What exactly is pelvic floor PT?
If you’ve never heard of pelvic floor physical therapy, you’re not alone!
While going to physical therapy (PT) for your hip, back, or shoulder is a common experience for many people, there is not as much awareness for the pelvic floor. But the fact is that every person has a pelvic floor, and many people experience dysfunction at some point in their lives!
What is the pelvic floor?
The pelvic floor is a group of muscles that sit at the base of your pelvis. These muscles are relatively similar in male and female pelvises. The pelvic floor has five major functions, the five S’s:
Support
The deep pelvic floor muscles sit at the bottom of the pelvis like a hammock. They provide support to the pelvic organs including the bladder, rectum, and reproductive organs.
Stability
Your core is made up of your abdominals, diaphragm, spinal muscles, and the pelvic floor. These muscles work together to provide your body with stability during movement and exercise.
Sphincteric
The superficial pelvic floor muscles wrap around the openings of your urethra and anus, helping to close these openings when you’re trying to hold in urine or stool. They also assist with emptying our bladder and bowels when we are ready to go.
Sexual
The pelvic floor muscles contribute significantly to sexual function by assisting with erection of both the penis and clitoris. They also contract rhythmically when you orgasm.
Sump pump
Lastly, the pelvic floor assists with circulation of blood and lymphatic fluid by acting as a “sump pump” to help fluid return back to the heart.
These muscles carry a lot of responsibility in the body! When the muscles are not working properly, we see symptoms associated with pelvic floor dysfunction.
What does pelvic floor dysfunction look like?
Since the pelvic floor has a wide variety of functions, pelvic floor dysfunction can come with a wide variety of symptoms! Some of the common symptoms that we see include:
Urinary leakage
Overactive bladder (OAB) or urinary urgency/frequency
Incomplete bladder emptying
Constipation
Fecal incontinence
Pelvic organ prolapse
Pelvic and/or abdominal pain
Tailbone pain
Pain with sexual activity
Both women and men can experience pelvic floor dysfunction, but women have a higher rate due changes surrounding pregnancy and hormones (menstruation and menopause). Some people might experience one symptom in isolation, while others might have a combination of problems.
If you are someone who experiences symptoms surrounding pee, poop, pain, or sex, pelvic floor PT may be the solution!
What does pelvic floor PT look like?
Pelvic floor physical therapists are individuals who first received a degree in physical therapy (usually a doctorate), then pursued additional training to specialize in the area of pelvic health. These therapists have often completed multiple courses throughout their careers in order to effectively treat a wide variety of pelvic disorders.
Initial visit
During your initial visit with a pelvic floor PT, your therapist will get a thorough history of your symptoms, relevant medical history, and ask about your goals with PT. Depending on your specific symptoms and history, your PT will likely perform an orthopedic and/or pelvic floor assessment.
An orthopedic exam may include assessment of your posture, breathing, mobility, and strength. The pelvic floor muscles do not work in isolation, but in coordination with the rest of your body. Therefore we want to get a full picture of how your body is functioning to see how this might relate to your pelvic floor symptoms!
The pelvic floor exam can consist of external and internal (vaginal or rectal) exams. Just as we look at the strength, mobility, and coordination of other muscles in the body, we can do the same for the pelvic floor! A pelvic PT exam looks different than a gynecologic exam and is typically more comfortable. There are no stirrups, and no need to scoot awkwardly close to the edge of the table!
For an external assessment, you may remain clothed or undress from the waist down with a sheet over your lap. Your therapist will assess the external structures and may test sensation, observe skin integrity, and assess general muscle coordination with things like a Kegel or push.
If your therapist thinks an internal assessment is appropriate, they will recommend a vaginal or rectal exam based on your symptoms. An internal exam is performed with one gloved, lubricated finger - no speculum or other instruments are typically used.
Pelvic floor exams should not be painful, and we work to make sure that patients are as comfortable as possible throughout the process. We will always get informed consent from a patient before performing any pelvic floor exams, and you are free to consent to as much or little as you feel comfortable.
Follow-up visits
Based on your therapist’s findings during the initial examination, your PT will give their recommendation for the frequency and duration of care. This varies based on the severity of your symptoms, how long things have been going on, and what works best for you.
Treatment for pelvic floor dysfunction may include stretching, strengthening, coordination training, manual therapy, and education. This is all based on your specific symptoms, and your therapist will modify or progress your program as needed each session. Physical therapy is a team effort between the therapist and patient, and you are always an active participant in your treatment plan!
Ready to try pelvic floor PT?
We understand that seeing a pelvic floor PT can often feel embarrassing or intimidating for people. Pelvic PTs are usually providers who are highly compassionate, empathetic people, and they see patients for these issues daily. There is never anything to feel embarrassed about!
There are multiple ways to locate a pelvic PT in your area. Websites like the Academy of Pelvic Health, Pelvic Guru, and Pelvic Rehab are all sites that allow you to search for providers by location.
Some states require a referral in order to see a physical therapist. Your OBGYN, primary care physician, or other medical provider can provide this for you if needed. In California, you can start seeing a pelvic PT without a referral!
Work with Remedy!
Erin Rahter is a doctor of physical therapy and is board certified in women’s health through the American Board of Physical Therapy Specialties (ABPTS). She is the owner and founder of Remedy Pelvic Health and provides in-home physical therapy services in the San Diego area. Virtual services are also available throughout California. She specializes in women’s health, prenatal, and postpartum care.
Want to learn more or ready to schedule? Click the link below to get started!