What is Pelvic Floor Physical Therapy?
Pelvic floor therapy involves physical methods of strengthening and/or relaxing the muscles of the pelvic floor that support the urinary and reproductive tracts, helping improve core stability and control over urination, bowel movements and sexual function in men and women.
Pelvic floor physical therapy uses a variety of different methods to:
- Increase pelvic floor muscle control
- Improve awareness of contraction and relaxation patterns
- Decrease pain and symptoms of pelvic floor dysfunction
Pelvic floor muscle tone can change due to trauma, childbirth, the aging process or stress. This may result in the muscles becoming too stretched and loose, weakened, or too tight and restricted. Both decreased and increased muscle tone can lead to pelvic floor dysfunction.
Research supports pelvic floor therapy as a minimally invasive treatment option that should be used as a first-line method for treating various types of pelvic floor dysfunction, including issues such as pelvic organ prolapse, urinary or fecal incontinence and painful intercourse.
Pelvic Floor Therapy: What to Expect
Since it is a mystery what a pelvic floor physical therapist does, it helps to know what to expect when signing up.
On the day of your pelvic floor therapy evaluation, you will be brought into a private treatment room. Your physical therapist will go over your medical history, symptoms, and complaints.
They will also perform a physical exam, which will consist of an external and at times an internal component:
- During the external exam, your physical therapist will assess your lumbar spine, sacroiliac joints, and muscles that surround or attach to the pelvis including the rectus abdominis, iliopsoas, and piriformis to check for pain, tightness or tenderness.
- During the internal exam, your physical therapist will assess your pelvic floor muscles for tone, elasticity, pain and tenderness. They may insert one or two gloved fingers into your vagina and/or rectum to palpate the pelvic floor muscles from the inside. A lubricant is often used to help ease the discomfort.
- Your physical therapist will also examine your ability to perform voluntary contraction and relaxation of your pelvic floor muscles, as well as movement of your pelvic floor with your breathing patterns.
After your physical therapist has completed the examinations and made a clinical assessment about the possible causes of your symptoms, you will be scheduled for follow-up sessions. Number of sessions and frequency of visits will be discussed between you and your therapist. Frequency and number of visits is individually based upon need. Each session last approximately 1 hour and will take place in a private treatment room.
Pelvic Floor Therapy Exercises and Treatment Techniques
Your treatment may consist of the following:
- Exercises to relax or contract the muscles of your pelvic floor, such as Kegels
- Manual therapy, performed internally and/or externally by your physical therapist, to relax the pelvic floor muscles and relieve pain associated with trigger points
- Biofeedback, with the use of an external sensor to sense the strength of contractions of the pelvic floor muscles to help you be aware of when you are contracting or relaxing these muscles
- Pelvic floor therapy devices to gently stretch the pelvic floor muscles and allow them to relax
How to Prepare
To prepare for pelvic floor therapy, you should arrive dressed in comfortable clothes that allow you to move your legs freely without restricting your movement. Your exam may include an internal component, so make sure your groin and genital area is clean before your appointment. Let your therapist know if you are menstruating. An internal exam is optional and is not required.
It is helpful to come prepared with a list of questions or concerns you want to ask your physical therapist during your exam and evaluation. Give yourself extra time to arrive at the physical therapy facility to fill out initial paperwork before your first visit.
You should bring the following with you to your first appointment:
- Form of identification, such as a driver’s license or passport
- Health insurance card
- List of any medications you are taking
- Prescription from a referring physician, if needed
Your Treatment May Be Different Based on your Pelvic Floor Disorder
Pelvic floor physical therapy is used to treat all types of disorders classified as pelvic floor dysfunction. Pelvic floor dysfunction can be subdivided into hypotonic, or low tone, and hypertonic, or high tone, disorders.
Muscle tone refers to the amount of resting tension in a muscle when it is not contracted. Too little or too much tone in the pelvic floor muscles can cause different forms of pelvic floor dysfunction.
Low Tone Disorders
When a muscle has low tone, the muscle is more relaxed and looser than normal, making it difficult to actively contract.
When the pelvic floor muscles are weak due to low tone and you have difficulty actively contracting them, your core cannot be adequately supported and your control over your bladder and bowel movements may be affected.
Low tone pelvic floor disorders that can be helped by pelvic floor therapy include:
- Pelvic organ prolapse: Abnormal descent of the pelvic organs, including the uterus, vagina, bladder, or rectum, from their normal positioning
- Stress incontinence: Involuntary leaking of urine during activities that increase intra-abdominal pressure, including coughing, sneezing, laughing, jumping, and heavy lifting
- Bladder Frequency: A condition characterized by urinary urgency, frequency, and urge incontinence when experience leakage associated with urge to urinate
- Fecal incontinence: Involuntary leaking of gas, fluid, or stool from the rectum
High Tone Disorders
When a muscle has high tone, the muscle is tighter and more restricted than normal. This can often cause pain when you try to relax or stretch the muscle.
When the pelvic floor muscles are excessively tight due to high tone, you may experience pelvic pain, muscle spasms, as well as pain and difficulty with insertion during intercourse or during a gynecological exam.
High tone pelvic floor disorders for which pelvic floor therapy may be recommended include:
- Vaginismus: Uncontrolled, involuntary spasm of the muscles surrounding the vagina that occurs with penetration
- Dyspareunia: Pain during sexual intercourse from vaginal penetration
- Vulvodynia: Pain and discomfort in the vulva, often referred from tight and dysfunctional pelvic floor muscles
For more information, visit our Pelvic Floor Physical Therapy program.