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Understanding Pelvic Floor Therapy for Pain, Leakage and Constipation

What is Pelvic Floor Physical Therapy

Pelvic floor physical therapy is specialized physical therapy aimed to treat pelvic dysfunction and promote optimal pelvic health for both women and men. Pelvic floor dysfunction refers to a wide range of diagnoses pertaining to the pelvic muscles and the pelvis, including urinary/bowel incontinence, pelvic pain, pelvic organ prolapse and postpartum pelvic girdle dysfunction among others. At least one out of every five Americans will suffer from a pelvic floor dysfunction at some time during their life.

Why would I need pelvic floor physical therapy?

There are many reasons one may need pelvic floor physical therapy. Pelvic dysfunction occurs when there is an imbalance of the pelvic and abdominal muscles and the surrounding joints including, lower back, hips, and coccyx, fascia, ligaments, tendons and organ position. The pelvic floor is an integral part of your core stabilization system which works intimately with your pelvic organs, bones and joints in the region. It’s always working throughout the day and is often overlooked as the cause of many issues related to pelvic pain during and after pregnancy, surgery or menopause and urinary and bowel incontinence.

Specialized pelvic floor physical therapists help men and women across the lifespan continuum, including young athletes, childbearing-aged women, peri-menopausal women and men with pelvic health complications. 

What is the pelvic floor? 

The pelvic floor is a group of muscles that attach to the pelvis. Their function is to support organs, allow for elimination, stabilize pelvis and hips, promote sexual function and sustain healthy blood flow. Remember pelvic floor muscles are just like any other muscles in the body. They contract, relax and function like a bicep muscle. Due to daily pelvic functions, including eliminations and sexual function, it’s important to remember the pelvic floor can be influenced by your organs, abdominal muscles and skeletal system and vice versa. For example, urinary incontinence is not “just a weak bladder” as thought by popular belief. But incontinence occurs because of pelvic muscle weakness, altered coordination of bladder, brain and pelvic muscles, as well as poor toileting habits.
 

Do men have pelvic floors too?

Yes. Even though men don’t carry children or go through menopause, they have a pelvic floor which functions similarly to a woman’s. Men with such dysfunctions will report a slower urine stream, difficulty or pain with erection, tailbone/lower back pain, constipation, or bowel or bladder incontinence. It’s not uncommon for a man to have an increase in these symptoms after having any kind of prostate surgery or hernia repairs. 

What can one expect during Pelvic Floor PT Evaluation?

Your first evaluation at Breathe Life Physical Therapy & Wellness, LLC, includes a one-on-one visit discussing your concerns and symptoms related to your pelvis and daily activities. You’ll have the opportunity to share your past medical history, including pregnancies, abdominal or back surgeries and gynecological/urinary history. An exam may include general movement like bending forward and backward, observing body mechanics and strength testing. A comprehensive review of the pelvic floor musculature, pelvic organ function and normal bladder/bowel habits will also be discussed.

An external and internal assessment of your pelvic muscles (through the vaginal or rectal canal) may be valuable; however, you can choose or refuse any part of the process with which you don't feel comfortable. 

An external pelvic floor assessment includes a visual assessment of the skin, symmetry and color of tissues, and observation of muscles performing a contraction.

An internal pelvic floor muscle assessment includes checking all layers of pelvic floor for strength, mobility, pain, symmetry and control. A therapist will also palpate muscles in all three layers of the pelvic floor to assess the coordination for functional activities like coughing, lifting and relaxation.

What happens at additional treatments?

The therapist designs individualized programs depending on the findings from the evaluation.  The PT may prescribe breathing and core stability exercises to improve the coordination of all muscles in the pelvis, back and core. They may also recommend relaxation and behavior modifications to improve pain or learn control for your daily toileting habits. Initially, you may require assisted neuromuscular training such as manual feedback via the internal pelvic muscles to improve muscle tone, activation and coordination. 

Does one need a prescription?

Yes. Just like traditional physical therapy, one will need a prescription for the treatments to be covered by your insurance. Your primary care provider, gynecologist or urogynecologist may write this type of prescription. Many pelvic conditions have multiple causes and may require a specialist to rule out more serious conditions. Therefore, it’s necessary to have your medical provider help coordinate care.

My gynecologist told me to do “kegels”. I do them every day, but I am not sure if they help to improve my leakage? What’s going on?

Kegels or a pelvic floor contraction is important to strengthen and maintain good function of the pelvic floor including improving incontinence. However, research shows 40 percent of women perform kegels incorrectly and can promote more leakage. Many women that have leakage with coughing, laughing and sneezing have an altered pattern of contracting their pelvic floormuscles. Believe it or not, too much pelvic muscle activation can promote incontinence. Pelvic floor PT can teach you to retrain your pelvic muscles to properly coordinate a contraction to eliminate or minimize most types of urinary incontinence.

How does the pelvic floor work with the core?

Remember, your pelvic floor is one aspect of the core which includes the diaphragm (breathing muscle), transverse abdominals, multifidus (small spine muscles) and pelvic floor. These four muscles make up the core. They must work together and manage your everyday movements and daily eliminations. They cannot and should not be addressed independently. The diaphragm and pelvic floor synchronize to monitor the pressure in your abdomen. Think of the pressure that occurs in your belly when you sneeze. This is scary for some… just thinking of it might make you think, “Squeeze the knees.” If the diaphragm and pelvic floor don’t coordinate well, leakage and other pelvic-related dysfunction can occur.

Dr. Amanda Heritage, PT, DPT, is the owner of Breathe Life Physical Therapy & Wellness, LLC, located in Collingswood. She has been practicing physical therapy for eight years with a strong focus on pelvic health. She offers complimentary, 15-minute phone consultations to educate and encourage women and men about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation. For more information or to schedule an appointment, call 856-210-3517, or visit BreatheLifePT.com

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