Pelvic Floor Therapy: What to Expect and More

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 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 symptoms associated with pelvic floor dysfunction. This article will discuss pelvic floor dysfunction and how therapy can help, as well as what to expect during a pelvic floor evaluation.

What is the Pelvic Floor

The pelvic floor refers to a group of muscles at the base of the pelvis. 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, which include the bladder, bowel, uterus and vagina in women, prostate in men, urethra, and anus.

Made of thick skeletal muscles, the pelvic floor muscles support and allow the anus, urethra, and vagina to function normally. These muscles allow the voluntary control of emptying and release of urine, feces and flatus. They are likewise important for sexual function.

Common Causes of Pelvic Floor Dysfunction

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In women, pregnancy and childbirth pose the main risks for developing pelvic floor disorders. The pelvic floor muscles can become strained during pregnancy, particularly if the baby was big and the labor was long or difficult.

Other factors that can lead to pelvic floor dysfunction include the following:

  • Obesity
  • Stress or direct trauma to the pelvic floor muscles
  • Excessive strenuous exercises
  • Recurrent cough
  • Chronic constipation or straining to poop
  • Menopause

Advanced age, mothers who had their first baby at a mature age, as well as a positive family history, all contribute to increased possibility of developing pelvic floor disorders.

Pelvic Floor Dysfunction: Common Symptoms

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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. There are three main types of this disorder:

  • Urinary incontinence
  • Fecal incontinence
  • Pelvic organ prolapse

In most cases, the issues occur along with other symptoms and may cause overlapping effects. Some of the symptoms associated with pelvic floor dysfunction in general include:

  • Lower back pain
  • Leakage of urine or stool
  • Painful urination or frequent need to pee
  • Constipation or straining to evacuate the bowels
  • An incomplete bowel movement
  • Erectile dysfunction in men
  • Pain during sex and difficulty reaching orgasm in women

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.

What Is Pelvic Floor Therapy

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Pelvic floor physical therapy is a treatment approach to help address weakness, pain, and dysfunction in the pelvic floor muscles. It 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 via an intrarectal or vaginal exam. 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

Pelvic floor therapy can assist in bowel and bladder control, and contribute to sexual arousal and orgasm, as well as help in proper posture and breathing.

Many of the symptoms caused by pelvic dysfunction can be 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 normally lines the inside of the uterus (the endometrium) grows outside of the uterus. Endometriosis most often involves the ovaries, fallopian tubes, and the tissue lining the pelvis. Symptoms vary and can include severe menstrual cramps, heavy menstrual bleeding, spotting, bowel movement discomfort, and fertility issues.
  • Urge Urinary Incontinence – when you feel a sudden, strong urge to urinate even when your bladder is not full. The urinary bladder contracts when it is not supposed to, leading to urine leaking through the sphincter muscles.
  • Stress Urinary Incontinence – when urine leaks out with sudden pressure on the bladder and urethra, like when laughing, coughing, sneezing, or during exercise. The sphincter muscles open briefly and urine leaks out.
  • Fecal Incontinence – when you lose the ability to control your bowel movement, causing stool to leak unexpectedly from your rectum before reaching the toilet. This can range from occasional leakage of stool with passage of gas to complete loss of bowel control.
  • Vaginismus – when penetration through the vagina causes an involuntary spasm of the muscles. This leads to sharp pain during sexual intercourse, insertion of tampon, or use of speculum during a gynecological exam.
  • Constipation – when bowel movements happen less often than normal, and stools become hard and difficult to pass.
  • Myofascial pain – when there is pain in the pelvic area, caused by pelvic muscles that are too tight.
  • Painful urination
  • Rectal pain
  • Pain in hip, abdomen, thigh or lower back
  • Pregnancy-related pain
  • Postpartum wellness

What to Expect During Your First Pelvic Floor Appointment

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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:

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 worse 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. 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.

This can be followed by a brief educational session regarding pelvic health. To help you understand the role that your pelvic floor plays for your health and wellness, your therapist may 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 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.

Treatment Options

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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 and length of your physical therapy sessions. Typically, you will also be taught to do home exercises that would assist in the treatment of your symptoms.

Techniques used in pelvic floor therapy include the following:

  • Biofeedback – a sensor is inserted into the rectum or vagina to monitor how your pelvic muscles work and detect abnormalities
  • Manual therapy – involves a series of internal and external soft tissue releasing techniques to address unwanted tension in the pelvic floor muscles, including kneading your muscles, joint manipulation, and joint mobilization
  • Behavioral modifications – diet and nutrition, fluid intake, and bladder and bowel habits
  • Relaxation and breathing techniques
  • Pelvic floor exercises – aid in the strengthening, relaxation, or retraining of your muscles, depending on your condition
  • Electrical stimulation – the use of a low voltage electrical current to teach you how to coordinate your muscle contractions
  • Vaginal dilators – tube-shaped plastic devices, that are progressively sized, are inserted into the vagina to help stretch tight tissues
  • 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

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A pelvic floor specialist is not 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 specific needs and comfort level. Below are listed some of the most frequently asked questions related to pelvic floor therapy:

  1. 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 will make it easier for your therapist to assess you.

  1. 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 of treatment. Initial and follow-up treatments can be done at any time during your menstrual cycle.

  1. 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.

  1. 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 therapy delivers 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.

  1. 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 generally takes about 6 to 8 sessions of one hour each for a few weeks. In severe cases, treatment may take several months. You may also need to return for periodic physical therapy to keep your pelvic floor issues in check.

Final Thoughts

Many women, and men, 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. With proper and early intervention, pelvic floor disorders may be corrected. If you are not symptomatic, but believe you are potentially at risk, screening is also available to evaluate your risk of developing disorders 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. Therefore, it is important that you find a therapist with whom you feel comfortable and can commit to working closely to improve your condition.

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