Pelvic health physical therapy includes exercises and manual techniques to strengthen the muscles of your pelvic floor. These muscles affect bladder and bowel function, pelvic pain, and sexual function.
A pelvic physical therapist evaluates how well your pelvic floor muscles are functioning in a private treatment room. The evaluation includes an external exam and an internal assessment using a probe in your rectum or vagina. Click here at https://saunders-therapy.com/ to learn more about this therapy.
Evaluation
Your physical therapist will ask you many questions – some might feel like TMI (taboo information) but this is part of the comprehensive exam process. They want to understand all the things that have happened to you and why they are causing symptoms so they can determine a treatment plan that will help.
They will perform external palpation which is feeling for the bony landmarks and muscles around your pelvic bones. They can do this without undressing if you are comfortable. They will assess your posture and movement patterns, looking for areas of tightness, sensitivity, and strength in the hip, lower back, and abdominal muscles that may be contributing to your pelvic floor problems.
Pelvic floor muscles are a series of deep internal muscles in your pelvis, located between the two sitting bones and the pubic bone. They support the bladder, uterus, and labia and have important roles in controlling the urinary tract, managing pressure changes with coughing or heavy lifting, preventing back pain, and helping control bowel movements. Men and women have these muscles and they are used by both!
The therapist will then do an internal exam of the pelvic floor muscles. This is done using a gloved finger, usually in the vagina or rectal canal. They will check for sensitivity in the muscles, see if you can contact them, and assess for symmetry, length, tone, and integrity of the muscles. They may also ask you to bear down or push out as if having a bowel movement, to check for the ability to voluntarily contract and relax the muscles. Unlike a gynecological exam, there is no need for a stirrup or speculum and the internal evaluation only takes a few minutes!
Exercises
Your pelvic floor muscles support your core, help with bladder control and, for women, allow for orgasms. But, over time, they can weaken, leading to conditions such as urinary incontinence or prolapse. Strengthening these muscles with targeted exercises can relieve symptoms and in some cases cure conditions.
Your physical therapist will develop an exercise program to either relax or strengthen your pelvic floor muscles, depending on what your condition requires. You may also learn breathing exercises to improve the coordination between your abdominal and pelvic floor muscles. These may include diaphragmatic “belly” or chest breathing, which can decrease pain and help prevent muscle spasms.
You’re probably familiar with the Kegel exercise, an intentional pelvic contraction that tightens these muscles. It’s often recommended by gynecologists and pelvic health PTs as an easy way to tighten these muscles without straining. But, if you search “pelvic floor exercise,” there are many more options that can target specific problems such as prolapse and urinary incontinence.
Other exercises may involve laying on your back with your knees bent and feet flat on the floor, hip-width apart. Then, while keeping your spine neutral, bring one leg down by contracting your core muscles and gently tapping that toe on the floor. Repeat this exercise with the other leg for 12 to 20 repetitions.
Another popular exercise is the bridge pose. This is done while lying on your back with your knees bent and your feet flat on the floor, hip-width aside. Then, lift your hips toward the ceiling, concentrating on engaging the core and pelvic floor muscles to avoid putting pressure on your lower back or neck. This can be repeated for five to ten breaths, then rest.
Manual Therapy
The pelvic floor is a group of muscles that support your bladder and bowels. It also keeps your uterus and rectum in place, which is important for women to prevent pregnancy. Women and men both have pain or dysfunction in their pelvic floor, which can affect daily life activities. Pelvic floor physical therapy can help relieve those problems so you can live a healthy, active life.
Manual therapy techniques include myofascial release, joint mobilization, skin rolling, and muscle massage to address tightness and musculoskeletal misalignment in the area. These techniques can reduce pelvic pain and improve function by restoring normal movement patterns and muscle reeducation.
Trigger point therapy is a hands-on technique that involves applying precise pressure to the tight areas of the body, called trigger points. These tight areas can cause pain throughout the body and are often the root of your pelvic floor problems. Physical therapists who are trained in pelvic floor manual release techniques can help identify and treat these issues.
Stretching and relaxation are also part of pelvic floor manual therapy. Adding these strategies to your everyday routine can ease tension in the area and increase flexibility and mobility. This helps improve the effectiveness of your exercise program and overall treatment results.
Your physical therapist will teach you how to use these strategies at home, helping you manage your symptoms and keep them from returning. They will provide you with a comprehensive plan to help you reach your goals. They will assess your progress and adjust your treatments to ensure you are making good progress.
Biofeedback
Often used in conjunction with manual therapy and a comprehensive exercise program, biofeedback provides a visual representation of muscle activity to help patients learn to strengthen weak muscles and train tight ones to relax. Many at-home modalities, such as electrical stimulation and surface electromyographic (sEMG) biofeedback, are available that can be used to address a variety of impairments including urinary incontinence and pelvic pain.
During the biofeedback session, your physical therapist will place one or more sensors on the skin and attach them to a machine that monitors your muscular responses. A computer screen displays the information, allowing you to watch your muscles contract and relax as you work to improve muscle control. Your physical therapist will also teach you to use these techniques at home.
Because the pelvic floor muscles are a group of internal muscles that are difficult to access, the biofeedback process can be helpful in both strengthening and training. In one study, using a combination of exercise and biofeedback with levator ani syndrome, biofeedback improved the symptoms significantly more than traditional physiotherapy.
Although some people are hesitant to try the method because of its association with mind-body treatments, it seems safe and does not have any negative side effects. It is an effective treatment for urinary incontinence and other health problems, such as constipation that results from tight muscles in the rectum (dyspareunia).
The first step is to get an evaluation done by a physical therapist to determine whether you might benefit from a pelvic floor biofeedback approach. Most patients undergo treatment over six to 12 one-hour sessions. The evaluation usually includes a review of bladder/bowel function and daily bowel/bladder habits and may include a non-invasive physical exam.
Electrical Stimulation
During the evaluation, your physical therapist will be able to determine the cause of your symptoms and will work with you to create a treatment plan. This will include hands-on techniques to stretch and strengthen the pelvic muscles, educating you on how to contact your pelvic floor muscles and biofeedback.
Electrical stimulation uses a gentle current to stimulate muscles and nerves for increased contraction and flexibility, normalizing of nerve function, and mobilizing restricted joints. It is usually a pulsed “bi-directional and biphasic” current to reduce skin and tissue irritation. This helps increase the number and strength of slow twitch fibers in the muscles making it easier to achieve stronger pelvic floor muscle contractions.
Depending on your symptoms, your physical therapist may also utilize internal techniques such as trigger point therapy (in which pressure is placed against specific points in the body, internally or externally through the vagina or rectum) and musculoskeletal mobilization techniques like skin rolling, myofascial release and joint mobilization.
Your therapist will be sensitive to your comfort level with these techniques and will not introduce them until you are ready to do so. If you are uncomfortable with these internal treatments, your therapist will provide you with a home exercise program that will help alleviate your symptoms without the need for these more invasive techniques.
Your therapist will be happy to answer any questions you have about the evaluation and treatment process. We will work together to establish your goals for physical therapy and how they relate to your daily activities. Common goals include: not having to urinate in your underwear at the office, being able to go for long walks or participate in your favorite hobbies without feeling an urgent need to use the restroom, reducing pain or discomfort during sex and enhancing orgasms, and returning to sports and exercise without bladder control problems.
