Understanding Pelvic Floor Physical Therapy for Women
As a pelvic floor physical therapist in Meredith, New Hampshire, I get many calls from women who were referred to me for different pelvic floor dysfunctions. But despite the increased awareness of pelvic floor physical therapy, often times these women don’t know what to expect from an evaluation and treatment for their problem.
In this blog I am going to take the time to explain more about pelvic floor physical therapy and give you a better idea of what to expect if you find yourself needing pelvic floor physical therapy.
Topics I will cover:
Anatomy
I like to think of the pelvic floor like a hammock of muscles at the bottom of your pelvis. There are 3 layers of pelvic floor muscles. These muscles surround the urethra, vaginal opening, and anus.
What I like to note about the pelvic floor muscles, is that a lot of them share attachment points to the pelvic bone with hip and low back muscles. The adductor muscles of the thigh (groin area) attach at the front of the pubic bone, and the hamstrings attach to your sits bones to name a couple. This goes to show how connected everything in the body is and why pelvic floor dysfunction can wreak havoc on other areas of the body.
Functions of the pelvic floor
The pelvic floor is important for support, sphincter control for bowel and bladder, and sexual function.
The pelvic floor works with the core to provide stability to the body’s foundation and keep organs from falling out the bottom of the pelvis. It also provides strength and function for sphincter control to allow for control when the body should or shouldn’t go to the bathroom (void).
When you want to void, the pelvic floor needs to relax in order to open sphincters to allow contents out. And when you have to go but aren’t in the bathroom yet, the pelvic floor functions to keep sphincters closed.
For sexual function, the pelvic floor must relax for penetration, and contract for orgasm.
Pelvic floor physical therapy
The pelvic floor muscles are just like any other muscle in the body. They can be injured, tight, weak, or uncoordinated leading to dysfunction. Physical therapy can help with pelvic floor symptoms by prescribing exercise, performing soft tissue work, habit retraining, working on breathing mechanics and teaching relaxation techniques.
Some other techniques that can be helpful in the general area of the low back and hips are dry needling, cupping, and muscle scraping. Addressing areas near the pelvic floor can also improve symptoms depending on the root cause of the issue.
Evaluation of the pelvic floor can include an intra-vaginal assessment. This is done with the physical therapist’s gloved index finger. This is to assess the function of the pelvic floor muscles.
An internal exam is not necessary if you are not comfortable with moving forward with this part of the assessment. But it gives the physical therapist much more information and allows for internal treatment.
Diagnoses pelvic floor physical therapy can help with:
Incontinence and urgency- Incontinence is when urine or fecal matter escapes when you didn’t mean for it to. Urgency is when you get a sudden urge to pee or poop and you have to get to the bathroom immediately or you will have an accident.
Dyspareunia & Vaginismus- Dyspareunia is when you have pain with intercourse or penetration. Vaginismus is when pelvic floor muscles spasm involuntarily upon vaginal insertion, which can happen with sex, tampon, insertion, or a pelvic exam.
Diastasis recti abdominis (DRA)- This is when your ab muscles separate down the middle. This happens during pregnancy to allow room for the growing fetus. It takes time to heal postpartum and pelvic floor dysfunction can impede its ability to heal. DRA can also happen from poor pressure management in the body in the same way hernias occur.
Pregnancy & postpartum- Pelvic floor physical therapy can help women who are having pelvic pain during or after pregnancy. But it can also help women with birth prep to reduce the risk of tearing during the birth process.
Pelvic organ prolapse (POP)- This is when there is laxity and weakness at the pelvic floor causing different organs bulge down in the pelvic floor.
Endometriosis & menstrual pain- There can be hormonal changes that affect the pelvic floor during different stages of your cycle. Endometriosis can cause painful periods. Pelvic floor physical therapy can help with painful symptoms associated with endometriosis and menstruation.
Pain in the low back, hips, SI joints, and/or tailbone- Pelvic floor physical therapy can help with pain in areas that may seem unconnected, like I mentioned above, the pelvic floor is connected to may areas of the body.
Do you need pelvic floor physical therapy?
Anyone can benefit from pelvic floor physical therapy whether or not they are experiencing symptoms. You can always improve your health by assessing for pelvic floor to improve your strength and optimize function for any of your activities and to prevent dysfunction in the future!
Some symptoms you may be experiencing that point to pelvic floor dysfunction include:
Heaviness in your vagina, bladder, or pelvis
Leaking when you cough, laugh or sneeze
Peeing your pants when you run
Experiencing fire crotch during pregnancy
Pain with sex
Postpartum recovery
You have a hernia
Frequent urination
Your core doesn’t feel strong even though you do ab exercises
My approach to pelvic floor physical therapy
So just like any other part of the body that could be injured, I want to assess how the pelvic floor coordinates movement, if there is any tension (muscle knots), and strength. The three movements I assess to gather this information include a pelvic floor contraction (kegel), bearing down (how you lengthening your pelvic floor), and a cough (creating pressure at the pelvic floor). First I watch how the pelvic floor coordinates movement visually, I palpate the external pelvic floor muscles, then I assess those movements digitally (with a gloved finger) at each layer of the pelvic floor.
Because you are a whole human, and not just a single body part, I also do a functional movement screen in standing, assess breathing mechanics, and test low back and hip strength.
Based on my findings we make a treatment plan together that best suits your needs.
How you can work with me
I am a physical therapist in the Lakes Region of New Hampshire, based out of Meredith.
I offer one-on-one physical therapy and wellness services. I have a special interest in treating active individuals, jaw pain, and women with pelvic floor dysfunction.
I offer concierge services, as well as in-office visits in Meredith and Laconia.
I take a holistic and movement based approach with my clients. Some of my treatment techniques include mind-body connect training, exercise prescription, habit education and management, and dry needling.
If you are in the Lakes Region and are looking for treatment, schedule a free discovery call through the link below. I look forward to connecting!
If you aren’t local to the Lakes Region of New Hampshire but need pelvic floor PT, you can find a provider near you!
*The information provided on this blog is intended for general wellness education purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physical therapist, physician, or other qualified health provider with any questions you may have regarding a medical condition.