Pelvic Floor Physical Therapy: It’s Not Just About Kegels and Leaking

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What is pelvic floor physical therapy?

Pelvic floor physical therapy can direct treatment to include your pelvic floor muscles that can become dysfunctional from a variety of reasons. These reasons may include but are not limited to pelvic organ prolapse, pregnancy and post-partum, chronic straining, post trauma, pelvic surgery, or hip and back injury. You have three layers of pelvic floor muscles like any other muscles in your body. Good treatment will not focus solely on your pelvic floor muscles and symptoms but determining what drives your symptoms. Sometimes pelvic floor muscle pain or dysfunction can be the result of an orthopedic injury that creates an imbalance and poor biomechanics around the pelvis.

What are the signs and symptoms I need to see a pelvic floor physical therapist?

Some common symptoms include but are not limited to:

Leaking urine with coughing, sneezing, laughing, or athletics
Urgency of urination and feelings of rushing to the bathroom.
Painful bowel movements or difficulty passing a bowel movement
Leakage of fecal matter or feelings of incomplete bowel emptying
Painful intercourse
Feelings of pressure or something coming out of your vagina or rectum
Difficulty maintaining an erection or pain with an erection
Pain in the perineum or tailbone with sitting
Si joint dysfunction
Hip and low back pain that traditional orthopedic therapy is not fully improving. These patients benefit from a team approach of both orthopedic and pelvic floor physical therapy


How does a physical therapist examine my pelvic floor muscles?

Treatment goes according to the patient’s comfort and they’re in control of the session. All treatments are in a private room behind closed doors. To examine how the pelvic floor muscles are functioning, the therapist uses a gloved finger with lubrication and will ask you to perform a variety of tasks such as pretending to stop the flow the urine. By performing these tasks, the physical therapist can determine the strength, power, coordination, and endurance of your pelvic floor muscles. The therapist can also determine if you have any painful muscles internally, check for pelvic organ prolapse, or any abnormalities that may be occurring.

I was told to do “kegels” by my previous physical therapist not specialized in pelvic floor and it made my symptoms worse, why is this?

Sometimes kegels can exacerbate pelvic floor dysfunction, hip, and back pain. Often therapists think kegeling is good for everyone, but that is not the case. For example, if your calf muscle was very tight, cramping, and painful you wouldn’t perform a bunch of heel raises. Instead you would want to work on the muscular restrictions and slow stretching and lengthening of the muscle. The same concept applies to the pelvic floor muscles. If the pelvic floor muscles are overused as a stabilization strategy and too active, continuing to shorten them by kegeling can worsen the pain. You may actually need down-training of the pelvic floor muscles and re-education of the stabilizers surrounding the pelvic floor such as your abdominal and hip muscles. The pelvic floor muscles attach into many sites at the hip, pubis, sacrum, and back and when they become overused they can cause excessive strain on the pelvis and surrounding ligaments and nerves.

I’m an athlete and work out a lot to stay really strong. Why do I have pelvic floor dysfunction, pain, or leakage?

Often athletes are strong but not efficient in how they use their bodies. Our bodies are very smart and find the easiest way to achieve a task at times, but this is not always the right way. For example, you may be able to make a plank look great from an outsider’s eye, but if you are clenching your pelvic floor muscles with limited use of your abdominals or proper breathing, overuse of the pelvic floor muscles occurs. Many things in the body should have a symbiotic relationship, meaning balance and “helping each other out.” However, you may have weakened pelvic floor muscles that can’t meet the demands of your sport and need strengthening. One of my favorite things to tell patients is “hips, core, and functional pelvic floor keeps you out my door.” Retraining exercises you do and how to do them more efficiently can help retrain your pelvic floor muscles to work optimally for demands of sport.

Want to Learn More?

There are many things you can do to prevent pelvic floor dysfunction. Many of them are simply developing healthy habits that you can adapt into your lifestyle right now ranging from limiting bladder and bowel irritants to proper breathing during exercise. You can email a pelvic floor question to Andrea Wood, PT, DPT, PRPC at Andrea@springforwardpt.com or come to our meetup on March 1, 2017 at 6pm- 7pm at Spring Forward Physical Therapy for part 1 of “The Healthy Pelvis” series. Learn everyday things to maintain optimal pelvic floor health! Bring your friends or loved one! We will be raffling off some great prizes!

Food and Drink Provided

RSVP to: Andrea@springforwardpt.com

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