Pelvic Health Physical Therapy

What is a Pelvic Health PT and my Pelvic Floor?

A pelvic health physical therapist has specialized training in Pelvic Health, and in the evaluation and treatment of the pelvic floor muscles, associated connective tissue, fascia, nerves, and bones of the pelvis. The pelvic floor muscles provide support to the pelvic organs: bladder, bowels, and uterus. They help to control urinary and anal sphincters for the release of urine, feces, and gas, as well as delay the urge to void, move bowels, and maintain continence. A healthy pelvic floor is also important for sexual function. For those with vulvas, this includes arousal, clitoral erection, and orgasm. For those with penises, this also includes erection, orgasm, and ejaculation. Healthy sexual function may also include being able to have penetrative sex without pain, as well as orgasm without pain. Sexual activity and intercourse should not be painful, and there are musculoskeletal- based treatments that can help to resolve these issues and restore optimal function.

Utilizing gentle, yet effective manual therapy techniques to relieve pain, improve tissue mobility, promote healing, and calm the nervous system. Helping to improve mobility, motor control and/or strength, individualized to your pelvic floor needs, as well as to the other areas of your body that may be causing and/or contributing to your pelvic floor dysfunction.

Why Would I Need Pelvic Health Physical Therapy?

Just like any muscles in the body, healthy muscles should be able to contract and relax through a normal range of motion, with the correct timing, for proper function. The pelvic floor muscles are also uniquely reflexive and are part of reflex loops that communicate with your nervous system, bladder, and bowels. This communication can become impaired for a number of different reasons and often include a combination of reasons: toileting habits and other activities, gastro intestinal issues, persistent pain, stress, pelvic floor dysfunction, issues with irritation at the peripheral nerves that communicate to the muscles or organs, or even nerve root inflammation at the spinal level from a back injury. Pelvic floor muscles can become too tight or restricted, overactive, weak, under-active, or injured, affecting their ability to do their job correctly. The pelvic floor muscles are part of your deep core musculature, and should be able to coordinate correctly with your diaphragm, spinal, and abdominal muscles to support your pelvic organs (uterus, bowels, bladder) and manage pressures during functional activity. There is often a misconception that one has to have delivered a baby via vaginal birth to have these issues, when in actuality pelvic floor dysfunction is common throughout the lifespan and can occur in athletes of all ages as well. Pelvic floor dysfunction can happen after having any abdominal or pelvic surgery and is also associated with genitopelvic pain diagnoses.

Difficulty with functional activities can vary from person-to-person. Some examples could include:

• Difficulty sleeping through the night due to pelvic pain

• Difficulty sitting without genital pain or bladder pain

• Not being able to have sexual activity, orgasm, or have intercourse without pain

• Experiencing strong urinary urgency after just going to the bathroom.

• Taking frequent trips to the bathroom — every 15-30 minutes for example, because of urinary urgency and the feeling of incomplete emptying

• Not being able to fully evacuate stool, having pain and/or straining during bowel movements

• feeling heaviness in your pelvis when bending down to pick up something off the floor, or carry your baby or child, or with specific exercises

• Not being able to perform daily activities, desired exercise, and athletics without leaking urine, stool, or gas.

The coordination of your pelvic floor muscles with the rest of your body involves a healthy nervous system, with correct communication to and from your brain from these muscles, as well as to and from pelvic organs.  Oftentimes the signals and communication of information can become mixed-up and altered when someone has persistent pain, injury, disuse or inactivity.

Pelvic Floor Dysfunction

Pelvic Floor Dysfunction is a condition that describes when the pelvic floor muscles are not functioning properly in their ability to contract,  relax/lengthen, and/or coordinate. Areas of these muscles may be overactive, tight, restricted, or have  tender points referring pain to your pelvic organs or genitals, compressing peripheral nerves, and/or restricting blood flow. The pelvic floor muscles could also be under-active, have lower tone, and be weak. You could have a combination of both overactive and under-active pelvic floor dysfunction. There could be scars, habitual holding patterns, hormonal changes, as well as digestive issues affecting pelvic floor muscle function. There could be musculoskeletal dysfunction outside of the pelvic floor, and habits and activities causing strain on or compensation at your pelvic floor.

The Difference at Whole Body Physical Therapy

At Whole Body Physical Therapy, you are looked at as a whole person. You will be listened to, heard, and treated respectfully with the utmost in skilled care. You and your physical therapist will be working as a team, and if you like, comprehensively with your other medical and healthcare providers. A skilled pelvic physical therapist should be able to determine if your pelvic floor may be contributing to your symptoms and which specific muscles are involved. At Whole Body PT this does not just include palpating muscles and assessing muscle function, but also assessing connective tissue/fascia around and in between nerves, organs, vessels, and joints. It also includes evaluating outside of your pelvis to incorporate your whole body. Your physical therapist understands these connections from head-to-toe, and knows how to examine and treat them, well. A thorough examination of spine, bony pelvis, hips, abdomen, posture, body mechanics (how you move, sit, walk, perform functional activity) is also performed. Its important to screen above and below your pelvis as these areas can be pieces to the puzzle as as well driving pelvic floor dysfunction. Some people have concerns that pelvic floor therapy will be uncomfortable, invasive, or painful. At Whole Body PT, your therapist is trauma informed and cares about your comfort. She knows that internal and external pelvic floor therapy treatment should not be painful to be effective. In fact, one of the goals of treatment is to encourage the desired change in the tissues without invoking a painful response or muscle guarding. With any patient, a pelvic floor exam and treatment are always optional and only done with the consent of the patient. There are other physical therapy treatment interventions that can be helpful for pelvic floor dysfunction that don’t involve internal pelvic floor treatment. It is not a requirement to have a pelvic floor exam to have a pelvic therapy appointment.

“April understands pelvic pain more than any other physical therapist I've seen. I ruled out PT as an option for my condition until I met her. Her gentle methods allow for pain-free sessions and more progress than I could have ever imagined.”

~ Nikki W.