Pelvic physical therapy is a highly specialized form of rehabilitation conducted by a physical therapist who has undergone training in examination and treatment of pelvic floor dysfunction. Pelvic physical therapy has been a form of rehabilitation for over 40 years. Due to the stigmatization of pelvic health issues, in the past many men and women experiencing pelvic floor dysfunction did not seek help and did not openly discuss their issues and rehabilitation process, thus for many years, pelvic physical therapy was widely unknown as a viable treatment option to the general public. This has changed over the past few years and pelvic physical therapy services have been more openly discussed in various media channels, in magazines, and online.
Pelvic Floor Physical Therapy addresses various issues of the pelvic floor muscles (PFM) and abdomen. The pelvic floor is a group of muscles, tendons, ligaments, and fascia tissues that form a sling-like hammock from the pubic bone to the tailbone and out to the “sit bones”- the bony protuberances that you sit on. They support the abdominal and pelvic organs (the bladder, uterus, and rectum) and assist in maintaining an upright posture. There are noted for their role in the control of the bladder and bowel and in sexual activity.
The PFM can become stretched, weak, or lose coordination after certain life events. These include pregnancy, delivery, or surgery. The muscles can also be injured with repetitive straining, such as chronic constipation, repetitive heavy lifting, and in with some impact sports such as gymnastics, tennis, basketball, volleyball, and running. When the pelvic floor muscles become weakened, urinary incontinence, fecal incontinence, and pelvic organ prolapse (POP) can occur.
Conversely, if the PFM become overactive, or overused, the result can be pelvic pain and decreased function of the muscles. Pelvic floor muscle dysfunction (PFMD) includes a variety of issues that occur when the muscles of the pelvic floor are not functioning properly. In the case of overactivity, they become too tight. Oftentimes, trigger points or tender points develop in the muscles that contribute to pain and loss of function. These are the same “knots” that you might find in your neck or back, that when you pushed upon are tender, and when you massage them, it relieves you of your pain.
Due to the complex nature of the anatomy and musculoskeletal functioning in this area, a detailed medical history, thorough examination, and unique plan of care is developed by a pelvic physical therapist to treat the underlying issues. This care is delivered often in conjunction with other treatments, and as a team approach with primary care physicians, nurse practitioners, OB-GYN providers, midwives, gastroenterologists, oncologists, and other members of the health care community.
What treatments are available in Pelvic Physical Therapy?
Pelvic physical therapists evaluate and treat a wide variety of pelvic floor and abdominal conditions. The diagnoses treated specifically to women include but are not limited to:
- Bladder Disorders
- Urinary Incontinence
- Urinary Urgency, Frequency, Hesitancy
- IC (Interstitial Cystitis)
- Bladder Pain Syndrome
- Bowel Disorders
- IBS (Irritable Bowel Syndrome)
- Constipation/incomplete emptying
- Pelvic Pain Conditions
- Levator Ani Syndrome: pressure or ache in the sacrum, coccyx, rectum, and vagina caused by overactivity of the levator ani muscles
- Dyspareunia (pain with intercourse)
- Anorgasmia (Difficulty achieving orgasm)
- Pudendal neuralgia
- Vulvodynia
- Vulvar vestibulitis
- Vaginismus
- Pelvic congestion
- Lichens Sclerosis & Lichens Planus (skin conditions associated with pelvic pain)
- Coccydynia (pain in the tailbone region)
- Post-Surgical Conditions
- Hysterectomy
- Hernia
- Laparoscopy including endometriosis excision
- Caesarean section
- Appendectomy
- Post Cancer Treatments
- Lymphedema
- Post radiation pelvic pain
What does the first visit of pelvic physical therapy look like?
The first session of pelvic physical therapy is an initial evaluation. You will be asked to fill out forms to provide your pelvic PT with a complete medical history including current medications, ongoing chronic conditions, surgeries, and other pertinent medical information. A good pelvic physical therapist will perform visits in a private room, and you are welcome to bring a partner, friend, or another chaperone for comfort if you choose to. The pelvic PT will discuss your medical history and ask specific follow-up questions pertaining to how your bladder, bowels, and sexual organs have been behaving. This helps the therapist better understand what the driving factors of your condition are. A good pelvic PT will seek to help you solve the underlying issue, not just treat the symptoms.
A physical examination will be performed. This includes an assessment of your posture, coordination, and an orthopedic screen of the spine, hips, and often knees and feet as they can be associated with issues in the pelvis- the body is a connected, dynamic structure, and it’s important to be thorough!
An external and most often, internal assessment of the pelvic floor muscles can be performed on the first visit, and sometimes is deferred to later sessions depending on the timeframe, needs, and desires of the individual patient. The external examination allows the pelvic PT to visualize the tone, integrity, and vascularization of the vulva and superficial pelvic floor muscles. This assessment gives important information to the pelvic PT as to the overall health of the vulva and pelvic floor muscles.
The internal assessment of the pelvic floor muscles consists of the therapist using a gloved hand (usually just 1-2 fingers) to assess the strength, endurance, and coordination of the pelvic floor muscles. The physical therapist will ask you to perform various types of pelvic floor muscle contractions (also called Kegels), as well as asking you to elongate or “drop” the pelvic floor by bearing down. This gives information on how the pelvic floor muscles are behaving throughout your day. Additionally, the therapist will assess areas of pain or tenderness inside the pelvic floor via the vagina. In some cases, particularly in the case of tailbone pain, a therapist might recommend a rectal assessment of the muscles and joints.
The first session will allow the pelvic PT to create an overall plan of care unique to your needs. The length of treatment may span from a few weeks to a few months depending on what your issue is, and how long your symptoms have been present.
Treatments consist of many different modalities of care. Manual therapy involves soft tissue mobilization, relief of trigger points, joint mobilizations, and scar tissue massage to restore health length and function of the muscles of the pelvis and abdomen. Biofeedback is a tool that allows the therapist to help you to “re-train” your muscles for better coordination. A sensor may be placed on the outside or inside of the body that is connected to a device that gives real-time feedback as to how your muscles are performing. Ultrasound imaging may also be utilized to show you your organs and pelvic floor for training purposes and to give the therapist added information. Exercises are tailored to help restore muscle functioning and are also an integral part of pelvic floor rehabilitation. These exercises may consist of specific forms of stretching, stability exercises, pelvic floor exercises, and overall wellness exercises.
Additionally, lifestyle changes might be part of the rehabilitation process. Certain foods, beverages, and habits can contribute to bowel and bladder dysfunction. Bladder irritants are often recommended to be limited to allow the bladder to heal and reset. Smoking cessation is recommended as it affects the bladder, vasculature, and nerves in the pelvis. Certain dietary changes might be recommended to allow for improved digestion and better bowel functioning as well.
How do I find a pelvic physical therapist?
Pelvic physical therapists are in all fifty states in the United States and most countries around the world. Your healthcare provider may already have a trusted relationship with a pelvic physical therapist, it is helpful to ask them for a referral to a pelvic physical therapist as most insurances cover pelvic PT, but require a referral from an MD, DO, nurse practitioner, or certified nurse midwife.
Written by Amanda Olson, DPT, PRPC
Certified Pelvic Floor Physical Therapist
President and Chief Clinical Officer at Intimate Rose: www.IntimateRose.com
