It can be hard to know what to expect during your first visit with a pelvic floor physical therapist. There are many steps to take for the physical therapist to get to know you, your specific movements, and design a treatment plan together. We are going to discuss what pelvic floor physical therapy is, who can benefit from it, specific diagnoses that we can help treat, and what an evaluation entails. But first, let’s answer the most important question, what is pelvic floor therapy?
Pelvic physical therapy is designed to evaluate, diagnosis, and treat disorders related to the perineum, vagina, bladder, vulva, and anal canal that cause disruptions to people’s activities of daily living.
Pelvic Floor Disorders
Pelvic floor physical therapists help a wide variety of people and diagnoses. For example, pelvic floor physical therapists can assist those suffering from pelvic tightness or laxity, urinary incontinence, fecal incontinence, pre/post-partum, interstitial cystitis, painful bowel syndrome, chronic pelvic pain, pelvic organ prolapse, stress incontinence, urge incontinence, pain during intercourse, pudendal neuralgia, vaginismus, vulvar pain, endometriosis, dyspareunia, back pain, sacroiliac pain, coccyx dysfunction, and dysmenorrhea. This is just a small list of the areas that pelvic floor physical therapists can make a difference.
The most common treatments of the pelvic floor are stress and urge urinary incontinence. Have you ever been on a trampoline with your children and felt the sudden urge to use the restroom? This is called stress incontinence, voiding under exertional positions like jumping on a trampoline! Other examples of this include running, lifting, and bike riding.
This is treated with a combination of bladder strengthening/retraining and re-education of pelvic floor muscles. This diagnosis affects many women, in fact; 49% of women who exercise regularly at the gym experienced some sort of stress urinary incontinence (McKenzie et al., 2016). Stress incontinence can lead people to have issues with urge urinary incontinence.
Urge urinary incontinence is loss of urine immediately led by intense urgency. When you are about to take a shower, do you feel the need to use the bathroom? This is your brain telling your bladder that you must use the restroom, even if you really don’t need to go.
Another example of urge incontinence is when you first put your key in the door and you feel the intense need to use the restroom. This is treated with bladder retraining, dietary and liquid assessments, and behavioral modifications.
Both conditions can be debilitating for young men and women. A study conducted in 6 weeks for 55 and older women focusing on bladder control re-training due to symptoms of urge/stress incontinence found 50% reduction of incontinence episodes vs no therapy (Subak, 2002). A physical therapist will use methods such as electrical stimulation, kegel exercises, and trigger point therapy to assist you on your road to recovery.
Pelvic Floor Evaluations
An evaluation of the pelvic floor starts with an assessment of posture, low back, hips and sacroiliac for abnormalities or possible contributions. Examining the abdominal wall, trunk, and pelvis including the piriformis, gluteal, adductors, and iliopsoas) for tone, spasm, edema, and abnormal sensation.
Visceral mobility and motility play an important role as well. An external exam of the vulva and perineum is used for assessment of strength and integrity of the surrounding skin. Lastly, an internal assessment helps assist in our diagnostic process, discuss areas of weakness/tightness, encouraged different movement patterns, and evaluate progress throughout treatment.
So, when do you know when to seek treatment for your pelvic floor? This answer is simple, as soon as possible! This may differ depending on your activity level and severity of symptoms. However, treatment should never be postponed until pelvic health symptoms are serious.
Always consult with your primary care physician to rule out infections and other skin conditions that may be contributing. Pelvic floor physical therapy can help a wide variety of people ranging from 18-99 years. Let us help you tackle your symptoms, so you can live pain and leak free.