Pelvic floor physical therapists treat problems that can be hard to talk about.
Urinary and fecal incontinence, constipation, pain during pregnancy and postpartum, painful intercourse – all are within the pelvic floor physical therapist’s purview. And they are very common issues that affect millions of people who could significantly improve their quality of life with some treatment.
Much of a pelvic floor physical therapist's work centers on helping patients get in tune with and control their pelvic muscles, which can be at the center of incontinence, painful sex and other unpleasant problems.
Patients need a referral to see a pelvic floor therapist. That doesn’t necessarily mean you have to schedule an appointment with your primary care provider, though. It may just involve a phone call or secure chat with your primary care provider's office.
A visit with a pelvic floor physical therapist starts with a conversation. Your PT will get to know your health history and is likely to ask:
- Do you have low back and hip pain that could be contributing to a pelvic health issue? The PT can perform an orthopedic evaluation of the musculoskeletal system as it relates to pelvic health.
- Are there lifestyle factors involved, such as how often you're emptying your bladder? If so, your PT may recommend “bladder retraining."
- Do you have a strong bladder urge? In that case, you could benefit from urgency reduction strategies.
- Are you drinking bladder irritants?
- Do you have trouble emptying your bowels? If so, you may benefit from a new bowel routine and colon massage.
- Are there lifestyle or behavioral modifications that might alleviate your issue?
You don't need to suffer. Ask your doctor if you should see a physical therapist.
The conversation and an exam – if there is one – take place in a private, one-on-one treatment room.
For an internal exam – often recommended for urinary incontinence, frequency and urgency; pelvic pain; pelvic floor weakness and more – the patient lies on a mat table surrounded by pillows. A physical exam is not required and is always a patient's choice. In cases where an exam is recommended, it is to help improve outcomes with isolating specific pelvic floor muscles, a complex area that is made up of 14 different muscles.
The conversations are, by nature, personal. Pelvic floor PTs often discusses with patients the best way to have a bowel movement. (There is a “best way,” although there’s no single best way for everybody. Strategies might include elevating the feet on a stool, leaning forward, deep breathing and generating top-down pressure.)
Prolapse — where an organ droops or shifts from its normal position — is a common problem.
Biofeedback is another tool. A non-invasive technique, biofeedback is used in pelvic floor PT for evaluation and as a treatment. Sensors are placed on the muscles and display the signal of the muscles on a computer screen as muscles contract and relax. It’s most useful in fine-tuning pelvic muscle control and improving coordination, endurance and strength.
The number of pelvic floor physical therapy visits a patient might need depends on how their body responds. It could take anywhere from two to 12 visits.
Treating women
Oftentimes women patients come to pelvic floor PT for help to strengthen their pelvic floor. If someone gets a strong urge to go to the bathroom but can’t make it in time without leaking, it may indicate weak pelvic floor muscles.
Sometimes, though, they need to relax rather than tighten. There’s a big misconception that every woman should be doing Kegels. For those whose pelvic floor muscles are already in hypertonic, or contracted, relaxation techniques are typically recommended – the opposite of Kegels.
Kegels are advised for people with prolapse – of the urethra, vagina or rectum – and those who don’t quite have the power to stop a stream of urine. Two of the more common reasons for prolapse are incorrect pushing during childbirth and pushing to have a bowel movement with constipation.
Pre- and postpartum moms are among those who can benefit from pelvic floor physical therapy. These visits focus on strategies for muscle recovery and function after both C-sections and vaginal deliveries. Pregnant women can meet with a pelvic floor PT before they give birth, too.
Treating men
Men sometimes have testicular and pelvic pain that appears to be prostatitis, but the symptoms don’t get better with treatment. This can be the pelvic muscles causing the pain. The treatment might include muscle relaxation, stretching and mobility exercises.
Men can do Kegels, too. If men experience urinary incontinence after having their prostate removed, pelvic floor contractions might help.
Erectile dysfunction (ED) is also classified as a pelvic floor disorder. If the cause of ED is impeded blood flow, pelvic floor physical therapy can be an effective treatment.
