Pelvic Floor Therapy Explained: Understanding What It Is and Who It’s For
Pelvic Floor Therapy is a specialty within Physical Therapy that specifically addresses issues related to pelvic health. Although this growing field has been around for several decades, many people still suffer in silence due to either lack of awareness of the specialty and/or hesitancy to discuss symptoms that are vulnerable and intimate. We must also acknowledge how one’s trauma may hold someone back from seeking care for their pelvic health. If you’re someone who has experienced pelvic pain, bladder or bowel symptoms, or concerns over sexual function, I encourage you to read on and explore the ways in which Pelvic Floor Therapy can help.
What is Pelvic Floor Therapy?
Pelvic Floor Therapy is a specialty within the field of Physical Therapy (PT) that addresses the muscles, ligaments, bones, and nerves in and around the pelvis. Of note, some pelvic floor therapists have a background in Occupational Therapy, but for the remainder of this writing, I will be referring to Physical Therapy, as this is where my training lies to speak upon.
Since the early 2000s, the Physical Therapy profession has changed to a Doctorate Degree. PTs are considered the “movement specialists” among healthcare providers and address neuromusculoskeletal injuries or disease. Those, like myself, who choose to specialize in pelvic health will undergo much more training to specifically address bladder and bowel concerns, pelvic pain conditions, sexual function, and symptoms associated with pregnancy and postpartum.
Your pelvis contains muscles, nerves, and ligaments, just like other areas of your body that traditional physical therapists may treat. And just like with other forms of physical therapy, a pelvic floor therapist’s role is to restore normal function, mobility, strength, and coordination. When there are impairments in this area leading to symptoms, we refer to this generally as “Pelvic Floor Dysfunction.”
What Causes Pelvic Floor Dysfunction?
Sometimes we can trace pelvic floor dysfunction back to a specific incident. Most often, however, people will report that symptoms either “came out of nowhere” or were building up over a long period of time. Anecdotally, I’ve found that it in most cases, it usually comes down to several factors that, over a periods of time, come together to create “the perfect storm.” This is especially true for patients who come to me after seeing 10+ doctors without an explanation for their concerns.
Here are some very common causes of pelvic floor dysfunction:
Injury (car accident, significant fall on your tailbone)
Surgery
Chronic constipation or straining of your pelvic muscles
Heavy lifting with straining and poor mechanics
Hip injuries (current or past)
Poor bladder and/or bowel habits (ie. holding your pee in all day, rushing/pushing out to pee faster)
Chronic stress and tension
Connective tissue disorders
Underlying medical conditions that further impact the pelvic floor (ie. Endometriosis, Cancer resulting in pelvic radiation tx)
How Does Pelvic Floor Therapy Work?
Pelvic floor therapy is more than just kegels. In fact, kegels can often be either ineffective or actually worsen symptoms, depending on the root cause of the dysfunction. Many people don’t realize this or understand what pelvic floor therapy truly entails. A pelvic floor therapist should first and foremost listen to your story and work to find the underlying cause for your symptoms. It’s true that there can be many different reasons causing the same symptom, which is why determining the cause is so important to direct effective treatment. For example, one person may experience bladder leakage due to a loss of pelvic floor support from something like Pelvic Organ Prolapse, while another person may experience the same symptoms due to overactivity of their pelvic floor muscles. Pelvic Floor Therapy should also include a comprehensive evaluation from head to toe, because pelvic floor dysfunction can be caused by, or exacerbated by, factors outside of the pelvis itself. Just as the evaluation should include a full-body approach, so too should treatment.
An internal pelvic floor evaluation is often performed as part of therapy and is quite helpful in guiding treatment. This differs from a pelvic exam done by a gynecologist or proctologist, as this type of examination focuses on the pelvic floor structures specifically. It’s important to know that a good therapist will explain the purpose and expectations with this kind of evaluation, as well as amend the evaluation if you’re not comfortable with internal work.
Pelvic Floor Therapy includes:
Patient education - helping you to understand your body, your experiences, and a plan to walk alongside you through recovery.
Manual Therapy - hands-on treatment for your bones or soft tissue. This can include things like massage, joint mobilization, cupping, taping, or dry needling.
Movement - optimizing mobility and strength/stability. This may include stretches, functional movement, and strengthening exercises.
Neuromuscular re-training and nervous system regulation strategies.
Optimizing bladder and bowel habits.
At Restore Pelvic Health & Rehab, we understand the unknown can be a bit scary, and so we like to provide our patients with a description of what to expect and explain our 3 component approach to therapy.
Who is Pelvic Floor Therapy for?
There are some common misconceptions about Pelvic Floor Therapy being only for women, those who are pregnant, or the older population. The truth is that all individuals have a pelvis and pelvic floor dysfunction can affect anyone. Symptoms are more common than you may think, but just because something is common does not mean it’s “normal.” The key question to be asking is, “when should someone see a pelvic floor therapist?”
Here is a list of reasons why you should seek out pelvic floor therapy:
Pelvic Pain - Endometriosis, Interstitial Cystitis, Chronic Prostatitis, Pudendal Neuralgia, Vaginismus, Vulvodynia, Pain in the lower back/hip/SI joint, testicular pain, penile pain, rectal pain, tailbone pain
Bladder Symptoms - Incontinence, frequency, urgency, difficulty emptying the bladder, frequent UTIs, phantom UTIs
Bowel Symptoms - Constipation, incontinence, urgency, bloating, fissures/hemorrhoids
Sexual Dysfunction - Pain with sexual activity, pain with orgasm, difficulty achieving orgasm, Erectile Dysfunction
Surgical Rehab/Prehab - Prostate removal surgery, Post-radiation therapy, C-section recovery
Pregnancy/Postpartum - Pain during pregnancy, birth prep, postpartum recovery and strengthening
Gender Affirming Care - Symptoms associated with gender affirming practices and/or surgeries (ie. binding, tucking, Vaginoplasty)
Final Considerations
Pelvic floor therapy is very personal, as well as complex. For this reason, I generally advise people to consider the following, when starting their pelvic health journey:
Be sure you are working with a board certified PT or OT who specializes in pelvic health. I do not recommend going to a general, orthopedic therapist, who claims they can also help with your pelvic symptoms. I used to be an orthopedic therapist so trust me when I say they are not trained in how to appropriately evaluate and treat pelvic floor conditions. Pelvic floor therapy is also not done by nursing or support staff in your doctor’s office. If someone is promising you this, I can assure you it’s not true pelvic floor therapy.
Ask your prospective pelvic floor therapist if they’re comfortable treating outside of the pelvis as well. Treatment needs to be comprehensive and not focused solely between your legs.
Pelvic Floor Therapy is for all humans, regardless of gender or body type. It can also serve as a fabulous preventative strategy, whether you’re preparing for childbirth, surgery, or menopause. It shouldn’t only be though of a rehab - but PREhab too!
Finally, you should feel informed and empowered, when you work with a therapist. Pelvic floor therapy is meant to help you get to the root cause of your symptoms and teach you how to resolve them. It should be collaborative, rather than passive, with you as an integral part of the medical team.
If you’re local to the Delray Beach area and are curious about Pelvic Floor Therapy or sexual wellness, our Doctor of Physical Therapy would love to work with you.
I hope this information was helpful and maybe caused you to look at symptoms you have been ignoring. If you need help finding a pelvic floor therapist in Florida, we hope that you will consider us for either in-person or virtual appointments.
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