Pelvic Floor Therapy: What to Expect

Pelvic floor physical therapy (PFPT) sometimes referred to as pelvic floor muscle training (PFMT), is a first-line conservative approach to treating most pelvic floor disorders. Pelvic floor disorders are conditions that affect the muscles, ligaments, and organs in and around the pelvis.

Someone with pelvic floor dysfunction has difficulty contracting and/or relaxing the muscles of the pelvic floor, causing difficulty with bowel, bladder, and sexual functions. They may experience pelvic pain, leakage, or difficulty passing bowel movements. Many people live with these symptoms because they don’t know treatments exist, or they are embarrassed to discuss symptoms with their healthcare provider.

But there is good news for anyone experiencing challenges with these functions. Physical therapy is an effective, painless, non-invasive treatment option for most pelvic floor disorders. Learn more about the benefits of PFPT for pelvic floor dysfunction and what to expect from therapy.

Pelvic Floor Disorders

Pelvic floor disorders often impact the pelvic organs including the which are supported by the pelvic floor. If the pelvic floor muscles aren’t functioning appropriately, pelvic organ functions can be affected. In contrast, dysfunction of the pelvic organs can affect the functions of the pelvic floor muscles. Pelvic floor disorders are quite common, and affect people of all ages and genders.

Common pelvic floor disorders include:

Fecal Incontinence

Fecal incontinence or accidental bowel leakage is the unintended passing of liquid or solid stool. Someone with fecal incontinence may feel a strong urge to have a bowel movement and not be able to control it, or may lose stool without being aware that it is happening.

Urinary Incontinence

Urinary incontinence (UI) is any unintentional loss of urine. There are many types of UI, but the most common are stress urinary incontinence (when someone leaks urine while coughing, sneezing, or exercising) and urge incontinence (when a person cannot hold their urine in time to reach the restroom). Oftentimes, people experience a combination of both of these two main types of incontinence.

Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is when one or more of the pelvic organs drop down from their normal position lower into the pelvis, often because the pelvic floor that supports them is not functioning properly. POP is classified in stages based on the amount of change in position of the pelvic organs.

Pelvic Floor Dysfunction Affects All Genders

It is a common misconception that pelvic floor disorders only affect women, or only affect people who have had a baby. However, everyone who has a pelvis has pelvic floor muscles, and dysfunction of these muscles can occur in people of all genders.

One of the most common conditions related to pelvic floor dysfunction is prostatitis, which refers to a group of conditions that affect the prostate gland. Half of all people with prostates will have symptoms of prostatitis during their lifetime. Symptoms typically include pain and inflammation. Stress, infection, and pelvic floor muscle spasms may lead to prostatitis.

Risk Factors for Pelvic Floor Disorders

Pelvic floor disorders have a range of possible risk factors and causes:

• Aging
• Childbirth
• Chronic disease
• Diet
• Exertion
• Genetics
• Heavy lifting
• Obesity
• Menopause
• Pregnancy
• Previous infection
• Scar tissue
• Stress
• Surgery

Pelvic Floor Therapy: What to Expect

Pelvic floor physical therapy is an effective first-line treatment option for people with pelvic floor disorders. The goal of physical therapy is to manage or improve your symptoms for a better overall quality of life. If your provider referred you to a physical therapist for PFPT, this is what you can expect.

1. Initial Assessment

PFPT begins with an assessment by a licensed physical therapist who specializes in pelvic health.

This evaluation includes a thorough health history and physical examination. Your therapist will ask questions regarding your bowel, bladder, and sexual functions to comprehensively understand your symptoms. Then, they will assess your spine, abdomen, pelvis, and hips to gain information about what structures may be contributing to your symptoms.

They often assess the strength, motor control, and endurance of your core support muscles and where tenderness, fullness, or pain is located. They may also look at your ability to coordinate the pelvic floor muscles during various positions and activities.

Your therapist will also perform an assessment of your pelvic floor muscles. The purpose of this assessment is to assess muscle and activity and organ positions and identify structures and muscles that may be causing symptoms.

Some of this assessment can be performed externally, and other aspects are more accurately performed with an internal assessment. If an internal assessment is appropriate for your condition, and you consent to participate, the therapist gently inserts a gloved finger into the vaginal or rectal canal, gently applying pressure to the various muscles and structures, and assessing the coordination and activity of your muscles. Overall, this first appointment should take around an hour.

2. Treatment Plan

Once your initial assessment is complete, your therapist shares their findings with you and creates a plan based on your symptoms, needs, and treatment goals. The number and frequency of follow-up visits varies from patient to patient. For most people, PFPT consists of a few follow-up sessions per week with regular assessments along the way.

3. Physical Therapy Visits

Once your treatment plan has been created, you can begin physical therapy treatment sessions. Physical therapy may consist of a combination of stretching exercises, strengthening exercises, coordination training, and hands-on techniques with your therapist, depending upon your symptoms and needs.

Generally, most exercises look similar to other “core” exercises, or possibly some yoga poses.  However, there are rehabilitation techniques that are appropriate for some people with pelvic floor dysfunctions that require specialized devices and more private space. If these techniques are appropriate for your case, your therapist will discuss the options with you.

4. Post-Therapy

Your PFPT program does not stop in the clinic. Your physical therapist will give you exercises to do at home to support your work in the clinic and move your closer to your treatment goals.

Too many people let bladder leakage and other symptoms of pelvic floor dysfunction stop them from doing the activities they enjoy. But there are affordable, convenient options to reduce and possibly eliminate your symptoms. Reach out to one of our to discuss whether or not pelvic floor therapy might be right for you.

Visit this link to find a physical therapy clinic near you.