Pelvic Floor Therapy

Pelvic pain may arise from urinary, digestive, or reproductive problems. However, some people experience chronic pelvic pain due to inflamed or damaged ligaments and muscles in the pelvic floor. For others, irritated nerves may be the cause of pelvic pain.

Discomfort that is linked to structures in the pelvis may be overlooked, especially if urinary or digestive issues are ruled out by a physician. If left untreated, the pain may become debilitating or may have a negative impact on social and romantic relationships.

Pelvic floor therapy is a beneficial pain management approach that focuses on restoring function, movement, and mobility of the pelvic floor. Physical therapists work toward identifying the structures that are triggering the pain or discomfort to establish a plan of care that targets the underlying problem. 

What Is Pelvic Floor Therapy?

Pelvic floor therapy—also known as pelvic floor physical therapy (PFPT) — is a form of treatment that helps improve pain, dysfunction, and weakness in the pelvic floor. Therapists may use a variety of painless, non-surgical strategies that aim at retraining the pelvic floor muscles and ligaments that help control bowel, bladder, and sexual function. Learning how to utilize the pelvic floor helps restore function and provides pain relief.

In both men and women, the pelvic floor consists of a group of muscles that extend from the pubic bone to the tailbone. Pelvic floor muscles contract and relax to help regulate bowel and bladder function, and to facilitate sexual function (e.g., intercourse, reproduction). For instance, when an individual needs to urinate, these muscles contract to prevent incontinence and relax to allow urination or bowel movements.

In women, the pelvic floor provides stability for the bladder which is positioned toward the front of the abdomen, and the vagina and rectum which are located toward the back of the trunk. The uterus is also held in place by connective tissues, ligaments, tendons, and muscles in the pelvic floor. Furthermore, pelvic floor muscles support a growing fetus during pregnancy and relax or stretch during natural childbirth. In men, the structures that make up the pelvic floor help maintain proper positioning of the urethra, bladder, bowels, and rectum. 

However, if any of the structures in the pelvic floor begin to weaken or do not work properly, a condition known as pelvic floor weakness may develop. An individual can experience pelvic floor dysfunction when the pelvic floor muscles do not function efficiently and have difficulty relaxing such as for bowel movements. These different issues may contribute to constipation, incontinence, pelvic spasms, pain during intercourse, or pain in the pelvic region, lower back, genitals, or rectum. 

There is no one clear reason why pelvic floor dysfunction develops, but experts believe that the following factors contribute s to the onset of this condition:

• Obesity
• Pelvic surgery
• Chronic constipation
• Aging and menopause
• Straining during weightlifting
• Nerve damage in the pelvic region
• Pelvic floor trauma (e.g., auto accident)
• Interstitial cystitis (painful bladder syndrome)
• Chronic, violent coughing (e.g., coughing fits)
• High-impact exercises (e.g., running, basketball)
• Strain on muscles and tissues during natural childbirth
• Overuse of the pelvic muscles (e.g., straining during urination or bowel movements)

Despite the underlying cause, pelvic floor dysfunction is a common reason why people seek pelvic floor physical therapy.

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Symptoms of Pelvic Floor Dysfunction

The following symptoms may indicate the presence of pelvic floor dysfunction. If any of these signs and symptoms are present, speak with a physician who can make a diagnosis and referral for pelvic floor therapy.

• Painful urination
• Frequent constipation 
• Needing to urinate frequently
• Lower back pain of an unknown cause
• Leaking urine or stool (incontinence)
• Pelvic pain with or without a bowel movement
• Having to strain hard during a bowel movement
• Pain with bowel movements
• Persistent pain in the pelvic region, genitals, or rectum
• Changing positions while on the toilet or using the hands to help pass stool and empty the bladder fully
• Feeling the need to force urine or bowel out or having to stop and start several times
• Painful intercourse
• Difficulty with erectile function
• Tailbone pain that limits sitting down

In addition, certain conditions and symptoms related to pelvic floor dysfunction differ between men and women. For instance, pelvic floor problems may cause groin pain, ejaculation difficulties, or erectile dysfunction in men. Furthermore, a prostate issue called prostatitis may lead to symptoms that are similar to pelvic floor dysfunction. Prostatitis is characterized by inflammation or an infection in the prostate. It can be treated with antibiotics, but in some cases, it resolves without the need for treatment. Differential diagnosis to rule out prostatitis is helpful.

Women with pelvic floor dysfunction may suffer from urinary, uterine, or vaginal problems, including pain during sexual intercourse. If pelvic floor muscles become strained or remain weak following pregnancy, a woman may develop stress urinary incontinence (SUI) due to pelvic floor weakness. SUI refers to the leakage of urine when an individual laughs, coughs, or sneezes. This condition is common in women but may also develop in men.

Complications that become chronic, lead to debilitating symptoms or disrupt daily activities warrant a consultation with a physical therapist who specializes in pelvic floor therapy.

What to Expect at Pelvic Floor Therapy?

The first meeting with a physical therapist will entail a consultation that consists of an assessment of the mobility and function of the pelvic floor muscles as well as a medical history review to identify the cause of the pain. 

The initial evaluation typically includes the following:

• An in-depth review of medical history (e.g., trauma, surgery, childbirth)
• A physical examination
• A thorough assessment of symptoms
• An evaluation of tight, painful, dysfunctional, or inflamed structures

During the physical exam, a client may be asked to walk, sit, and stand to pinpoint potential joint or postural issues that may be contributing to the pelvic pain. The therapist will also evaluate whether muscle or bone problems in the hips, lower back, abdominals, buttocks, thighs, or sacroiliac joints may be placing stress on the pelvic floor muscles. In addition to assessing posture and joint function, an internal exam may be necessary.

Therapists who perform pelvic floor therapy received specialized training in pelvic floor muscle dysfunction in order to approach this portion of the exam in a safe, professional, and ethical manner. As most clients may feel uncomfortable during this part of the examination, a therapist will perform each step slowly and clearly explain the procedure. 

Clients are always encouraged to ask questions and ask a therapist to pause the exam to discuss any apprehensions or discomfort or alternatives to internal examination. After the examination is complete and the underlying issue is identified, the therapist will design an individualized treatment plan.

During a therapy session, the physical therapist will demonstrate pelvic floor exercises and techniques that are appropriate. Depending on the clinical findings of the examination, this may include stabilizing core muscles (the major muscles that support the trunk) or learning to relax the pelvic floor. Focus is placed on the trunk of the body, as it is important to coordinate, strengthen and retrain abdominal, diaphragm, and back muscles in addition to those in the pelvic floor. 

After determining which ligaments, muscles, and tendons are too tight, specific stretching exercises that improve flexibility, mobility, and coordination become an integral part of the therapy. Relaxation techniques, diaphragmatic breathing, and postural exercises are also taught during sessions to improve symptoms and overall well-being.

The specific therapeutic regimen a therapist will establish depends on an individual’s physical status and symptoms. Therapists also work with clients on behavioral modifications that include dietary and lifestyle changes that can help relieve pain and discomfort. Adhering to the treatment recommendations and behavioral modifications promotes long-term improvement.

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How Does Pelvic Floor Therapy Work?

Pelvic floor therapy involves different strategies that target the affected region to relieve pain, restore function, and improve mobility. Physical therapists may employ one or more of the following techniques during sessions:

Manual Therapy – Multiple techniques to address restrictions in the muscular, visceral, and neural structures of the body. For example, a trigger-point release technique helps relax tight muscles and boosts blood circulation. Trigger points refer to sensitive areas in muscle and connective tissue that cause pain when the area is pressed and some referred pain. Trigger-point release in the pelvic region may involve the use of the hand or a specialized tool to apply pressure that releases tension.

Visceral mobilization – A manual release technique that focuses on reducing pain and restoring the normal movement of internal organs such as the bladder, stomach, liver, prostate, urethra, and intestines.

Biofeedback – A procedure in which special sensors are used to monitor the pelvic floor muscles as they are clenched or relaxed. This helps the therapist and the patient to recognize the muscles that need to be retrained and strengthened.

Pelvic floor exercises – Pelvic floor exercises help coordinate, relax, and strengthen the group of small muscles in the perineum, vagina, and rectum that form a sling of muscles from the pubic bone at the front to the tailbone at the backside. Pelvic Floor exercises (previously called Kegels) are particularly useful in cases of SUI, where leaking occurs during coughing, laughing, or sneezing. Practicing pelvic floor exercises regularly can also enhance sexual health by improving erectile function and orgasm.

Weighted vaginal cones – A therapist may recommend the use of cone-shaped weighted devices, typically of increasing weight, which are inserted into the vagina, and held in place by pelvic muscle contractions. Initially, a client may try to keep a cone in place for about 5 minutes, two times a day. The weight and duration of placement is gradually increased as the muscles become stronger.

Vaginal dilators – A specialized device that helps relax and stretch the vaginal canal before intercourse or a pelvic exam. The dilator also retrains vaginal muscles and helps improve the mobility of scar tissue that may have developed during surgery, radiotherapy, or childbirth. The dilators—which are for home use— increase in size in response to expansion and relaxation of the vaginal wall.

Electrical stimulation therapy – Estim, a stimulation procedure that involves the administration of impulses through sensors placed inside the vagina, anus, or on the skin. The impulses target pain, muscle weakness, spasms, swelling, and inflammation depending on the established frequency. Estim works by either stimulating muscle contraction and release or providing neuromuscular impulses to reduce pain and overactive bladder. Clients can also perform this type of stimulation at home with the use of portable units. The recommended treatment times vary depending on the device that is used, but the stimulation procedure typically takes about 10-15 minutes. 

Therapeutic ultrasound – A technique that is different from a diagnostic ultrasound in that it provides deep, gentle heat to connective tissues—including ligaments, muscles, and tendons—to increase blood circulation, decrease inflammation, and reduce pain.

Benefits of Pelvic Floor Therapy

Before clients decide to work with a physical therapist who offers pelvic floor therapy, they often consider the benefits and advantages of receiving this type of treatment. Furthermore, physicians typically recommend this form of therapy due to its positive outcomes, but the nature of the therapy makes some clients uncomfortable. 

Although this type of therapy may involve an examination of sensitive areas as well as the use of techniques that target structures in the pelvic floor, clients who adhere to the treatment regimen can anticipate the following benefits:

• Reduced pain or complete pain relief
• Increased mobility and range of motion
• A lowered risk of experiencing chronic pain
• Restored pelvic floor function 
• Corrected bowel and bladder function
• Improved reproductive or sexual function 
• Reduced pain during intercourse

It is important to overcome apprehensions related to pelvic floor therapy, as the benefits can dramatically improve overall well-being and quality of life. 

Summary

If you’re suffering from pelvic pain of a known or unknown cause, our expert physical therapists at FYZICAL can help. Our dedicated team understands that pelvic floor problems can be a troubling and personal issue that may be hard to discuss. At FYZICAL, you will work with highly trained therapists who have expertise in treating delicate pelvic conditions.

Pelvic floor problems don’t have to reduce your quality of life. Our compassionate team of professionals is ready to answer any of your questions and design a treatment plan that makes you feel comfortable. Every part of the therapeutic regimen will be explained in detail and we will monitor your progress along the way. Don’t let frustration, embarrassment, or worry stop you from getting the assistance you need.

Locate a FYZICAL near you to learn more about our services.

FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!

To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book.