Key takeaways:
Pelvic floor disorders can cause various issues, including incontinence and sexual dysfunction.
Pelvic floor physical therapy may relieve pain, increase muscle control, and improve function.
Treatment might include pelvic floor exercises and tips on managing your condition.
You may benefit from pelvic floor physical therapy if you have bladder leaks, pain with sex, or chronic constipation. These are signs of pelvic floor dysfunction, which can affect people of all genders.
Pelvic floor physical therapy involves exercises, hands-on therapy, and lifestyle modifications. It's a first-line treatment option for many pelvic floor disorders, including incontinence and pelvic organ prolapse.
How does pelvic floor physical therapy work?
First things first: If you suspect you have a pelvic floor disorder, visit a healthcare provider. Symptoms can mimic other conditions that affect your urinary, gastrointestinal, or reproductive organs. So it's important to get an evaluation. Your provider can rule out other conditions and refer you to a pelvic floor physical therapist (PT) if necessary.
A pelvic floor PT has specialized training in pelvic floor dysfunction and related conditions. During your first visit, your PT will review your symptoms and medical history. Then, they will do an external exam to assess your posture, breathing, lower back (lumbar spine), and hips. Your PT might also do an internal exam to assess your pelvic floor muscle strength and function. They will look for tender spots or trigger points that cause pain.
This thorough evaluation will help your PT determine the cause of your symptoms. Your issues may be related to uncoordinated, weak (hypotonic), or overactive (hypertonic) pelvic floor muscles.
What does pelvic floor physical therapy involve?
After your first visit, your PT will develop a treatment plan based on your medical history and exam results. Pelvic floor physical therapy may consist of the following.
1. Exercises
If your pelvic floor muscles are weak, your PT will guide you through strengthening exercises like Kegels and postural exercises that target your core. And if your pelvic floor muscles are too tight, your PT will guide you through breathing techniques and stretches to help relax your muscles.
2. Manual therapy
Hands-on treatment, such as soft tissue massage, may improve pain and function. Manual therapy often includes internal (vaginal or rectal) trigger point release. If it does, your PT will use a lubricated, gloved finger to reach trigger points in your pelvic floor. They gently press on those areas, releasing muscle tension and easing pain.
3. Biofeedback therapy
Biofeedback therapy allows you and your PT to track your pelvic floor muscle strength and activity. It uses a device called a sensor probe. Your therapist will put the probe in your vagina or anus and attach sensors to your stomach. The device then provides feedback like sounds or alerts to make you aware of when you contract or relax your pelvic floor muscles.
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4. Electrical stimulation
This treatment option stimulates nerves in your back and pelvis with mild electrical impulses. It's designed to help you contract and strengthen your pelvic floor muscles. It may also ease pelvic pain.
5. Patient education
Your PT will discuss lifestyle changes to improve your pelvic floor health. These may include managing stress, losing weight as needed, and making dietary modifications (like avoiding bladder irritants). You will also get a home exercise program.
What conditions can pelvic floor physical therapy treat?
You might not think about your pelvic floor until you have a problem with it. But this group of muscles, tissues, and ligaments at the bottom of your pelvis has a big job. Think of the pelvic floor as a sling that supports the bladder, bowel, and reproductive organs. This includes the vagina, cervix, and uterus in people with female anatomy.
Pelvic floor muscles change at different life stages. For example, pregnancy, childbirth, or prostate surgery may affect your pelvic floor. Age, weight, or menopause can also be a factor. When the muscles become too tight or weak, it can lead to pelvic floor disorders. Symptoms may include bladder or bowel leaks and pelvic pain.
Physical therapy can successfully treat various pelvic floor disorders and related symptoms, such as:
Urinary incontinence: Physical therapy may reduce symptoms of urinary incontinence, including bladder leaks and urgency.
Fecal incontinence: Pelvic floor exercises, biofeedback, and rectal balloon training can help treat bowel incontinence.
Pelvic organ prolapse: This common condition occurs when weak pelvic floor muscles make the uterus, bowel, or bladder bulge into the vagina. Some risk factors include vaginal birth, chronic constipation, and increasing age. Pelvic floor muscle training is one of many effective treatment options. It can also be a preventative measure, as pelvic floor therapy may increase muscle strength during pregnancy.
Constipation: Techniques such as abdominal massage and biofeedback devices may relieve chronic constipation. Diet modification tips and assistive devices (like the squatty potty) can make it easier to have a bowel movement.
Sexual health problems: Pelvic floor PT can help treat sexual dysfunction in people of all genders. This includes vaginismus and other conditions that cause pain with intercourse, reduced sensation and pleasure, and erectile dysfunction.
What are some common exercises used in pelvic floor PT?
Physical therapy exercises target overactive (tight) or underactive (weak) pelvic floor muscles. Here are a few exercises you might learn in treatment.
1. Kegels
Kegels may be the most well-known pelvic floor exercise. They involve contracting and relaxing your pelvic floor to strengthen your muscles. There are several ways to do Kegels. For example, your PT might show you how to do them with weighted kegel balls.
Lie down with your knees bent and feet on the floor. You can also perform this exercise sitting up.
Squeeze your pelvic floor muscles. Engage the same muscles you would use to stop the flow of urine and the release of gas. Doing this will target the right muscles to activate your pelvic floor.
Breathe deeply as you hold the contraction for 5 to 10 seconds.
Release the hold and relax your pelvic floor muscles.
Repeat, working up to 10 to 15 reps twice a day.
2. Heel slides
This exercise targets deep abdominal muscles, which may stabilize and support your pelvis.
Lie on your back with your knees bent and feet flat on the floor.
Engage your core by squeezing your abs and pressing your lower back into the floor.
Tighten your pelvic floor as you would during a Kegel.
Keep contracting your muscles. Slowly slide your right heel away from you, straightening your right leg as far as you can.
Relax your muscles as you slide your right heel toward you and return to the starting position.
Repeat 5 to 10 times on both sides.
3. Happy baby pose
Your physical therapist will opt for stretches over strengthening exercises if your pelvic floor is too tight. The happy baby pose will help you relax your pelvic floor muscles.
Lie flat with your knees bent and your feet on the floor.
Bring your knees to your chest, keeping your hips down and your spine neutral.
Grab the inner arch of each foot. If you can't reach your arch, hold your ankles. The soles of your feet should be facing the ceiling.
Gently pull your knees further toward your armpits.
Hold this position or rock side to side for 30 to 60 seconds.
Repeat once or twice a day.
The bottom line
Pelvic floor disorders such as urinary incontinence and pelvic organ prolapse are common. They can cause painful and uncomfortable symptoms that disrupt your life. Weak, tight, or uncoordinated pelvic floor muscles are usually to blame.
Pelvic floor physical therapy is a conservative treatment option that addresses the source of the problem. Exercises, trigger point release, and other methods may reduce pain and improve function.
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