Pelvic Floor Physical Therapy

What is the pelvic floor?

The pelvic floor refers to the muscles that support your reproductive and urinary tract, including your bladder, uterus (or prostate), and rectum, also wrapping around the urethra, vagina (in females), and rectum. These muscles attach to your pelvis and to your tailbone and sacrum. In addition to providing support, they also help you control bladder and bowel function

When these muscles aren’t working as they should, they can cause pain and other symptoms that interfere with daily functioning. Physical therapy can help ease pain and associated symptoms, getting you back to normal functioning. 

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a treatment to help address pain, weakness, and dysfunction in the pelvic floor muscles. The type of therapy prescribed will depend upon the symptoms you’re experiencing. For example, some symptoms will require relaxing and lengthening of the muscles, while others may require strengthening the muscles. 

Pelvic floor physical therapy can be used to treat pelvic floor dysfunction and the symptoms so often associated with it. Some symptoms that can be improved with pelvic floor physical therapy are:

  • Urinary problems, such as:
    • Urinary incontinence
    • Urinary frequency
    • Urinary urgency
    • Painful urination
    • Difficulty stopping or starting urinating
    • Difficulty fully emptying the bladder
  • Bowel problems
    • Fecal incontinence
    • Straining or experiencing pain during bowel movements
  • Unexplained pain
  • Pain during intercourse

If you have any of these symptoms or have a diagnosis of interstitial cystitis (IC), pelvic floor therapy might be right for you. 

What types of doctors or physical therapists specialize in pelvic floor physical therapy?

If your doctor recommends pelvic floor physical therapy, you should make sure you work with a doctor who is specially trained in techniques that have been proven to help patients with IC, pelvic pain, and other symptoms related to pelvic floor dysfunction. 

At Beaumont, our urogynecologists and physical therapists work together to provide women with expert care in an understanding, comfortable environment. They are knowledgeable, experienced specialists who stay up to date on the latest treatment options for pelvic floor disorders. 

Pelvic floor physical therapy techniques

When you start working with a physical therapist to address pelvic floor functioning, there are some things you can expect. 

At your first appointment, your therapist will likely do an assessment before deciding which types of therapy will be most effective. That assessment may include an evaluation of both external and internal muscles. You may be asked to stand, walk, and sit so the therapist can see whether you may have posture or joint issues that could be affecting the pelvic floor muscles. 

Hands-on physical therapy

Most physical therapy to treat pelvic floor dysfunction and pain is hands on, which includes both internal and external therapy. Because internal physical therapy may be difficult for some people, therapists are sensitive to the needs of every individual and will not begin with internal physical therapy until you are ready. 

External physical therapy techniques include:

  • Nerve release
  • Trigger point therapy
  • Myofascial release, also called deep tissue massage
  • Skin rolling
  • Joint mobilization

Internal techniques may include using a specialized instrument or a finger inside the vagina or rectum to do trigger point therapy. Trigger point therapy may be done by putting pressure on a specific spot or by injecting anesthesia into the trigger points. These injections are often done by a doctor or nurse practitioner rather than a physical therapist. 

Depending on your condition, your therapist may also suggest Kegel exercises to strengthen your muscles. He or she will help train you on the proper way to do Kegels.

Tools used during pelvic floor physical therapy

Physical therapists use tools and technology to help treat pelvic floor dysfunction. One of the goals of tools is to help you strengthen and learn to relax the muscles in the pelvic floor. Some tools also help reduce pain. 

Tools may include:

  • Electrical stimulation, which can help reduce pain and muscle spasms. Your therapist may do treatments in the office or give you an electrical stimulation unit to use at home.
  • Dilators- progressively sized tools inserted into your vagina to help stretch tight tissues. 
  • Biofeedback uses electrical impulses to help teach you how to relax the affected muscles. Biofeedback units work in one of two ways. You can attach electrodes to the body (usually in the area between the vagina and anus), or you can use a probe inside the vagina or rectum. The electrodes or probes sense the tension or relaxation of your pelvic floor muscles, and the resulting information displays on the biofeedback device’s readout. Your therapist will explain to you what your readout goal is and will help you train your muscles to get the desired readout. You may be able to rent a device to use at home in addition to using one in the office.
  • Therapeutic ultrasound uses sound to produce warming that can help reduce muscle spasms and increase blood flow. It can also help reduce inflammation. There are some ultrasound devices that can be used at home.
  • Interferential therapy is another type of electrical stimulation. This type of therapy is used to help reduce pain and spasms. You can also use these devices at home.

How to choose a physical therapist

It’s important that you find a physical therapist who has knowledge and expertise in treating pelvic floor dysfunction. It’s okay to ask questions before starting therapy – in fact, it’s encouraged. You want to make sure they are experienced with treating pelvic floor dysfunction.