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Pelvic Floor Physical Therapy

What is it?

Pelvic floor physical therapy addresses problems with the muscles deep in the pelvis. When these muscles don’t work well, patients may experience bladder or bowel leaking, pain with intimacy, constipation, or pelvic organ prolapse. A pelvic floor physical therapist can assess the muscles and then prescribe strengthening, stretching, relaxation and coordination exercises.

The Pelvic Floor

The pelvic floor is a hammock-shaped group of muscles that sit in the base of the pelvis.  There are three layers of muscles.  As a group, they close off the opening of the pelvic bones. Like all muscles, the pelvic floor muscles have a full range of motion.  They close and lift with contraction and open and drop down with relaxation. The muscles sit in a way that allows them to provide support to the organs housed in the pelvis – the bladder, rectum and uterus.  While slightly different in shape and orientation, both women and men have pelvic floor muscles.

Function

The pelvic floor muscles have four main functions:

  • Sphincteric – what they are best known for, the pelvic floor muscles tighten to close the urethral and anal openings to hold back urine, stool, and gas
  • Stabilizing – when the pelvic floor contracts, there is is lifting motion that draws the bony pelvis together, making it more stable to allow for improved weight shifting (ex. walking)
  • Supportive – the pelvic floor muscles provide support to the organs of the pelvis (bladder, rectum, uterus) against gravity and high impact activities
  • Sexual – contraction of the muscles of the pelvic floor and proper blood flow to the surrounding tissues are essential for a healthy sexual response

Dysfunction

Like any muscle in the body, the pelvic floor muscles can be dysfunctional.  They can be too tight, too weak, poorly coordinated, or untrained.  This can lead to symptoms such as incontinence, urgency, and pain.  A pelvic floor physical therapist specializes in assessing the muscles of the pelvic floor to find out the underlying cause of these symptoms.

What to expect – the first visit

The first appointment is an hour long.  Before any exam, the physical therapist will ask about your history and symptoms including bowel and bladder habits, activities that cause pain, and any birth or surgical history.  This information will drive the physical assessment.  The muscles of pelvic floor can be assessed  both internally (vaginal or rectal) and externally.  Unlike a gynecological exam for women, there is no speculum inserted or stirrups to put your feet in.  All patients give written and verbal consent before internal assessment and treatment.  Other assessments may include looking at posture and movement.  You will be given suggestions to start working on and may be asked to track times of pain and bladder or bowel function to review with your PT at the next session.

What to expect – follow up visits

Follow up visits are typically half an hour long.  They include a review of your symptoms and any manual treatment needed.  This may be internal (vaginal or rectal) treatment for muscle release or coordination training.  Treatment may also include breathing exercises, strengthening, stretching, bladder retraining, and postural adjustments.  These are things patients are expected to work on at home to maintain progress between sessions.