Pelvic Floor Therapy: What It Is and Why It Matters for Women’s Health
WHAT IS PHYSICAL THERAPY?
To understand pelvic floor physical therapy, we must first understand physical therapy as a whole. The profession of physical therapy has certainly morphed over the years, but the modern-day version is an individualized combination of manual therapy techniques, customized strength training, and a mix of modalities – dry needling, biofeedback, and education – to name a few.
The Physical Therapist is responsible for the musculoskeletal system of the body. Orthopedic surgeons handle surgical cases of bone/joint dysfunction, chiropractic specializes in the nervous system and skeletal alignment, and physical therapy specializes in the neuromuscular system.
Let’s compare chiropractic care and physical therapy. How do you know which one is best for you? The truth is: they compliment each other.
Chiropractic care includes mobilization and manipulation of the central nervous system. Chiropractic care functions on the concept that your central nervous system, which includes your brain and spinal cord, cannot function properly with the peripheral nervous system, which includes the nerves in the arms and legs, without the spine in proper alignment. If the bony structure of the central nervous system, meaning the skull and spine, are in proper alignment, the nervous system can function optimally and communicate well with the peripheral nervous system.
Physical therapy functions on the concept that bones are nothing more than a system of levers and pulleys – meaning, bones do not move out of alignment unless the muscles pull them out of alignment.
Which means: you can get as many chiropractic adjustments as you’d like, but if you don’t address the muscles that are pulling the bones out of alignment in the first place, you’ll continue to have the same symptoms, and be treated by chiropractic care for the same malalignment, over and over again.
Each joint in your body (yes, your spine, your shoulder, your knee, etc.) functions on an equal-and-opposite system from the muscles. For example, in the elbow, you have a biceps muscle that flexes, or bends the elbow, and you have the triceps which extends, or straightens the elbow. If both the biceps and triceps have optimal length and strength, the elbow should be able to move well through full range of motion without pain or dysfunction.
When joints are not in proper alignment, or you are experiencing pain or dysfunction, this is often caused by asymmetrical strength, stiffness, or weakness of the muscles that affect the joint. This is where physical therapy comes in handy, and this is also why strength training is such an important piece of physical therapy. The physical therapist will use modalities and myofascial release to help manage your pain and symptoms, but strength training is the true solution to the problem.
The role of the physical therapist is to guide you through strength training, while focusing on prioritizing movement quality and teaching you awareness of your system, to help the system function properly again.
WHAT IS PELVIC FLOOR PHYSICAL THERAPY
Many people do not realize the importance or benefits of pelvic floor physical therapy until they seek treatment when they’re already experiencing symptoms.
Pelvic floor physical therapy is going to prioritize the balance of the muscle strength, length and function on your center of mass. We focus mainly on the combination of abdominals, back muscles, hip musculature and the pelvic floor muscles themselves. These four muscle groups work together, and our job is to identify and correct imbalances between them.
If these muscle groups are unbalanced, and therefore, not functioning optimally, the body is more likely to start experiencing symptoms. Many people are not familiar with how pelvic floor physical therapy can help, and often do not seek treatment until they’re already experiencing symptoms.
Improved Bladder and. Bowel Control
If you have been struggling with bladder or bowel issues, pelvic floor physical therapy should be your first stop after talking with your doctor! With a combination of myofascial release, strength training, and numerous other techniques pelvic floor physical therapy can address a whole host of bowel and bladder symptoms:
Urinary leakage
Urinary urgency – needing to go ASAP out of no where, can commonly have triggers like running water, or getting home from work
Urinary frequency – being the friend who pees too all the time – like ALL the time
Urinary evacuation difficulty – can’t get it all out, or difficulty starting the flow of urine
Urinary flow changes – spraying all over the bowl, slow stream
Post-micturation dribble – you pee, you wipe, you stand, a little more comes out
Bladder pain
Anal leakage – gas or stool
Bowel urgency
Bowel frequency
Chronic constipation
Pain with bowel movements
Bowel evacuation difficulty
Chronic hemorrhoids or anal fissures
Support for Pelvic Organ Prolapse
Using a combination of strength training, pressure management training, pessary education and activity modification, pelvic floor physical therapy can prevent symptoms from worsening and in some cases, reduce the need for surgery. Symptoms you may be experiencing that could warrant a referral to pelvic floor physical therapy include:
Vaginal heaviness that worsens throughout the day or with high intensity exercise
Feeling or seeing a protrusion outside of the vaginal canal
Feeling like you’re wearing a tampon when you aren’t
Sensing that something is blocking the vaginal entrance during intercourse or with tampon usage
Prenatal Birth Preparation, Pain Management, and Postpartum Recovery
Pregnancy places a significant amount of stress on the entire body, leading to symptoms like back or pubic bone pain, diastasis recti, pelvic pain, incontinence or prolapse. Up to 80% of folks who deliver a baby vaginally have some degree of prolapse. Pelvic floor physical therapy can address these symptoms and correct the muscle imbalances contributing to the symptoms.
While some folks may deliver their baby via cesarean, everyone can benefit from pelvic floor physical therapy postpartum. We can support folks in coaching them through a return to activity, improving cesarean scar healing, and correcting the muscle discoordination that often happens during pregnancy due to the changes in alignment during pregnancy.
Symptoms we can address that may occur during pregnancy or postpartum include:
Maximizing mechanical fertility (for those trying to conceive)
Low back pain
Hip or leg pain
Sciatica, SI joint pain, pubic symphysis pain
Vaginal dryness causing pain with intimacy, or discomfort during daily activities
Cesarean scar healing
Perineal tear healing
Pain with intimacy during or after
Pain with orgasm during or after
Enhanced Sexual Function
Your pelvic floor muscles are responsible for supporting sexual function for both males and females. The pelvic floor allows for arousal of the clitoris, and helps your body to build up toward orgasm. However, too much stiffness or tension in the pelvic floor muscles can make penetrative activity or orgasms uncomfortable and even painful. Meanwhile, too much weakness in the pelvic floor muscles can make orgasm difficult or even impossible to achieve. Pelvic floor physical therapy can address this by reducing tension and building strength and coordination to correct this!
Symptoms that can be addressed by a pelvic floor physical therapist:
Pain with all penetration
Pain with penetration in specific positions
Pain with initial insertion of a penetrative object
Pain with deep penetration
Pain with speculum exams
Difficulty or inability to insert tampons or menstrual cups
Penetrative gripping – it feels like your muscles won’t let go during penetration
Painful orgasm or pain after orgasm
Anorgasmia – difficulty achieving orgasm, or inability to achieve orgasm
Reduced Pelvic Pain, In general
Pelvic pain is not an exclusive condition to folks who are pregnant, postpartum, or navigating pain with penetration. Pain can also occur at baseline as a result of other chronic conditions. Pelvic floor physical therapy can help maximize mobility and function in a system that is otherwise affected by a known or unknown condition, including but not limited to:
Endometriosis
Adenomyosis
PCOS
Lichen’s sclerosis/planus
IBS
Crohn’s disease
Ulcerative colitis
Post-operative hysterectomy
Interstitial cystitis
Chronic UTI’s or BV
Benign fibroids
Menopause
Other symptoms that pelvic floor physical therapy can address that are often associated with the conditions listed above include:
Chronic bloating or GI dysfunction
Painful periods
Painful ovulation
Severe physical premenstrual symptoms – cramping, low back pain, sacral pain, etc.
Pain with intimacy or changes in intimacy during or after menopause
Increased bleeding after intimacy during or after menopause, where other causes have been ruled out
Chronic hip or low back pain associated with hormonal changes during the cycle
Burning with urination, or urination frequency
What to Expect From a Pelvic Floor Physical Therapy Session
If you are considering pelvic floor physical therapy, this is what a typical plan of care might include:
Initial Assessment:
Discuss your concerns, medical history, medications, diet/exercise regimen, and birth history (when applicable)
Outline your goals for therapy
Assess your posture/alignment, lumbar spine and hips, abdomen, external and internal pelvis
Review findings and how we plan to address them
Establish a home exercise program and walk you through how these elements will help you to achieve your goals
Personalized Treatment Plan – depending on how you present, treatment may include:
Myofascial release and manual therapy techniques to reduce tension
Host of modalities: cupping, dry needling, or biofeedback cueing to improve muscle function, mobility and awareness
Breathwork and mobility
Strength training and targeted pelvic floor exercises
Daily activity modification
Dietary and fluid management
Frequency of visits varies from person to person, based on how your body presents, your goals, your budget, your support, and your time availability.
Home Exercise Program to continue making progress between sessions.
Our goal is to ensure that, by the time you discharge from our care, you can and have been able to be an active contributor to your healing because you truly understand what’s going on in your system and therefore, can support your body with autonomy.
FAQs About Pelvic Floor Therapy
What is pelvic floor therapy used for?
Pelvic floor therapy is used to treat and manage a whole host of conditions and symptoms. The most common symptoms we address are urinary incontinence, chronic constipation or bowel issues, pelvic organ prolapse, improve mechanical fertility, and prenatal and postpartum management.
For the prenatal client, our goals are to maximize your birth experience by helping guide you into what positions work best for your body for labor and delivery, minimize the likelihood of severe perineal tears, help improve your pushing efficiency which can potentially speed up your labor, and manage any symptoms that arise during pregnancy.
For the postpartum client, our goals are to address your muscle imbalances associated with pregnancy (weaker abs, glutes, overactive back muscles), improve your body’s coordination and strength postpartum, help heal perineal tearing and cesarean scars.
What are the benefits of pelvic floor physical therapy?
It improves bladder control, relieves pelvic pain, enhances sexual function, and supports postpartum healing.
How many sessions do I need?
Most patients see progress within 2-8 sessions depending on the condition, but the timeline depends on the severity of symptoms, chronicity of symptoms, and multiple contributing factors.
Is pelvic floor therapy painful?
Therapy should not be painful, though some manual techniques may cause mild discomfort. Your therapist will adjust based on your comfort level.
Is Pelvic Floor Therapy Right for You?
If you're experiencing bladder leaks, pelvic pain, or are trying to conceive, pregnant, postpartum or menopausal, pelvic floor therapy could be the solution you need. With expert guidance and a customized approach, you can regain control and feel more confident in your body.
Interested in learning more? Contact us to schedule a consultation and start your journey to better overall health today!
