Pelvic Floor Health

Pelvic floor physical therapy

Pelvic Floor physical therapy is not a new therapy. It has been used for many years with excellent results in the United States and other countries.
75-80% of our patients will see significant improvement or cure with this therapy program. As with any treatment, there will be some individuals who will not benefit from this non-surgical therapy. Patients with the greatest success are those who are motivated and follow instructions. Pelvic floor physical therapy has no significant side effects and exercises can be continued in the comfort of your home when treatment is completed in order to maintain positive results.

Indications for pelvic floor physical therapy

Here are some indicators that might determine that you need pelvic floor physical therapy: 

  • Stress Incontinence
  • Urge Incontinence
  • Urgency
  • Urinary Frequency
  • Pelvic Pain
  • Rectal Pain
  • Pain with Intercourse
  • Prenatal & Postpartum
  • Menopausal Changes

To determine if pelvic floor physical therapy will help you, ask your healthcare provider for more information or a referral to our office.

How does pelvic floor physical therapy work?

The pelvic floor consists of muscles that form a sling from the pubic bone to the coccyx (tail bone). These muscles function to support our pelvic organs and control the release of urine, gas and bowel contents. Weakness in these muscles can result in stress incontinence (leakage of urine or stool) when a person, cough, sneezes, laughs or jumps. Many things can cause these muscles to weaken including, childbirth, high impact activity, chronic constipation, obesity, menopause and poor body mechanics. Significantly weak pelvic floor muscles do not optimally support the organs above it and can result in a pelvic organ prolapse. Kegel exercises do work; however, many people perform them incorrectly and done incorrectly, they can promote incontinence.

Urgency, frequency, and urge urinary incontinence are conditions in which the detrusor muscle (the involuntary muscle of the bladder), becomes overactive. Behavioral changes and education received through pelvic floor physical therapy, if followed, can help reduce or even eliminate these problems, often preventing the need for medication.

Pelvic pain can arise from muscles and connective tissue (ligaments) in the structures of the pelvic floor and occasionally due to irritation of nerves in the pelvis. Often pelvic floor muscles that are too tight and that can result in pain with bowel movements or even with intercourse.

Pelvic floor physical therapy is a practice of healing that restores function and reduces pain using techniques to improve bony alignment, reduce trigger points, and improve muscle coordination and strength.

Personalized program

This therapy combines a personalized program with office treatment visits. A comprehensive plan of care is developed to meet the needs of your specific problem. The evaluation begins with talking to the physical therapist about your current problem/concern. You will be asked about pain (if relevant), previous pregnancies and deliveries, surgical history, medication history and previous tests or imaging. You will be questioned about bladder retention or leakage, how frequently you are voiding (urinating), diet, activity level, and information regarding pads you have been using along and any other pertinent questions deemed important.

The physical therapist will then perform a quick orthopedic assessment looking at the way your hips and back are aligned, assessing range of motion of your joints as well as strength testing.

The evaluation typically ends with an internal examination of the pelvic floor muscles. The pelvic floor muscle examination requires the patient to undress from the waist down, but draping will be performed for privacy. The physical therapist completes the exam using a gloved hand as the testing instrument. Speculums are rarely utilized. For this examination, the physical therapist will examine the perineal area (vaginal area) externally to look for any asymmetries, scarring, or tissue abnormalities that help us identify areas of inflammation or irritation. Following this external examination, an internal examination will be performed with the patient’s permission. The internal examination utilizes a gloved hand as the physical therapist’s tool to assess the muscles of the pelvic floor. Through palpation of the vaginal wall, the physical therapist can assess muscle tightness, areas of tenderness or pain, and muscle strength. The pelvic floor muscles will be assessed for strength to better help understand areas of weakness and dysfunction.

Through this examination, the physical therapist will find any muscle weakness, tightness, and areas of dysfunction. Combined with the history, this helps the physical therapist create a treatment plan for your pelvic pain or bladder dysfunction. Treatment often involves manual treatment both internally and externally, strengthening, relaxation training, and behavioral interventions that all work together to solve your problem!

Individualized plan of care

Based on your health history and the comprehensive evaluation performed by your physical therapist at your first appointment, a plan of care is developed specifically for you.

This may include: 

Manual Techniques
Physical therapists use their hands as diagnostic tools to assess restrictions, tender points, swelling, muscle guarding, atrophy, nerve irritation and skeletal malalignment. Their hands are also used to treat these problems, provide feedback to the muscles, and facilitate the activation of certain muscle groups. Other techniques that may be used include scar mobilization, connective tissue manipulation and joint mobilization.

Strength and Endurance Training
Therapeutic exercises are specific solutions for physical therapy that are designed to treat problems like injuries, reduction in muscular function, impairment of skeletal function, minimized flexibility, and lack of strength and endurance by targeting them specifically. Sometimes therapists will make use of biofeedback or neuromuscular electrical stimulation (NMES) to assist in attaining specific goals. Biofeedback is a type of therapy that uses sensors attached to your body to measure key body functions. Biofeedback is intended to help you learn more about how your body works. This information may help you to develop better control over certain body functions and address health concerns. NMES is a technique used to elicit a muscle contraction using electrical impulses.

Bladder Retraining
Once strength is improved, the bladder can be “retrained” to hold a larger volume of urine so bathroom stops are not as frequent.

Dietary Changes
Often simple dietary modifications can help alleviate bladder dysfunction.

Follow up visits

After your initial visit, you will be asked to return to the office for a series of pelvic floor physical therapy visits. Patients are typically seen one time per week for 30 minutes. Most people require 6-8 treatments before they are discharged with a home exercise program. A positive change in your symptoms should be noticed in 3-4 visits. This does not mean you will be cured in 3-4 visits, but you should begin noticing improvement. Research has shown that patients who adhere to their prescribed exercises and individualized instructions are significantly better at achieving their goals and demonstrate a greater increase in physical function. The physical therapist is there to guide and support you, but ultimately it is up to the patient to do what is required of them.

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