Pelvic Physical Therapy

What is a Pelvic PT and my Pelvic Floor?

A pelvic 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. Sexual activity and intercourse should not be painful, and there are treatments that can help 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 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 in younger female athletes in high impact sports, and doesn’t discriminate between gender, age, or even if a person has given birth or how they gave birth. Pelvic floor dysfunction can happen after having any abdominal or pelvic surgery including cesarian section, or hysterectomy for example.

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

• Not being able to sleep through the night due to pelvic pain

• Not being able to sit without genital pain or bladder pain

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

• Not being able to function without taking frequent trips to the bathroom — every 15-30 minutes for example, because of urinary urgency

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

• Not being able to bend down to pick up something off the floor, or carry your baby or child without feeling heaviness in your pelvis

• 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.

**Many of the conditions/diagnoses listed also benefit from medical management and/or further diagnostic work-up due to suspected hormonal issues, inflammatory conditions, endometriosis lesions, skin conditions, and/or other pain management strategies. Whole Body PT has an excellent referral network of providers to collaborate with in order for you to reach your optimal health and treat any underlying or contributing causes of your symptoms.

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, as well as digestive issues affecting pelvic floor muscle function. Someone could have hormonal imbalances as well that may affect their pelvic floor. There could be other musculoskeletal dysfunction of the pelvis, and in other areas of the body causing strain on or compensation at your pelvic floor. This could include patterns in movement, gait, biomechanics, exercise habits, posture and lifestyle. It’s important that your PT looks for and figures out the cause of your pelvic floor dysfunction, so that you are treating the cause and not just chasing symptoms. Pelvic Floor Dysfunction can be a cause or a contributor to various pelvic conditions, and can be vastly improved or corrected so that the person returns to their optimal function. Pelvic Floor Dysfunction could also be a contributor or a cause to persistent back, hip and groin pain. Unless these muscles are checked by a pelvic floor therapist, there is no way to determine this, as well as how these muscles are coordinating with other muscles in your hips and trunk. If your back, hip or groin pain persists even with orthopedic physical therapy treatment, a pelvic floor examination may be necessary to get to the root cause and resolution of your symptoms.

Post-Partum Physical Therapy

In the post-partum individual, there may have been injury to the pelvic floor muscles and associated connective tissue, joints and bones of the pelvis, pelvic nerves, and/or spine from giving birth. This can result in perineal tearing, pelvic organ prolapse, pudendal neuralgia, dyspareunia (pain with intercourse), coccyx/tailbone pain, lower back pain, sciatica, urinary and/or fecal incontinence. Pelvic floor muscles (just like any other muscles in the body) require rehabilitation to re-learn how to perform their job and function optimally again. Scarring from c-sections or ANY abdominal surgery can also lead to or contribute to pelvic floor dysfunction. Scarring can also be a cause or contributor to changes in sensation or pain in the genitals and/or lower abdominal and pelvic region. Sometimes scarring, restricted tissues, and/or overactive pelvic floor muscles can give someone the sensation of urinary or fecal urgency, and can contribute to poor mobility of the digestive system and or/constipation. In the post-partum person, pelvic floor dysfunction can be coupled with weakened and/or lengthened abdominal muscles, diastasis recti, hormonal changes that contribute to ligament laxity, vulvar dryness and/or pain, along with postural changes that occurred with pregnancy. These changes can continue to remain post-partum. This break-down in stability, coordination and/or strength in the musculoskeletal system can be complicated with hormonal changes, pelvic organ prolapse, previous orthopedic injuries, and repetitive stress on healing, tight, and weakened tissues with the demands of caring for babies and children.

Just like an athlete who, for example, has sprained ligaments in his or her knee, the muscles around the knee need to be retrained again to work with the rest of the leg, hip, and trunk. Our pelvic floor muscles, just like any other muscles, deserve the utmost in care and proper rehabilitation post-partum.

The Difference at Whole Body Physical Therapy

At Whole Body Physical Therapy, you are looked at as a whole person in a whole body. 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 comprehensively with your other medical and healthcare providers. A skilled pelvic physical therapist should be able to determine if and which areas of your pelvic floor may be contributing to your symptoms, including examining neural and connective tissue/fascia, and 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, as areas above and below your pelvis could be contributing to your condition, as well as could be the driver of your pelvic floor dysfunction. Pelvic physical 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 and function without invoking a painful response, and to calm the sympathetic nervous system.

Too often I hear patients say that they were told to do kegels by a practitioner who hasn’t actually examined their pelvic floor muscles thoroughly. Traditionally, OB/GYN’s, urologists, NPs, PAs, etc. are trained in the physical examination of the pelvic organs and diagnose pathology and medical conditions through medical testing (lab work, imaging). They do not do the same specific physical examination of the pelvic floor, and the rest of the musculoskeletal system, as the pelvic physical therapist does. The examination of the pelvic floor and the treatment of pelvic floor dysfunction is the pelvic therapist’s expertise.

There are also physical therapists who say they treat many of the pelvic conditions listed, but haven’t actually gone through the training to examine the pelvic floor internally. Without actually examining the pelvic floor muscles, the assessment and treatment plan could be incorrect. This could lead to further dysfunction, or the patient not improving. For example, often urine leakage or incontinence can occur from a too tight, restricted, overactive, and/or painful pelvic floor. This results in a weak pelvic floor. If the pelvic floor muscles can’t lengthen or relax appropriately, or have pain with attempt to relax or contract, the muscles don’t go through a normal range of motion to generate sufficient strength and to maintain endurance in order to do their job of supporting the pelvic organs. This can lead to urinary leakage. Advisement of doing kegels in this example, even thought the patient reports symptoms of urinary incontinence, would not initially be the indicated treatment, and could actually end up worsening the patients symptoms. It could make the pelvic floor more overactive or shortened, leading to more pain, leakage, and/or dysfunction.

In general, if kegels are actually indicated, patients would require feedback with internal assessment from the physical therapist to ensure they are performing the contraction and relaxation correctly, and that they are doing the correct type and the amount that is appropriate for them. These exercises would need to be incorporated and progressed into functional and higher level activities as well. Correct guidance and treatment for your specific body and specific needs is key. This is based on a thorough evaluation and your PT being skilled in a variety of treatment strategies.

“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.