The first question I start with during every initial evaluation is this: “So, what do you know about pelvic floor physical therapy?” I usually get a shrug, maybe an awkward laugh, or every once in a while the person I’m seeing it has googled it and their findings made them nervous. So let’s start off this blogs journey by demystifying the experience that is pelvic floor physical therapy.
Physical therapists are specialists in the way our bodies move and function and the way our muscles, ligaments and bones affect that movement and function. Pelvic floor physical therapists specialize further in the muscles that constitute the pelvic floor. The pelvic floor is the literal and figurative bottom of your body. It spans from your pubic bone to your tailbone and between your ischial tuberosities, or SIT bones. Spoiler alert: men and women both have it.
Because of where these muscles are located and how they are structured, they affect the function of your bladder and bowels as well as participation in sexual activity. They can also contribute to pain in the pelvis, back, hips and abdomen. These muscles, like all muscles, can be spasmed and tight or weak and ineffective. Often times they can be both tight and weak at the same time, but that’s a story for another post.
As pelvic floor physical therapists, our job is to determine how the muscles in your pelvic floor are affecting symptoms you’re experiencing like urinary incontinence, fecal incontinence, painful intercourse, prolapse, tailbone pain, vulvar and vaginal pain, diastasis recti, rectal pain, constipation… the list goes on and on.
When you see a pelvic floor physical therapist, your session will likely start with a lot of conversation to give us the best picture of what’s happening with your pelvic floor. All of that information will help guide our physical evaluation, which can include screening your lumbar and thoracic spine, hip mobility, lower extremity strength and control of your abdominals. It can also include a screen of your internal and external pelvic floor muscles, if you are comfortable with it at the time. It is important that if you’re not comfortable with a pelvic floor examination, you let your therapist know. An internal exam provides us with valuable information that helps get you better faster, but if we can’t look internally, we can still get information from other parts of your body and I never want that to be the reason someone shies away from getting help.
All of that information will help us determine whether you’re a good fit for physical therapy, a plan of action to start off managing your symptoms and getting you feeling better and ideally a rough estimate of how long we expect we’ll have to see you for results. At the very least, we can help you understand what’s happening in your body and how this very important bundle of muscles, that usually goes ignored, can be contributing to the concerns at hand.
Pelvic floor physical therapy typically includes a combination of exercise, of some sort, along with hands on manual therapy, of some sort. I say of some sort because often times when we hear of pelvic floor PT we think “kegels, kegels, kegels,” but in reality, kegels are not the best option for some conditions. Strengthening is a big part of pelvic floor physical therapy, but so is learning how to relax.
Physical therapy can include a lot of things. You may learn about how our bladder and bowels are supposed to function and tips to help yours function better. You may learn how to breathe better for your body and how to use that breathing to assist in a global relaxation of your pelvic floor and self. You may learn you’ve been doing that infamous kegel wrong all along AND how to do it correctly. Your physical therapy experience will be catered to you specifically, but can include: exercise, stretching, dietary modifications, fluid intake modifications, retraining your muscles to function better, biofeedback, meditation and lots of time for questions.
The quick and dirty is: If you have pain in your pelvis, bladder or bowel dysfunction and complaints regarding your sexual function, consider pelvic floor PT.
Thanks for reading! If you have questions or comments, please feel free to leave them below or email me at firstname.lastname@example.org.
-Rebecca Maidansky, PT, DPT