Pelvic Floor Therapy
What is the Pelvic Floor?
To understand the purpose of Pelvic Floor Therapy, we must first understand the Pelvic Cavity, which houses the Pelvic Floor. The Pelvic Cavity is one of our many body cavities in the human body, located below our stomach and surrounded by pelvic bones. This region contains major arteries, nerves, and muscles, alongside important waste and reproductive organs. The pelvic floor, also known as the pelvic diaphragm, is a group of sling-shaped muscles that spans the area at the lower-most section of the pelvic cavity. The pelvic floor is home to those important pelvic muscles that provide direct support to our pelvic organs: the bladder, bowel, rectum, and the uterus in women. We use our pelvic floor muscles by contracting and relaxing them to enable bowel and bladder movement. Dysfunction of the pelvic floor occurs with improper contraction and relaxation of the muscles and leads to various conditions and symptoms.
Although both men and women can experience pelvic floor dysfunction, women are more susceptible to dysfunction due to physiological changes that are necessary to accommodate the baby during pregnancy and the use of pelvic floor muscles to support birth and recovery after birth.
How Does The Pelvic Floor Affect Our Day-to-Day Lives?
The muscles of the pelvic floor ultimately help give us control over our voluntary bladder and bowel function. The pelvic floor is also very important for sexual function: In men, the pelvic floor helps with erectile function and ejaculation, and in women, contractions of the pelvic floor directly contribute to sexual sensation and arousal. Many women with dysfunction in their pelvic floor experience pain during, before, and after intercourse.
It is especially important for women to maintain strong pelvic floor muscles. For example, if they choose to have a baby, the pelvic floor needs strength to provide optimum support during and after pregnancy. Moreover, a woman’s hormonal changes from menopause can also affect their bladder control and leads to undesirable leaking.
For men and women, when we perform activities such as heavy lifting or coughing and sneezing, the pelvic floor is responsible for resisting increases in intra-pelvic and abdominal pressure. The diaphragm and the pelvic floor move simultaneously during respiration, and the pelvic floor tightens in anticipation of high-pressure respiratory activities. A weak pelvic floor can thus result in unwanted leaks and discomfort during those moments.
Additional factors that may lead to weak pelvic floor muscles include:
- Not keeping the muscles active
- Being pregnant and giving birth
- Being overweight
- Chronic coughing from asthma or respiratory infections
- Growing older
Common symptoms of Pelvic Floor Dysfunction include:
- Persistent or on-going pain in the lower back without cause (non-injury)
- Pain with sexual intercourse
- Decreased pelvic floor awareness
- Frequent sensation of needing to urinate
- Strong urge to urinate
- Pain during urination
- Frequent feeling of needing a bowel movement, or incomplete bowel movements
- Constipation or pain during a bowel movement
What is Pelvic Floor Therapy?
Pelvic Floor Therapy is a specialized form of physical therapy that aims to address the affected areas of the Pelvic Floor that can cause undesirable symptoms in the bladder, bowel, or reproductive regions. The therapy consists of a one-on-one session with one of our licensed physical therapists and begins by assessing the patient’s medical history, including past surgical history, current physical ailments, current level of activity, and a review of the patient’s medications. A complete orthopedic examination would then take place to evaluate function in the spine, abdomen, and hips. Our pelvic floor therapists will then perform external and internal manipulations of the pelvic floor muscles in order to properly evaluate the muscle tone at rest and while strained.
Our Greater Therapy physical therapists can assess pelvic floor strength using several methods. Palpation is a technique that is commonly used to assess the pelvic floor muscles and involves gentle, internal examination of the vagina or rectum to access the muscles. This method is the most common as it provides real time feedback to the patient and the therapist regarding the strength of the pelvic floor. Pelvic floor physical therapy can also be used in conjunction with other methods of treatment in order to provide the best approach to strength and recovery. Other techniques that a pelvic floor physical therapist might implement could be:
- Manual therapy – a hands-on technique that massages and stretches the muscles to relax them, decrease pain, and improve range of motion
- Pelvic floor biofeedback – a thin probe is inserted into the vagina or rectum to examine the condition of the pelvic floor through a display on a monitor
- Electrical stimulation – a low voltage electrical current that can be implemented to teach patients how to coordinate their muscle contractions
What Can Pelvic Floor Therapy Help With?
Although the pelvic floor is often not thought of as an area to exercise, it can be consciously controlled and, therefore, trained much like other muscles in the body. Pelvic Floor Dysfunction, the umbrella term with many associated conditions and sets of symptoms, is the inability to appropriately tighten and relax the pelvic floor muscles, and discomfort or loss of function associated with the pelvic floor.
Myofascial Pelvic Pain
Chronic pelvic pain is defined by pain below the belly button that lasts for at least six months. Persistent pelvic pain should be evaluated and then treated accordingly. When the muscles in the bowl of the pelvic floor become too tight, a condition called myofascial pain, or pain caused by muscle irritation, can occur. It can sometimes be difficult to identify the cause of this pelvic pain because of the many important organs in the pelvic region. A licensed physical therapist that specialized in the pelvic floor will be able to assist with the cause and if a patient would benefit from pelvic floor therapy. The physical therapy for myofascial pelvic pain can take several months of consistent sessions depending on the severity.
Stress incontinence is the condition in which someone involuntarily urinates during physical movement or activity such as coughing, sneezing, running, or heavy lifting. These activities and movements put pressure on the bladder, and without a strong pelvic floor, can lead to unwanted bowel and bladder movement and control. Urge incontinence occurs when you have a strong, sudden need to urinate. The bladder then squeezes, contracts, or spasms, and you lose urine. These contractions often occur no matter how much urine is in the bladder. Urinary incontinence is more common among women; however, is it not a normal symptom that occurs during/after pregnancy or with age.
During pregnancy, pelvic floor therapy can help the body cope with the growing weight of the baby and provide a strong base of muscles for support. Additionally, stronger pelvic floor and core muscles before the birth of a baby will ease the efficiency of childbirth and allow the mother to heal easier following birth.
Some patients may be referred to a pelvic floor physical therapist as a result of IBS (Irritable Bowl Syndrome), fecal incontinence, fecal smearing, and other discomfort associated with constipation.
Pain with sexual intercourse (Dyspareunia) can occur due to several factors including insufficient lubrication, injury/trauma during delivery, irritation of vulvar tissues, gynecological surgeries, psychological issues, stress, or history of sexual abuse. Levator Ani Syndrome occurs when there is unusual tension in the pelvic floor muscles, which can lead to pain, pressure, or aching in the sacrum, coccyx, rectum, or vagina. Pain may increase during intercourse and can affect the ability to perform sexually.
Coordinating with medical doctors and our pelvic floor therapists at Greater Therapy Centers will allow a personalized treatment plan to be created in order to address these conditions and maintain a strong pelvic floor. If you have reason to believe your pelvic floor isn’t offering the support you need, contact our team at any of our Dallas-Fort Worth locations for a consultation.