Pelvic Floor Physical Therapy – What To Expect

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A pelvic floor physical therapist specializes in caring for and treating dysfunctions in the pelvic floor and ensuring the patient has optimal pelvic floor health. Did you know that 1 in 3 women experience a pelvic floor disorder of some kind? More shockingly, most women couldn’t explain the function of the pelvic floor, or describe the anatomy of the region in much detail. Pelvic floor physical therapy is essential not only due to the commonality of issues, but to provide education on the region which is a crucial structure impacting the functioning of the entire body.

The pelvic floor is greatly affected by childbirth, as the muscles, fascia, and ligaments encapsulated in the pelvis are put under significant strain and load. All women should have pelvic floor physical therapy treatment during pregnancy and in the postnatal stages, to ensure optimal pelvic health and facilitate the return of optimal strength, mobility, and functioning. On a musculoskeletal level, a dysfunctioning pelvic floor can impact the way the body moves in day to day activities, which can be inconvenient and distressing to the patient.

Pelvic floor physical therapy exists to treat and prevent both urinary and bowel incontinence, address sexual dysfunction including pain and tension, treat trauma experienced in the lower abdomen and pelvic regions, ensure optimal muscle activation and strength in the region, and thus facilitate lower body stability. This includes the ribcage, spine, hips, and pelvis. Further, treatment will involve training the patient to engage in optimal breathing patterns to assist in the reduction of tension and ensure the pelvic floor region can stretch for required tasks such as urination, bowel movement, sexual activity, and childbirth. Discuss exercise habits, and prescribe what is suitable.

What do they do in pelvic floor physical therapy?

What happens in pelvic floor physical therapy varies depending on the patient’s context and needs when symptoms are assessed. After a medical questionnaire and discussion of personal health history, an internal assessment often occurs, in which the pelvic floor physical therapist can assess the health of the region, and perform manipulation in the area, to the tissue. This is essential in the process of alleviating tension, muscle imbalances, and tender areas. Internal work is conducted through the vagina or rectum, which can be emotionally or physically uncomfortable for the patient. A pelvic floor physical therapist is aware of these natural feelings associated with the examination and will work with the patient to ensure they feel as comfortable and safe as possible under the circumstances.

Pelvic floor strengthening is also a key component of pelvic floor physical therapy, particularly if the patient is experiencing any form of pelvic floor dysfunction, such as incontinence. A well-known method to increase the endurance and stamina of the pelvic floor muscle group is Kegel exercises, which are conscious muscle contractions of the pelvic floor. Many women do not do Kegel exercises correctly. A pelvic floor physical therapist can test the strength of your pelvic floor and the quality of your kegel exercises.

Education is also a crucial component of pelvic floor physical therapy. A patient needs to understand why they issue manifested itself, their treatment options, and how they can prevent issues in the future. For example, a pelvic floor physical therapist may prescribe specific exercises to complete daily at home to strengthen the pelvic floor region. They should explain why each exercise is necessary to the patient, and how the anatomy of the region works as part of the educational piece of the treatment. Often, exercises address issues of strength and allow the patient to gradually regain control of the region. An environment of nun-judgmental, open-communication with your pelvic floor physical therapist is a must.

Is pelvic floor physical therapy painful?

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For the most part, pelvic floor physical therapy is not painful. In fact, often after a single session pain and tension can be reduced for the patient. However, some discomfort may be experienced in an internal pelvic exam or internal manipulation of the pelvic floor region. A well-trained pelvic floor physical therapist is aware that this form of treatment, whilst often necessary, can be uncomfortable. Considering this, they will do their best to make sure the patient is aware of what they are doing, why they are doing it, and check-in with the patient often.

How long does pelvic floor physical therapy take?

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This is very much based on the patient’s needs and the situation they are presenting. An initial appointment should last around 60-90 minutes. During this appointment, the patient’s medical history will be discussed, along with a health questionnaire so the physical therapist can approach treatment with a good understanding of the individual’s medical history. Often a pelvic exam will be conducted, which can involve an internal and external examination. The physical therapist will test the functioning, mobility, tenderness, and strength of the pelvic floor muscle region. Based on the examinations, the physical therapist will likely recommend follow-up appointments that target the specific issue the patient may present. These will likely be 30 to 60 minutes in length, over a period of 4-8 weeks, dependent on the situation.

For patients who are pregnant, a pelvic exam is recommended after 12-18 weeks of gestation. This will involve an internal assessment, an ultrasound of the pelvic floor and abdomen region and potential prescription of an at-home pelvic floor exercise program to prepare the pelvic floor region for birth. Ideally, a couple of follow up appointments from 6 weeks postnatal is ideal for mothers as the Pelvic Floor recovers from birth. It is, after all, the most stress and load the pelvic floor muscles will ever experience, so it is essential healing is optimized and strength to the region is re-gained.  A pelvic floor physical therapist will always tailor exercises to the individual’s personal situation and needs.

Does pelvic floor therapy really work?

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Pelvic floor physical therapy is essential to restore optimal health to the region for any woman post-childbirth, or experiencing forms of discomfort in the lower abdomen and pelvic region. The main issues that cause discomfort to the pelvic floor are:

  • Urinary and bowel incontinence
  • Sexual dysfunction including painful intercourse
  • Hypertonic Pelvic Floor (a tight and tense pelvic floor region)
  • Trauma to the region as a result of childbirth
  • Trauma from medical procedures
  • Injury to the region as a result of impact etc.

The presence and availability of pelvic floor physical therapy aren’t optimal for the number of women experiencing issues. Something else to consider is that all women who are pregnant should be engaged in pelvic floor physical therapy – that requires a lot of trained pelvic floor physical therapists, or increased methods of accessing treatment, no matter location. This is why telehealth is becoming increasingly popular as a way to participate in pelvic floor physical therapy.

Other barriers preventing women from seeking pelvic floor physical therapy involve the cost of treatment, fears of discomfort from internal work and examination, and time management worries in committing to multiple sessions.

How do you do pelvic floor physical therapy at home?

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Due to the current world situation as a result of COVID-19, pelvic floor physical therapy is transitioning to be available via telehealth. This removes geographical barriers to accessing healthcare, is more affordable, and reduces the patient’s stress around travel and potential exposure to illness. Telehealth works for both initial visits and follow-up consultations, with this academic study mentioning that “all participants felt their needs were met and that they received good care during the (telehealth) session”.

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The physical therapist will ask the patient a variety of questions in order to assess and diagnose the patient. From here, they can prescribe the best series of specific exercises and self-release techniques that address the individual needs of the patient. These exercises are designed to be completed at home on a daily basis, requiring minimal equipment. For patients that own simple equipment like a foam roller, physical therapists can integrate these tools into a rehabilitation program. For example, a foam roller can be utilized to alleviate tension around the spine, glutes, tailbone, and upper hamstring region, which can provide relief to a tense pelvic region. Make sure to wear comfortable clothing you can move in, and make yourself a safe space to carry out the exercises and self-releases.