Diagnoses/Conditions that we work with:
PGAD (Persistent Genital Arousal Disorder) / GPD (Genito-pelvic Dysesthesia)
Painful Orgasm
Anorgasmia
Painful erection, painful ejaculation
Clitoraldynia
Vulvodynia & Vestibulodynia
Vaginismus
Dyspareunia/painful penetration
Bladder Pain Syndrome/IC
Testicular, Penile, Scrotal or Groin Pain
Chronic Prostatitis
Urinary Retention/Difficulty starting urine flow
Chronic Constipation
IBS and reflux
Pelvic Organ Prolapse
Urinary Incontinence
Fecal Incontinence
Pudendal Neuralgia
Coccyx/tailbone pain
Pubic Pain
Lumbosacral Pain
Sacroiliac Joint Dysfunction
Pre and Post-Partum Physical Therapy
Round Ligament Pain
Diastasis Rectus Abdominus (DRA)
Post-operative abdominopelvic surgeries (c-section, hernia repair, colorectal, hysterectomy, endometriosis excision, myomectomy, tumor removal, etc)
Endometriosis
Gender Affirmation Rehabilitation

Photo Credit: Derek Stettler; Edit: Rochelle Brodin

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. 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 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 as well. It doesn’t discriminate between gender, age, or even if a person has given birth or how they have birthed. 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.

An appointment with pelvic health physical therapist is not like going to a urologist or gynecologist. Traditionally medical providers such as OB/GYN’s, urologists, NPs, PAs, etc. are trained in the physical examination of the pelvic organs. They diagnose pathology and medical conditions through a physical exam and medical testing (lab work, swabs, 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.

With that said, many of the conditions/diagnoses listed above also benefit from medical management and/or further diagnostic work-up to rule out pathology and look for other root causes and contributors to symptoms. For example, a common cause of vulvovaginal sexual pain that also can contribute to urinary symptoms and infections are hormonally mediated changes to the vulvar tissues. This is often seen in perimenopause and menopause and is called GSM (genitourinary syndrome of menopause), and while lactating (genitourinary syndrome of lactation). While a pelvic therapist can screen for conditions like GSM, diagnosis and the prescribing of vaginal and vulvar hormones to treat the effected tissues comes from a licensed medical provider. Other examples include diagnosing and treating infections, inflammatory diseases, endometriosis, hypermobility syndrome, skin conditions that affect the genitals, and abdominal or inguinal hernias. All of these can cause symptoms of pelvic pain and can also be present with pelvic floor dysfunction. Another example is that one may see a urogynecologist for a pessary fitting. Some patients may benefit from medically based pain management strategies such as nerve blocks, botox to the pelvic floor, suppositories, and oral medications. Many patients also benefit from working with mental health providers including sex therapists, rheumatologists, gastroenterologists, nutritionists, acupuncturists, and functional medicine practitioners. Whole Body PT has an excellent referral network of providers to collaborate with in order help you reach your goals, as well as diagnose and treat 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, 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.

Some examples include patterns in movement, gait, biomechanics, exercise, toileting 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 key to find the root cause and have 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 motility of the colon 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 and vulvar dryness and/or pain, along with postural changes that occurred with pregnancy that continue to persist. 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 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, and to help calm the nervous system. 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.