The term “pelvic floor” refers to the group of muscles that attach onto the pelvis and support the abdominal structures. These are also the muscles that control the sphincters for urination and defecation. Pelvic floor dysfunction refers to pain in this region and is a common occurrence that affects millions of people, regardless of gender. Surprisingly, many cases of pelvic floor dysfunction actually go untreated. According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, 25% of women in the U.S. live with one or more disorders of the pelvic floor. Whether people believe that this type of pain is something they should learn to live with or they’re just not aware that pelvic floor treatment is available to them, it seems clear that the general public is not clued in to the fact that pelvic health is an issue that can be addressed with physical therapy.
Pelvic floor dysfunction may be a result of pregnancy and childbirth, infections, chronic low back pain, SI dysfunction, trauma, surgery or generally weakened pelvic muscles, among other causes. The symptoms of pelvic floor dysfunction vary but typically include any sort of pain in the pelvic region: pelvic pain, perineal pain, pain with intercourse, tailbone and groin pain, incontinence (both urinary or fecal) and constipation. It’s a common belief that only women suffer from pelvic health issues but in fact, both men and women are susceptible.
How do I know if I’m at risk for pelvic floor dysfunction?
Pelvic health dysfunction may occur in women at any time. The first signs may arise as women become sexually active though the risk of pelvic floor issues increase with age. Pre and postpartum women as well as postmenopausal women may be at a higher risk as new issues come up when hormones are altered. Estrogen and progesterone keep the pelvic tissue healthy but once these hormone levels decrease, it becomes atrophied and the muscles and tissue can become thinner, leading to more problems.
It really should be standard for postpartum women to come in for at least one session of physical therapy. Even if it’s not pelvic floor related, pregnancy can promote issues that throw everything off, like diastasis recti which is an abdominal separation. A vaginal delivery also makes a woman more susceptible to urinary incontinence.
Men may suffer from pelvic health issues as a result of weakened pelvic muscles or those who are post-prostatectomy. Pelvic pain in men is typically muscular and is common among older men with prostate issues. In some instances, pelvic pain can be the result of chronic constipation and the symptoms become a product of the tightness in those muscles. Tight pelvic muscles are also common for athletes due to the frequent use of these muscles. Runners who hold their urine longer than normal, weightlifters who misuse their muscles and athletes who frequently jump—such as gymnasts—may be more prone to tight pelvic muscles.
How is pelvic floor dysfunction diagnosed?
Patients typically seek help for pelvic floor dysfunction when they experience pain, usually with intercourse, or symptoms of incontinence, the latter of the two being more common. Your primary care physician would likely refer you to a gynecologist or a urogynecologist (who has more of a specialty with incontinence).
How can physical therapy help with pelvic floor dysfunction?
Physical therapists can help with pelvic floor dysfunction by working to strengthen the weakened muscles or relaxing muscles that may be too tight. Through a combination of manual therapy techniques, custom exercises, stretching and patient education, your physical therapist will work with you to pinpoint the cause of your pelvic floor dysfunction and create a plan of care that is unique to your body and specific symptoms. Treatment for pelvic floor dysfunction can be thought of the same way any sort of physical therapy treatment is, it’s simply a different part of the body. As part of an initial evaluation, your physical therapist will find out why this dysfunction happened (because it did happen for a reason). The benefit of going to a PT for pelvic floor dysfunction is that they’ll conduct an examination, factoring in all of the activities that you enjoy doing to figure out the cause. As opposed to a specialist who may only focus in on one area, physical therapists look at the whole person.
Manual therapy techniques like soft tissue massage and trigger point release can not only help to locate trigger points and tightness in muscles, they can also pinpoint which are the correct muscles to use while exercising. Your PT will work on you externally to palpate and treat the pelvic floor muscles through the hip and groin area. They’ll show you how to relax and strengthen your muscles, working to increase your hip and core strength while teaching you techniques to alleviate some of the tightened muscles. Your PT will typically prescribe some exercises though they’ll assess your unique condition before doing so. They’ll always look at your hip range of motion, core and lower back to teach stable, diaphragmatic breathing.
Your length of care depends on your specific issues, how much pain you’re in, if you’ve had treatment before and a number of other factors. Similar to regular physical therapy, a general plan of care is about 6-8 weeks. If a lot of manual massage and education is required, it can take a bit longer.
Why do I need PT? Can’t I just do kegel exercises?
Depending on what your dysfunction is, Kegels might actually worsen your problem, namely if the issue is that you’re too tight. Kegels are prescribed for those with weak pelvic muscles and not enough tone. Pelvic floor treatment is very individualized; not everyone should be doing kegels, some people absolutely not. (Sidenote: A large number of people actually perform kegels incorrectly. Your PT can tell you if you’re contracting your muscles properly.)
But what if the problem is not musculoskeletal?
PTs can test to see if incontinence is a result of weakened muscles. If the area is properly strengthened, they’re able to tell that it’s not a musculoskeletal issue. They also look for red flags like signs and symptoms of cancer and listen for things that don’t make sense. Physical therapists are well-trained in recognizing when a condition is outside the scope of their practice and will happily refer you to the appropriate practitioner.
Is there anything I can do to prevent pelvic floor issues from happening?
We exercise cardiovascular health why don’t we exercise pelvic health? Women can also educate themselves as much as possible on how their bodies are going to change and react.
Physical therapists can provide the necessary tools to treat pelvic floor dysfunction, allowing you to return to a pain-free life, stronger and healthier than ever. After treatment, yoga and Pilates can be a great way to keep up your body and maintain your core as well as anything that has core strengthening while maintaining neutral spine and relaxation techniques can help to maintain the strength that you’ve built up during your PT treatment.
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