My interest in pelvic floor therapy started during my third clinical rotation. While I had come prepared to treat chronic low back pain, post surgical conditions, sports injuries and other general orthopedic conditions I had very little knowledge on pelvic floor dysfunction. My clinical instructor was treating a recently married, young woman for pelvic pain that was impacting her ability to have intercourse with her new husband. Just like most of my patients I see today, I thought to myself, “How can physical therapy help with that?” And trust me, after three years of treating pelvic floor dysfunction, I only wish more therapists would have the same realization; there is a large and under served population, of women and men, who have been passed between doctors, told it was all in their head or brushed off due to “the normal aging process” that can and should be helped.
The term pelvic floor refers to the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum and help these organs function. Similar to other muscles found in your body, these pelvic floor muscles can be weak or contracted causing leakage or pain. As musculoskeletal experts, retraining muscles to decrease pain and improve mobility is in our wheel house! This particular group of muscles just happens to be on the inside.
How these muscles become weak or contracted can occur in multiple ways and present differently for each patient so I always start my initial evaluation with a good history. Many patients come in with a complex medical past but there are some who are not sure why their symptoms started. I also like to assess your hip flexibility as well as core and leg strength because of the close proximity and shared function of these structures.
The reason you need to specifically see a pelvic floor physical therapist is because we are trained to perform an internal assessment of the pelvic floor muscles. This is NOT the same as a gynecological exam…no speculum or stirrups required. (While I cannot say I understand what a patient is going through, I can say I have had this performed on me multiple times in a room of 30-40 people.) The purpose of this assessment is to identify which muscles are contributing to the problem and why, so, we can figure out the appropriate course of treatment.
Treatment may include internal trigger point release or massage, biofeedback to down train muscles, dilators and hip flexibility to help decrease pelvic pain with wearing tight fitting clothes, intercourse, tampon use and other daily activities. When muscles are weak exercises such as Kegel are performed to strengthen as well as education on diet and voiding habits to decrease urinary frequency or leakage with cough, laugh, sneeze or a strong urge.
Pelvic floor dysfunction is not restricted to gender or age or postpartum women and can have a major impact on a person’s quality of life. Feelings of social isolation, depression and anxiety are all to common in this population. If you think you may be suffering from this condition, please do not wait to ask your doctor about seeing a pelvic floor physical therapist.
For more information:
Pelvic Pain Explained; what everyone needs to know by Stephanie A. Prendergast and Elizabeth H. Rummer