Ask a Pelvic Floor Physical Therapist

This is the number one question I get as a pelvic PT and it is a great question! A lot of people feel silly asking this but it absolutely isn't. In our society, we often don't talk about "private" issues that involve the pelvic floor so it's very common to not be familiar with the topic.

The pelvic floor is basically a term describing a group of muscles and connective tissues, attaching from your pubic bone to your tailbone to create a "sling". They have several important functions that we can summarize here:

Stability: The pelvic floor muscles attach to the bones in your pelvis, therefore providing structural support to your spine, hips, and pelvic girdle during every activity you do (sitting, standing, walking, running, etc.).

Support: The "sling" of the pelvic floor supports vital abdominal and pelvic organs, including the bladder, uterus, and rectum.

Sphincter Control: The pelvic floor muscles help control the urethral and anal sphincter, meaning it can aid in controlling the release of urine, bowel movements, and gas.

Sexual Function: These muscles and tissues play a very important role in sexual arousal, orgasm, penetration, and more.

Circulation: The pelvic floor muscles act as a blood/lymph pump to remove congestion and swelling from our pelvic region.

All in all, a pretty important group of muscles! We should definitely be talking about them more.

A pelvic floor physical therapist is first and foremost a physical therapist who has completed a bachelors, masters, or doctorate in a physical therapy program and has a license to practice physical therapy. He or she has also completed additional training to treat pelvic-related conditions. Just as some doctors specialize within their field, pelvic PTs are the same. Not every pelvic PT is comfortable or trained to treat all or specific pelvic-related conditions, so it's important to ask questions to understand if they are the right fit for you.

Pelvic floor physical therapy is treatment provided by a pelvic floor physical therapist.  It might include the following:

• Simple questions to better understand your medical history and personal goals (for example, you may want to stop leaking urine when playing with your kids in the yard)
• An evaluation of your posture, flexibility, coordination, and strength usually of your trunk and lower body
• If appropriate, an internal assessment of your pelvic floor muscles via the vagina or anus. There is no speculum (woohoo!) and the pelvic floor muscles are more superficial than the depth required for assessment during a traditional pelvic exam.
• Education regarding your pelvic floor condition
• A discussion with you to create the best plan of care for your goals based on evaluation findings – this may include Kegels or it may focus on other treatments such as stretching, improving muscle coordination, strengthening, re-training movements, and more.

Pelvic PTs treat a variety of conditions, to name a few:

• Urinary and/or fecal incontinence
• Pelvic prolapse (often described as a bulging or increased pressure at the vaginal opening)
• Pelvic pain (pain with penetration, numbness or pain in the perineal area and/or legs, vulvar or vestibular pain)
• Difficulty emptying bladder or bowels
• Constipation
• Bowel, bladder, and gynecological conditions (interstitial cystitis, IBS, endometriosis, etc.)
• Low back, sacroiliac joint, groin, and hip pain
• Pregnancy and postpartum recovery including diastasis recti and cesarean scar tissue mobilization
  Sexual dysfunction
• And many more

Seeing a pelvic floor physical therapist after childbirth offers many benefits. Pregnancy and childbirth are incredible miracles of life but can be a source of trauma to the body. Once your baby arrives, it can be so incredibly hard to make time for yourself. However, you deserve to feel good in your body. Communicate with your pelvic PT if you have concerns about fitting sessions into your schedule; he or she can help design a program that fits into your day-to-day life while still bringing you closer to your goals.

If you have no immediate pain or concerns, you can wait to see a pelvic PT until 6 weeks postpartum, or until your doctor has cleared you to begin physical therapy. If you have concerns, see a pelvic PT immediately so they can help you gain relief sooner rather than later.

Contact your doctor for a referral. Pelvital can refer you to a pelvic floor physical therapist, if you need help locating one.

Stress urinary incontinence is the leakage of urine with "stressors" on the body, which can include coughing, laughing, sneezing, running, jumping, or even daily activities such as standing up from a chair or climbing stairs.

Stress urinary incontinence can be caused by a multitude of factors and is rarely due to one impairment. The body's trunk, including the diaphragm, abdominal muscles, lumbar muscles and the pelvic floor, regulates pressure during these various activities. Urine leaking can occur when one or more of the components of this pressure regulation system are not functioning as they should during a stressor activity. 

Some women want or need help from a pelvic floor physical therapist.

A pelvic floor physical therapist can perform a full assessment and evaluation on you to determine what factors of the pressure regulation system created by your trunk's deep core muscles (diaphragm, abdominal, lumbar and pelvic floor) are not performing as they should. They will identify the reasons behind this dysfunction based on your personal medical history and evaluation findings, and work together with you to determine where to begin treatment.

They will teach you how to properly activate, strengthen and coordinate relevant muscles that you need for the activities you do on a daily or recreational basis. After all, you can be an excellent weightlifter, but that doesn't automatically make you an excellent dancer or tennis player. Being strong is important but even more so, learning how to use and coordinate those muscles properly during activity is a key ingredient to a comprehensive recovery.

Pelvital can refer you to a pelvic floor physical therapist, if you need help locating one.

Some women want or need help from a pelvic floor physical therapist.

Your pelvic floor physical therapist helps determine the proper treatment regimen and home exercise program for you. Every woman is different. We are all shaped differently, have experienced different things medically and personally, and think differently. That is what makes us all so beautiful! And so, what works for you may not work for another person and vice versa. Your pelvic floor PT determines what is right for you.

It might be that your pelvic floor muscles are very weak. Maybe you've tried doing 30 Kegels a day before and it didn't work. But...let's say you do a Kegel and I do a Kegel. Who is to say we know if we are doing the same thing? You could be doing it correctly, but I could be squeezing my glutes or holding my breath without realizing it. A pelvic PT can assess and teach you how to properly do a Kegel as well as design a strengthening and coordination program for you to do at home and/or in the clinic.

Or it might be that your pelvic floor is very strong but you are not coordinating your abdominal muscles properly during jumping jacks. This could be creating increased downward pressure in your trunk and pelvis, therefore resulting in urine leaking. A pelvic PT can teach you how to activate, coordinate, and apply your newly gained muscle knowledge specifically to jumping jacks, or the activity that causes your bladder leaks.

Pelvital can refer you to a pelvic floor physical therapist, if you need help locating one.

Yes, absolutely! Although there may be more than one suspected cause to your SUI, there are many things that can be done to improve your quality life. Sometimes we blame one event for causing an issue when it can actually be due to many different things that have built up over time. An easy example is a sedentary person going for a hike and blaming their new onset back pain on the hike when it’s possible that her posture for the last several years impacted the function of her core and back muscles. The hike was the straw that broke the camel’s back.

This is not always the case, a healthcare professional such as a pelvic PT can work with you to determine what the underlying impairments to your SUI are, to maximize your recovery and return to prior function without difficulty. You can also try Flyte to strengthen and treat your pelvic floor muscles at home.

It makes sense to assume that having a cesarean delivery does not impact your pelvic floor muscles, as you did not have a vaginal delivery. However, the abdominal muscles work very closely with the pelvic floor, with an impact on surrounding connective tissue, to provide stability to your lumbar spine and pelvic girdle. Cesarean scar tissue can inhibit abdominal muscle activation, therefore affecting proper pelvic floor function. A pelvic PT can address your abdominal muscles in addition to your pelvic floor muscles to improve your SUI.