If you live with urinary dysfunction, painful intercourse or pain in the pelvic area, pelvic floor physical therapy may be the key to relief. In fact, it can be used to treat many disruptive, uncomfortable or painful conditions involving the pelvic floor.
What is the pelvic floor?
The pelvic floor is a group of ligaments, muscles, tendons, nerves and connective tissue that provides the base and support for the pelvic area. Both women and men have a pelvic floor. Some key details:
In women, the pelvic floor holds the bladder in the front, uterus at the top, and the vagina and rectum in the back.
- In men, the pelvic floor supports the bladder, bowel, urethra and rectum.
- The openings from these organs (the urethra from the bladder and the anus from the bowel) pass through the pelvic floor.
- In both men and women, the pelvic floor muscles attach to the pubic bone at the front and the tail bone at the back.
Why is the pelvic floor important?
For both men and women, the pelvic floor plays a key role in bladder and bowel control because it’s responsible for “holding” those organs. It can also be important for both women and men’s sexual health. For men, weakened pelvic floor muscles can contribute to erectile dysfunction; for women, tightened pelvic floor muscles can cause pain during intercourse. Both women and men can experience urinary dysfunction, including adult and teenage athletes who participate in high impact sports.
Other Types of Pelvic Floor Dysfunction
Pelvic floor dysfunction can encompass a wide range of problems, including:
- Bladder pain
- Bowel incontinence
- Frequent urination and urinary incontinence
- Groin, lower abdominal, pubic or tailbone pain
- Hip pain and other orthopedic issues
- Pain in the sacroiliac (SI) joint
- Pelvic asymmetry
- Pelvic organ prolapse (POP)
- Pelvic pain
- Pubic or tailbone pain
- Urinary dysfunction because of high impact sports
When can pelvic floor physical therapy help?
While some of these conditions may require surgery to repair structural defects, physical therapy can be a solution for others.
“The best candidates are patients who are interested in conservative treatment options,” said Sarah Sydnor, PT, WCS, a physical therapist at the Outpatient Rehabilitation Center who specializes in treating the pelvic floor. “They may not be surgical candidates for various reasons — or, they may not require or want immediate surgery.”
If you have pelvic floor symptoms that prevent you from enjoying life, you may wish to give physical therapy a try.
50% of post-childbirth women will experience pelvic organ prolapse
69% of women with pelvic organ prolapse have multiple pelvic floor disorders
One-third of elite athletes report stress urinary incontinence
84% of patients with fecal incontinence have not told a physician
More than half of women with pelvic pain don't know how to seek treatment
71% report improvement in painful intercourse after physical therapy
What to Expect
At the First Appointment
Like many patients, you may be nervous or anxious when beginning therapy. At the first appointment, your therapist will explain what therapy entails and address all your concerns and questions. The appointment is in a private treatment room; therapy will not begin until you are comfortable and ready to begin. “Many women are familiar with physical therapy, so we explain how this treatment is still physical therapy — just for a different part of the body,” Sydnor said. You should be encouraged to ask questions, and your therapist should take time to answer them.
Like many outpatient therapies, physical therapy for the pelvic floor includes exercises, manual techniques and movement coordination. However, incorporating electronic therapies can also be helpful. One therapy is biofeedback, in which small, painless electrodes are applied to the area being treated; this could be the perianal, genital or rectal area. For many patients, biofeedback can be a very effective way to improve bladder function.
When necessary, your therapist may need to do an internal exam. Although it can be uncomfortable, it’s an important part of the appointment. “Imagine you go to a therapist for a shoulder injury,” Sydnor said. “If they ask you questions but never actually look at your shoulder, that would be weird. To know how your pelvic floor is working, we need to be able to see it and assess it to give you a correct and safe physical therapy diagnosis.”
Length of Treatment
One visit per week for eight weeks is a common scenario for pelvic floor physical therapy. However, the length of treatment will vary depending on the diagnosis, severity of the dysfunction and your individual goals. The goal of any therapy is to help you return to your ideal level of function so you can enjoy a more active, independent lifestyle.
Kegel Tips and Other Exercises
As a pelvic floor physical therapy patient, you’ll be prescribed an individualized home exercise program based on the physical activities you enjoy: low impact walking, biking or swimming. Another familiar exercise is the Kegel, pioneered by gynecologist Dr. Arnold Kegel in the 1940s. Although many patients are familiar with Kegel exercises, Sydnor said they are often performed incorrectly.
“People tend to squeeze way too hard when doing a Kegel,” Sydnor said. “Never do a Kegel while actually urinating, and never hold your breath while doing a Kegel. Do the Kegel contraction gently while breathing out slowly.” She offers these tips on how to perform a Kegel exercise properly.
Pelvic Floor Physical Therapy Results
After pelvic floor therapy, you may be able to enjoy results like:
- Returning to a favorite sport
- Getting through the day without incontinence
- Being able to start a family
Before any of these things are possible, it’s important to reject the idea that your problem doesn’t matter. “I think many women minimize their symptoms as normal,” Sydnor said. “They think, ‘It’s normal to leak urine,’ or ‘pain during intercourse is normal,’ or ‘I did just have a baby’.” With the right treatment and support, problems like these can be corrected.
You’re not alone in the struggle for better pelvic health. Meet women of all ages at Monday Night Out: Support and Solutions for Women’s Pelvic Health, a weekly support group.
Within several visits, patients should start to notice improvement. If you don’t notice any changes, adjustments can be made during a re-assessment appointment. “Recovery is a process and occurs at a different speed for each person,” Sydnor said. “We recommend having a conversation with your therapist regarding gains and setbacks.” After reaching your goals, it is recommended that you check in with your therapist annually or semi-annually.
How to Get Pelvic Floor Physical Therapy
To start pelvic floor physical therapy, you’ll need a physician referral. For women, many referrals come from a specialist in urogynecology or OB-GYN. For men, referrals often come from urology or a physician providing post-prostate surgery care. Primary care providers may also refer patients to this treatment.
This article is published by Loma Linda University Health to provide general health information. It is not intended to provide personal medical advice, which should be obtained directly from a physician.