterus. Symptoms vary and can include severe menstrual cramps, heavy menstrual bleeding, spotting, bowel movements discomfort, and fertility issues.
- Incontinence Issues
- Urge Urinary Incontinence – when you feel a sudden, strong urge to urinate even when your bladder isn’t full and the urinary bladder contracts when it’s not supposed to. Thus, you feel the need to urinate more often.
- Stress Urinary Incontinence – when urine leaks out whenever you exert pressure on the bladder and urethra that occurs when laughing, coughing, sneezing, or when you exercise.
- Fecal Incontinence – when you lose control of your bowel movement, causing stool or feces to leak unexpectedly from your rectum before reaching the toilet.
- Vaginismus – an involuntary tensing of the muscles of a woman’s vagina when penetration is attempted, which can cause sexual intercourse painful or impossible.
- Painful Sex
- Pelvic Pain
- Pregnancy and Post-Partum Wellness
What to Expect During Your First Pelvic Floor Appointment
It is typical for patients to have questions concerning what to expect during the first appointment with a therapist when addressing pelvic health issues. Here is a walkthrough of what you can expect during your first visit for a pelvic floor therapy appointment:
Step 1: Discussion of Medical History and Symptoms
The first portion of your initial appointment will likely be dedicated to discussing your medical history, lifestyle, and the symptoms you are experiencing. You may be required to answer questions about your injury history and what makes the symptoms worst or better. The information you provide will help your therapist understand your concerns and collect information to guide them in coming up with a treatment tailored for your specific condition.
Step 2: External Exam
The second half typically consists of an external examination and a brief educational session regarding pelvic health. The external exam involves assessment of your lower back, sacroiliac joints (the two strong joints that link your pelvis and lower spine), abdomen, and hips. Individuals dealing with pelvic floor disorders commonly have a range of motion, strength, or flexibility issues in these particular areas.
To help you understand the role that your pelvic floor plays for your health and wellness, your therapist may also show you a pelvis model. This also helps you fully understand the problem.
Step 3: Internal Exam
With your consent, the last part of your appointment will involve an internal pelvic muscle assessment. This is the part that many women feel nervous about. But, such an exam is encouraged, to help your therapist gain as much information as to provide you the right treatment fit for your pelvic floor issue.
Often, people with pelvic floor dysfunction deal with the inability to properly command the muscles to contract and relax. An internal examination will allow your physical therapist to assess the strength, endurance, flexibility, coordination, and tenderness of the muscles that make up and surround the pelvic floor. You will be undressed from the waist down and cover yourself with a drape sheet for privacy. At this point, no equipment is often required, only a gloved finger.
The internal assessment will involve the health provider assessing the pelvic floor through inserting one gloved and lubricated finger gently into either the vagina or anus to determine muscle tenderness, tone, strength, and motor control issues that are causing discomfort, pain, or functional impairments.
Prior to doing an internal exam, your therapist should explain to you what they will be doing. If it makes you more comfortable you may bring along a chaperone with you during your appointment. Your physical therapist should guide you throughout the examination.
Guided by the results of the assessment, the therapist can determine the best course of treatment to address your specific pelvic floor concerns and issues. You will be provided with the details of the findings and the recommended treatments.
Based on the findings, your therapist will determine the frequency of your physical therapy (number of times in a week) and how long it will take. Typically, pelvic floor physical therapy includes activities you must do at home to help assist in the treatment of your symptoms.
Possible treatment options include the following:
- Biofeedback – where your therapist will use a sensor in your rectum or vagina to monitor your pelvic muscles and detect abnormalities.
- Manual Therapy – This involves a series of internal and external soft tissue release techniques to address unwanted tension in the pelvic floor muscles, including kneading your muscles, joint manipulation, and joint mobilization.
- Relaxation and Breathing Techniques
- Behavioral Modifications – This includes your diet and nutrition, fluid intake, and bladder/bowel habits.
- Exercises you do at home that aid in the strengthening, relaxation, or retraining your muscles, depending on your condition.
- Exercises to help with bladder control like Kegels (the practice of repeatedly contracting and relaxing the pelvic floor muscles that control the flow of urination).
- Trigger point massage for muscle tension relief
Pelvic Floor Therapy: Other FAQs
A pelvic floor specialist isn’t only professionally trained in helping people with pelvic floor problems but is also knowledgeable in alleviating any physical and emotional discomfort a patient may feel when dealing with pelvic conditions. As with other physical therapies, the processes involved during your pelvic floor therapy can be modified to meet your needs and comfort level. Below we have listed some of the most frequently asked questions related to pelvic floor therapy:
What should I wear during my first pelvic floor therapy appointment?
While you are not required to wear anything specific, wearing loose-fitting clothes that allows you some mobility is recommended during your initial evaluation. This way, it is easier for your therapist to assess you.
Can I come to my pelvic floor therapy appointment even if I am on my period?
Yes, you can complete your physical therapy appointment even if you are on your period. Your menstrual cycle does not get in the way and initial treatment and follow-ups can be done at any time during your menstrual cycle.
I am pregnant, can I still have therapy?
Pelvic floor therapy is safe for pregnant women and can help in strengthening the pelvic floor muscles and prevent urinary incontinence and prolapse. Your therapist can also educate you on proper posture, relaxation strategies, and safe exercises. Be sure, however, to inform your therapist if you are pregnant or you think you might be.
What kind of results can I expect?
The result of your treatment largely depends on your diagnosis and motivation. Your physical therapist will work closely with you to come up with a plan to treat you as effectively and efficiently as possible. This treatment plan may include a home program with exercises, activities, and lifestyle habit changes that can influence the success of your specific goals. Pelvic floor PT will deliver the most desirable outcome when the patient is committed to making lifelong habit changes that will help alleviate symptoms and strengthen the pelvic floor muscles.
How often should I see my therapist?
The length and duration of the therapy will depend on the patient’s condition and goals. Treatment of myofascial pelvic pain with the therapy generally takes about 6 to 8 sessions of one hour each for a few weeks. In severe cases, it may take several months. You may also need to return for periodic PT to keep your pelvic floor issues in check.
Many women feel uncomfortable when talking about personal topics such as pelvic floor disorders and symptoms like incontinence. However, pelvic floor dysfunction is a common medical experience among women. With proper and early intervention, pelvic floor disorders may be corrected. If you are non-symptomatic but believe you are potentially at risk, screening is also available to evaluate your risk of developing issues with your pelvic floor.
It is crucial to be as thorough and detailed as you can when talking to your pelvic floor therapist. The information you provide will guide them in coming up with the best treatment and rehabilitative process for you. That said, it is important that you find a therapist with whom you feel comfortable and can commit to working with you closely to improve your condition.