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Pelvic Floor Physical Therapy – What Is It and Who Is It Good For?

Womens Health 1

What is the pelvic floor?

You may have heard about the pelvic floor and kegels, but first let’s talk about what the pelvic floor is.  The pelvic floor isn’t just for women.  Everyone has a pelvic floor, no matter what genitals we have.  Though we all have a pelvic floor, every body looks or is shaped a little different from the next and so too are its genitals – and that is the way it is supposed to be!  To start, our pelvis is made up of three bones, the ilium, ischium, and pubis, which connect all around via joints, ligaments, and connective tissues to form a belt-like structure.  We have multiple muscles that connect to the pelvis and structures to form a hammock-like support, called our pelvic floor.  These surround and connect with our various openings unique to each person and their genitals.  The pelvic floor also helps us to control our bladder and bowels, allow sexual function, control our hips, and manage pressure within our abdomen.

What is a pelvic floor PT evaluation?

A pelvic floor PT evaluation is uniquely tailored to you, your preferences, and your needs in order to get you the relief you want and deserve!  Your evaluation starts out with getting to know YOU!  It is important for us to talk about what motivates you and what goals you have so that we can optimize your care to improve your daily life, your relationships, and your wellbeing.  We know it may feel uncomfortable to talk about leaking pee during your workouts or a good hard laugh or having pain with sex and the impacts it can have on your life.  Therefore,  the first step in getting the results you want is working with a healthcare partner that you can trust.  

In the physical evaluation, we assess posture and breathing to gain an understanding of how your body supports itself.  Depending on your level of comfort and the types of issues you are dealing with, your evaluation can be performed by 1) externally assessing some hip and pelvic floor muscles by checking different hip motions and positions and touching the muscles, and/or 2) internally assessing the pelvic floor muscles (similar to if you were at you OB/gynecologist’s office) via vaginal opening (or in some cases, rectal opening), for strength, tension, relaxation, and coordination of contraction.  We know this may sound scary, but it’s not nearly as bad as you think.

What are the most common conditions that can benefit from pelvic floor physical therapy?

Urinary or bowel incontinence (leakage of pee or poop), pelvic paindiastasis recti (abdominal gap or tenting/coning), dyspareunia (persistent pain with attempted or completed vaginal penetration), vaginismus (inability to penetrate the vagina), vulvodynia (vulvar pain without clear identifiable cause), pelvic organ prolapse, endometriosis (growths of uterine-like lining outside the uterus), dysmenorrhea (painful menstrual cramps). 

Some of these conditions can be managed solely with physical therapy, and others may be managed by a combination of medical interventions alongside physical therapy to maximize your results.  There are treatments for all of these we can help you with, as well as exercises you can do to help.  Many times just knowing what’s wrong, what to avoid, and what you can do to help is enough to give people a little hope that this can go away.  It can.  And with the right help it will. 

Why am I leaking? What are factors that influence urinary leakage?

Urinary leakage can happen for many reasons and is one of the most common things people come to see us for. Some factors that can influence one’s likelihood of urinary incontinence include age, pregnancy, childbirth, menopause, hysterectomy, and obesity. Leakage can also be associated with a variety of factors including bladder irritants (triggers like coffee, alcohol, acids), poorly trained bladder habits (going too frequently or not frequent enough), weakness or poor coordination of pelvic floor muscles with laughing, coughing, sneezing, or lifting, and some conditions or infections in the body.  

The most common types of urinary incontinence that we see are stress incontinence, urge incontinence, or a mixture of both stress and urge incontinence.  Stress incontinence happens when there is pressure exerted on the bladder, such as during coughing, laughing, sneezing, exercising, or lifting something heavy. In that scenario, the pelvic floor muscles cannot overcome the stress, which can be due to weakness or poor coordination/timing.  Urge incontinence occurs when you feel an intense need to urinate and then get leakage of urine.  People with urge incontinence often feel like they need to urinate frequently and have difficulty holding it throughout the night.  Urge incontinence can have many causes, ranging from non-optimal habits (including hovering over the toilet seat or always peeing before leaving the house), to a minor infection or another condition in the body.

What is diastasis rectus abdominis / diastasis recti?

Diastasis rectus abdominis (DRA) is a separation or gapping between the two sides of the outer abdominal muscles that make the “6-pack” abs. When forces build up in our abdomen, they can cause stretch of the connective tissue in the center called the linea alba. 

Diastasis most often can occur in pregnancy as the body stretches to accommodate the growing baby and it often resolves on its own in the first few months after birth. DRA commonly occurs in infants and spontaneously resolves over time, as well. However, DRA can occur in anyone, including men, women, not just from stretching the tissues, but also from genetics, abrupt changes in weight and stomach obesity, or poor core control technique with pressure building up in the abdomen, such as holding one’s breath during lifting (Valsalva) or straining during a bowel movement. 

DRA is often pain-free and symptom-free, however some may report a visible or palpable separation of center of the abdomen, feeling “loose or flabby” in the stomach muscles, doming or tenting of the center of the abdomen during lifting, sitting up or rolling in bed, or certain exercises. 

Physical therapy can help adults with DRA manage pressure within their abdomen and manage symptoms, while also improving their endurance and strength for proper control during daily activities and their physical endeavors. In pelvic floor physical therapy, we will assess your stomach muscles, as well as your posture, breathing, strength, endurance, mobility, and coordination during activities.

Starting a program early in pregnancy that focuses on proper stabilization of the core and pelvic floor muscles has shown to be effective in improving function and managing pressures that can put extra strain on a diastasis.

SIDE NOTE: Abdominal hernias can sometimes be managed conservatively through similar training with physical therapy, working on awareness and coordination of abdominal support during daily activities and pressure management techniques.

When should I see a pelvic floor physical therapist versus a traditional physical therapist? 

For low back, hip, buttock or groin pain, you may elect to go to an outpatient orthopedic physical therapist, however pelvic floor physical therapists can also treat these conditions due to the overlapping of muscles and coordination involved in those body regions and the pelvic floor. If you struggle with incontinence, pelvic pain, pain during intimacy, or diastasis recti symptoms, a physical therapist with additional education and practice in pelvic or women’s health physical therapy is a great place to start.  Some physical therapists have experience treating these conditions without the additional training.  Since many of these treatments are private and complex in nature, you definitely want to seek out a professional with experience in both internal and external treatments, even if you decide that your level of comfort just lies in external treatments.  Luckily KinetikChain Denver has a therapist trained in pelvic floor treatments!

What is helpful for pelvic floor relaxation?  How can I get it to relax?

Hip opening stretches and deep breathing are great for pelvic floor relaxation. As you inhale, think of the pelvic floor descending as you create space for your diaphragm to descend, ribs to expand, and lungs to fill with air.  Often, hip stretches lying with your back supported can allow your low back and hips to relax so you can focus on the relaxation of the pelvic floor.  It is important to learn how to relax the pelvic floor muscles fully in order to effectively contract those muscles when necessary.

What is helpful for pelvic floor activation? Is it just kegels?

Pelvic floor activation can be subtle so it is important to find what works for you. Kegel exercises are a simple, equipment-free way to work the pelvic floor muscles, however it can be easy to compensate with other muscles (like squeezing the butt or inner thighs).  Exhaling fast as if breathing through a straw or with an audible “shhh” can help you contract and lift your pelvic floor when developing awareness of the muscles.  Different positions of the body can be easier or harder for you to feel contraction of your pelvic floor muscles.  Try laying on your back, or on your hands and knees, or sitting in a chair.  Kegel exercises may be what you think of when you think of pelvic floor activation, however we can build onto that and get great activation of the pelvic floor muscles in other exercises as well, such as during squats and birddogs.

Are you struggling with any of the issues in this article? Or do you want to learn more about your pelvic floor health proactively? Give us a call or click our “cost and availability” button and we will help you make the best decisions about your future. YOU ARE WORTH IT.  If you would like to speak privately with a women’s health and pelvic floor PT you can call 720-651-0674 or you can just request to speak to a women’s health PT when you fill out one of the forms on our website and we call you.

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