What is the pelvic floor?

A pelvic floor is a group of muscles located at the bottom of your pelvis, which surround your genitalia. These muscles work to support your abdominal contents (specifically the rectum, bladder, and uterus), allow for urination and defecation, prevent leakage of urine or stool when not desired, and help sexual processes including pleasure responses and reproductive functioning.

These muscles also help to stabilize the pelvis, working with your abdominal muscles, back muscles, and diaphragm to make up your core. For proper functioning of the pelvic floor, it is important to have:

Strength:

• To stabilize the pelvis and prevent hip, low back, and pelvic pain
• To prevent leakage of urine or stool with increases in abdominal pressure, such as with sneezing, coughing, squatting or jumping

Endurance:

• To maintain proper spine posture and stabilize the pelvis over longer periods of time and with longer physical activity

Flexibility:

• To relax and stretch for bearing down when trying to urinate, defecate, or during childbirth
• To promote pelvic mobility for dynamic activities, such as walking, running, or stair climbing

Motor control:

• To allow you full control of when you urinate, defecate or flatulate
• To prevent painful conditions of the hip, low back, and pelvis

Does everyone have a pelvic floor?

Yes! All people, regardless of gender, have pelvises and therefore have pelvic floor muscles.

Should pregnant or postpartum women have pelvic floor physical therapy?

Absolutely! Whether you’ve delivered vaginally or through a Cesarean section, being pregnant for 40 weeks puts a lot of pressure on the pelvic floor, which could lead to tension, weakness, and motor control impairments. If you are currently pregnant, that is often the best time to see a pelvic floor physical therapist. You then have the opportunity to not only learn how to use your pelvic floor as your body changes and grows but also how to effectively use your pelvic floor during labor and delivery. This can help reduce the risk of tearing and post-partum related issues like incontinence and pain. Having a baby is beautiful and joyous, but physically demanding! A pelvic floor physical therapist can help you prepare for the changes and rehabilitate your body so you can be at your best for your baby!

Common Misconceptions:

“I do Kegels so I don’t need pelvic floor physical therapy!”

• Kegel is the term for pelvic floor contractions, named after the person who studied the effects of strengthening the pelvic floor. While Kegels can be a very helpful tool in pelvic floor rehab, strengthening is not always the answer for incontinence. Sometimes incontinence can be caused by muscles that are too tight or too contracted. If the muscles are always contracted or “on” then contracting them further will just lead to more tightness, more fatigue, and more leakage. Plus, studies have shown that most people do Kegels incorrectly! A pelvic floor physical therapist will help you determine if Kegels are right for you!

“I don’t plan on having a baby and I’ve never had a baby so I don’t need pelvic floor physical therapy!”

• Women are not the only people that have pelvic floors. Still, pelvic floor dysfunction can arise in women even if they have not had children. There are common diagnoses that can be treated with pelvic floor physical therapy.

“Men don’t have pelvic floor problems!”

• There is a very high prevalence of prostate problems in older men. Because of this, men are particularly susceptible to pelvic floor issues such as incontinence or difficulty voiding. There are some common diagnoses that can be treated by a pelvic floor physical therapist.

How a Pelvic Floor Physical Therapy Specialist Can Help

At your initial evaluation, a pelvic floor physical therapist will first discuss your concern and answer any questions in order to try to find out your goals for physical therapy treatment. Patients often have a lot of questions about their bladder, bowel, and sexual health. Following the initial discussion, we will perform a physical evaluation, which includes watching you walk, squat, bend over, and breathe – all to observe for any muscle imbalances, mobility deficits, or postural dysfunction. In addition, we may also assess your hip and core strength. Then, we will evaluate the strength, endurance, flexibility, and motor control of the pelvic floor muscles. This will typically involve internal palpation of these muscles via the vaginal or rectal canals. We will then develop a treatment program together to help you achieve your goals.

The Pelvic Floor Physical Therapists at Excel Physical Therapy pride ourselves on being open-minded, conscientious, and calm. We understand the sensitive nature of the pelvic region and will never do anything which makes a patient feel uncomfortable. Pelvic Floor Physical Therapy is performed in a private area to be respectful and sensitive to a patient’s needs. We do our best to educate you on what is happening, what we’ll be doing, and what to expect in your plan of care. Our mission is to help you achieve your recovery goals!

Common Diagnoses (Not a complete list of ALL diagnoses seen by a pelvic floor PT):

• Pelvic Pain
• Vulvodynia, Vestibulodynia
• Vaginismus, Dyspareunia
• Pelvic Organ Prolapse
• Pudendal Neuralgia
• Overactive Bladder
• Urinary Frequency
• Nocturia (urine frequency at night)
• Urine or Fecal Incontinence
• Interstitial Cystitis
• Constipation
• Incomplete Evacuation
• Irritable Bowel Syndrome (including Crohn’s, ulcerative colitis)
• Post-Surgical (abdominal surgeries, prostatectomy, hysterectomy, gender affirmation surgery)

If you are experiencing any of the above-mentioned conditions, or if you have additional questions, please feel free to contact us and we will connect you with a pelvic floor physical therapist in your area who can provide further assistance!

Samantha Fazio, PT, DPT

Learn about Pelvic Health and the benefits of Pelvic Health Physical Therapy in our March 2020 Excel PT Newsletter!