If you’re reading this, I’m assuming that you’re already aware that you have a pelvic floor. And if you didn’t know, you now you do. (If you want more information about your pelvic floor, please check out my earlier blog post: https://dramyosborne.com/blog/2019/09/18/the-pelvic-floor-what-is-it-and-what-can-go-wrong/). But, chances are you don’t a lot about what pelvic floor physical therapy is, per se. I’d venture to guess that the vast majority of my PT school cohort knows very little about what pelvic PT actually entails. So, of course I don’t expect the lay person to know anything about it either!
First, let’s talk about who needs pelvic floor PT, because it’s indicated more often than people realize. If you are dealing with painful bladder syndrome, urinary incontinence, urinary urgency/frequency, urinary hesitancy/incomplete bladder emptying, pain with peeing, getting up more than once in the middle of the night to pee, chronic constipation, hemorrhoids, anal fissure, fecal incontinence, pelvic organ prolapse, pain with sex, pelvic girdle pain, pain associated with endometriosis, pudendal neuralgia, vulvodynia, vaginismus, lower abdominal pain, testicular pain, rectal pain or tailbone pain, you would like benefit from pelvic floor physical therapy!
Pregnant women and postpartum women also benefit greatly from pelvic PT! Even if a woman isn’t having symptoms during pregnancy, I encourage women to seek a pelvic floor evaluation around 34 weeks gestation. At this visit, their PT can assess the position of their pelvis, the tone of their pelvic floor and help them to prepare for labor and delivery. And of course, I encourage every single woman to seek a postpartum pelvic PT assessment, regardless of their method of delivery. The pelvic floor goes through a lot of changes through pregnancy, labor and delivery. And just like any muscle – when it is injured it should be rehabilitated! A good pelvic PT will also assess and treat the entire body in order to help women return to their prior level of function.
Also, if you’re dealing with a chronic hip injury (especially hip labral tears and femoroacetabular impingement), as pelvic floor dysfunction is often a contributing factor that goes untreated and inhibits full healing! I’ve seen several women undergo hip surgeries and not make a full recovery until they’ve received treatment of their pelvic floor!
So what does a pelvic floor PT appointment look like? Your first visit will focus primarily on subjective history-taking. Your PT will ask you questions about your symptoms in order to understand what is going on. They will likely look at your posture, possibly watch you walk and may do some simple strength or range of motion tests to understand what’s happening globally in your body. That’s not so scary.
Here’s how the pelvic floor assessment goes down. Remember that your PT is VERY aware of the sensitive nature of this type of treatment and will ensure that you maintain as much modesty as possible throughout the duration of the examination. Your PT will step out of the room and ask you to undress waist-down. You will lie on your back and can cover yourself with a drape or sheet that is provided to you. The most superficial muscles of the pelvic floor are assessed externally, and the therapist will palpate these muscles by touching areas in your perineum. You may be asked to cough, contract your abdominal muscles, kegel and bear down while your therapist assesses the muscle tissue. The deeper muscle tissue is assessed via an internal assessment, which can be done intra-vaginally or intra-rectally. The PT just uses their gloved index finger, and no speculum or instruments are needed. Once again, the PT will palpate different areas within the deeper pelvic floor and may ask you to cough, bear down or contract your pelvic floor. During the exam, your PT is looking for areas of hypertonicity or muscle tightness, weakness and coordination issues. I always remind my patients that they are in control of the session. If something is uncomfortable or unbearable, the PT will stop what they’re doing immediately.
The biggest question I get is: will it hurt? I acknowledge, this isn’t the most comfortable thing to have done, but it shouldn’t hurt. I can assure you that an internal pelvic floor session is more tolerable than a pap smear or prostate exam.
Depending upon the findings of the exam, your PT will assign you an exercise program, which may be as simple as breathing exercises. They will also discuss their findings and give you a plan of care, with expectations related to prognosis and timeframe.
See, that isn’t so bad! But, I can completely understand why people have trepidation about this. Just remember, your PT is a trained professional and is there to help you eliminate the symptoms that you’re experiencing.
One of the reasons I’m so passionate about pelvic PT is that people typically respond so well to treatment. And more often than not, they’ve been dealing (sometimes silently) with their symptoms for a long time! So if you or anyone you know has been dealing with any of these issues, encourage them to find a pelvic PT. No one should have to deal with these debilitating symptoms that are typically embarrassing and isolating. Pelvic floor PT has the potential to change people’s lives!
