Picture this: You are a woman 4 months post-partum and your friend Super Sally is begging you to embark on a “get fit” journey with her. You feel enthusiastic about this, because you are eager to feel “normal” again after having a baby. As you begin to work out in the weeks following, you notice some urinary leakage with jumping or during a squat. You may begin to notice hip, back, or sacroilliac pain that starts as an annoyance, but now is disturbing your work. Suddenly intercourse is painful, and you think you must be going crazy. Your vagina may have a “pressure” like feeling at the end of the day or during a workout you can’t quite describe. You start to feel frustrated and wondering why you can’t seem to get back into the shape you once were, so you seek orthopedic physical therapy for your “strange diffuse pain.” Your pain gets better by about 65% percent with physical therapy, but you still feel this sense your body isn’t functioning the way it should.

This scenario is just one of many scenarios where a physical therapist well versed in pelvic floor can play a vital role into getting you closer or to the 100% you use to be. The pelvic floor has become a bit of the “lost muscle” group in orthopedic physical therapy, possibly due to the privacy of the matter. You have muscles in your pelvic floor like other muscles in your body that play a vital role in musculoskeletal support, sexual health, and overall organ function. These three layers of muscles aid in providing support to your pelvis that includes your sacroilliac, hip, and pubic symphysis joint. They also maintain continence to urine and feces, assist in sexual function, keep your pelvic organs in the appropriate place such as your uterus or bladder, and act as a lymphatic and venous pump system to the pelvis. In the scenario above, adding pelvic floor muscle rehab to the treatment plan may be the addition to help breakthrough your plateau.

All of the pelvic floor muscles and the nerves that run through them have potential to refer pain to your hip, back, pelvis, abdomen, and legs. In cases of pain around the pelvis, it is of the utmost importance to remember the pelvic floor muscles as part of the treatment plan. If you had shoulder pain you would want someone to examine your neck and visa versa. The same applies for patients with hip, back, or pelvic pain, because hips, core, and functional pelvic floor will really keep you out of a pelvic floor physical therapist’s door. Leaking or urgency of urine and feces, pain with intercourse, feelings of pressure in your vagina or rectum, difficulty sitting, or discomfort with tight clothing around the pelvis can all indicate there is a problem with your pelvic floor muscle function.  The causes of pelvic floor muscle dysfunction can range from a wide variety of issues relating to pregnancy and post- partum, muscle weakening and loss of power during menopause, pelvic surgeries such as a hysterectomy, poor motor control and breathing patterns in high level athletics, poor voiding habits, poor postural habits, and diagnosis such as endometriosis, pelvic organ prolapse, and lichen sclerosis to name a few.

If you experience any of the symptoms above, you should consider adding a physical therapist well versed in the pelvic floor muscles to your treatment team. At Spring Forward Physical Therapy we come from a wide range of perspectives to help treat the causes of your pain and prevent it from reoccurring. Working as a team to combine these perspectives that includes a therapist well versed in pelvic floor muscles can help you achieve your goals and keep your body functioning optimally.

Andrea Wood, PT, DPT, PRPC

Knowledge is power, empower yourself for your health