Women and Men's Pelvic Floor Therapy

What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of PT that addresses pelvic floor dysfunction. Two main types of pelvic floor dysfunction exist; the first involves weakness of the pelvic floor muscles resulting in incontinence of urine or stool and the second involves pelvic floor tension/muscle spasms that result in pain and possibly incontinence.

What is the pelvic floor?
The pelvic floor is comprised of a complex matrix of skeletal muscles that form the bottom of your inner core. These muscles are located at the bottom of the trunk and run from the pubic bone to the tailbone wrapping around the vaginal and rectal openings. The pelvic floor has 4 primary functions that are extremely important in life. These functions are:

  1. Supportive. These muscles act to support all the pelvic organs (the bladder, urethra, uterus, vagina, prostate and the rectum).
  2. Stabilization. The pelvic floor muscles serve an integral part of your core structure, working the abdominal, lumbar and hip muscles for stabilization.
  3. Sphincteric. These muscles help control the elimination of gas, urine, or stool.
  4. Sexual Functioning/Reproduction

What are common complaints with pelvic floor dysfunction?
Examples of typical complaints include:

  • Involuntary loss of urine, stool or gas.
  • Deep pain in the low back that can radiate to the abdomen, groin, hips and/or legs.
  • Vaginal pain and or pain with sex.
  • Pain with urination, bowel movements, sitting, standing or walking.
  • Urgency and/or frequency of urine and/or defecation.
  • Rectal pain.
  • Pelvic pressure or a falling out feeling.
  • Pain at the penis, testicles and/or prostate.

What should you expect?
On your first visit a thorough evaluation will be completed. Evaluations include thorough history taking, postural assessment, rang of motion measurements, palpation of key muscles of the pelvis and surrounding areas, strength testing, analysis of movement patterns and structural alignment of the body. Often times it is necessary to complete an internal pelvic exam to assess the pelvic floor musculature. Once this is completed all of the evaluation findings will be discussed with you and goals and treatment approaches determined.

How is pelvic floor dysfunction treated?
Specific treatment approaches used by pelvic floor physical therapists will vary according to the dysfunction determined by the evaluation. These approaches include but are not limited to the following:

  1. Manual Therapy: Manual therapy may be used to realign the bones of the pelvis or spine. It is also used to release tension in the muscles that attach to the pelvis including the pelvic floor muscles. Techniques such as myofascial release, trigger point release, soft tissue mobilization and scar mobilization, if applicable are commonly used. When it is found that internal restrictions are present, whether it be muscle spasm, scar tissue, fascial restriction or weakness the same techniques can be used to address these muscles with internal techniques.
  2. Strengthening: If it is determined that there is weakness present, which is typically the case with incontinence, this is addressed with a specific exercise program tailored to meet the needs and abilities of each individual.
  3. Neuromuscular re-education with biofeedback: Biofeedback is a treatment technique that allows the physical therapist to show the patient his/her muscular activity using sensors that detect the electrical activity of the muscles. This technique can be used for "down-training" to decrease excess muscle tension/spasm or "up-training" to increase muscle recruitment and strength. This training can assist the patient to gain improved control of urination or defecation.
  4. Patient Education and home program: Education is probably the most important element of your therapy. You will be taught how and why your problem developed as well as prevention of further dysfunction. In order to achieve long term carryover of this type of therapy, you will need to be an active participant by following through with an individualized home exercise program that your therapist will instruct you in.

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