Pelvic Floor Physical Therapy; An Introduction
Dr. Angel Rivera
Pelvic floor physical therapy (PFPT) has been gaining popularity in recent years. This form of physical therapy is used as a conservative treatment option for various abdominal and pelvic floor conditions. Many individuals also choose to see a pelvic floor physical therapist preventatively to ensure that these disorders do not develop or progress down the road.
What Is A Pelvic Floor Physical Therapist?
Physical therapists are healthcare providers who undergo a three-year post-graduate doctorate program. At the end of their program, or shortly after, they take a national boards examination. Once they pass this exam they can get licensed to practice in the state of their choosing. Each state requires slightly different paperwork and/or law exams in order to gain licensure.
Doctors of physical therapy (DPTs), as they are referred to, are masters of the musculoskeletal and neuromuscular systems. They are trained to assess muscles, joints, connective tissues, and nerve function to help heal an injury, regain function, decrease pain, and/or improve quality of life.
A pelvic floor physical therapist specializes in the muscles, joints, connective tissues, and neuromuscular system of the pelvic area. This involves the aforementioned structures on the inside and outside of the pelvis such as:
A pelvic floor physical therapist needs some extent of advanced training in this specific field. One can gain this knowledge from doing one or all of the following:
- Shadowing a practicing pelvic floor physical therapist
- Taking courses on pelvic floor health, postpartum, etc.
- Obtain an additional board certified in women’s health / pelvic health
How Do I Know Pelvic Floor PT Is For Me?
Pelvic floor physical therapy might be helpful for you if you have been diagnosed with or experience:
- Pelvic organ prolapse
- Fecal incontinence
- Urinary incontinence
- Overactive bladder
- Interstitial cystitis
- Peripartum or postpartum pain or concerns
- Pelvic floor dysfunction
- Chronic pelvic pain
- Low back pain
- Diastasis recti
- Sexual dysfunctions (i.e. vaginismus, erectile dysfunction, etc.)
Some individuals might seek out a pelvic floor physical therapist preventatively. If they have a family member with any of the above conditions, or believe they might be at risk for any of the above conditions, they may reach out for ways to help prevents them.
Your urologist, gynecologist, or primary care doctor may give you a referral for pelvic floor physical therapy, but you do not need one. DPTs are qualified to recognize when a disorder or condition is purely musculoskeletal and within their scope of practice, or is something you would need medical attention for.
Isn’t Pelvic Floor PT Just For Women?
Although this field of physical therapy tends to be more popular among women (especially since a bulk of it revolves around childbirth and the after-effects of childbirth) men can also experience various forms of pelvic dysfunction as mentioned above. Men can benefit just as equally from pelvic floor PT as women can.
What Does A Typical Session Look Like?
These appointments tend to be very intimate, so they will be performed in a private room. Your first appointment will begin with a thorough discussion about your medical history, as well as your social, bowel/bladder, and sexual history. Some questions may include:
- Are you sexually active?
- Do you or have you ever had pain with intercourse?
- Does sexual intercourse increase your symptoms?
- Do you have low back pain?
- Do you have abdominal pain?
- Do you have pelvic pain?
- Have you ever fallen on your tailbone?
- Have you ever given birth? Please list how many births and what type of delivery (vaginal delivery, cesarian section, miscarriage, abortion).
- Have you ever experienced physical, emotional abuse, or trauma?
- Do you experience any urinary leakage? How frequently?
- Which activities cause urine leakage- coughing/sneezing, laughing, lifting, running/jumping, nervousness, unknown?
- Do you ever experience leakage and don’t feel it?
- How often do you get up to urinate at night?
- Do you have pain with urination?
- Do you experience stool leakage?
- How often do you have bowel movements during the week?
- Do you often experience constipation?
Your physical therapist will also ask what your goals are. Some patients seek pelvic floor PT to improve their sexual health, others wish to improve difficulties with incontinence.
Once your PT understands what your concerns are and determines a diagnosis, he or she will undergo a physical exam. This will include an assessment of gait (how you walk), posture (in sitting and standing), breathing patterns, muscle strength and muscle endurance. This assessment is typically accompanied by abdominal palpation, intervaginal palpation, and/or inter-rectal palpation (following your consent).
Following the initial evaluation, your physical therapist will come up with a treatment plan. This will involve regular appointments, typically over the course of 2-6 months. These appointments will include multiple forms of treatments such as:
- Myofascial release, trigger point therapy, and/or massage.
- Electrical stimulation: Electrodes placed on muscles to isolate and assist with muscle contraction.
- Biofeedback: Electrodes placed on muscles that give visual or audible feedback on the strength of specific muscles contractions (or relaxation).
- Vaginal weights to help strengthen pelvic floor muscles.
- Pelvic floor muscle exercises and/or kegel exercises.
- Breathing techniques to aid in muscle relaxation and proper muscle engagement.
- Postural education with sitting, standing, daily activities, etc..
- Education on bowel and bladder habits, postures and techniques.
In addition to what you do with your physical therapist in the office, you will also be prescribed a home exercise program. This involve exercises and techniques for you to perform on your own. A home exercise program may include exercises involving equipment used in the clinic, or something as simple as being mindful of posture and breathing throughout your day.
Where To Look For When Finding A Pelvic Floor PT?
You will want to look for a physical therapist who specializes in women’s health and/or pelvic health. Many of these therapists will hold a board certification in women’s health. This requires coursework, field hours, and passing an extensive exam. It is not necessary for a PT to have this certification in order to be a pelvic floor PT.
Lastly, and most importantly, you should be comfortable with your provider. You will be sharing very intimate details with this person, so you want to be sure you can be completely transparent and comfortable with them.
References and Sources:
Rosenbaum, T. Y., & Owens, A. (2008). Continuing medical education: The role of pelvic floor
physical therapy in the treatment of pelvic and genital pain-related sexual dysfunction
(cme). The Journal of Sexual Medicine, 5(3), 513-523.
Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of
pelvic floor dysfunction in women. Current Opinion in Obstetrics & Gynecology, 31(6),