What is Pelvic Floor Therapy and do I need it?

Updated: Aug 10

TLDR


What is Pelvic Floor Physical Therapy?


Pelvic floor physical therapy is a specialty of physical therapy that focuses not only on the pelvic floor, but the whole body as it relates to the pelvic floor. For example, someone might be experiencing painful intercourse, as well as neck and jaw pain that contributes unknowingly.



Pelvic floor therapists are required to take advanced classes and acquire certifications outside of their doctorates to be able to treat pelvic floor conditions. With a background in orthopedics, we are uniquely qualified to help you truly understand the root causes of your musculoskeletal pain, as well as help you fix it.



What is the pelvic floor?


Answered more in detail in our blog post here, the pelvic floor quite simply is a group of muscles sitting within the bowl of your pelvis. These muscles function to keep us continent, help provide sexual pleasure, support our organs from below, and help us stay upright throughout the day.


The pelvic floor works in conjunction with your diaphragm and deep core to keep you balanced and upright, to help transfer load from daily activities, breathe better, have good bowel movements, and so forth. It's much more of an important canister than we realize.


To picture this more easily, think of soda can. Except instead of all the sides being metal, they're all muscles. The soda can relies on equal tension of all sides to keep its shape and not spill soda all over the place, and the same goes for our abdominal-pelvic canister.




What does Pelvic Floor PT treat?


While the list can go on and on here, to simplify it down we will consider the most commonly seen diagnoses:


  • Bowel dysfunctions (i.e. constipation, and anything else you could picture going wrong here)

  • Painful intercourse or insertion of objects (think tampon or speculum at the GYN's office)

  • Urinary issues (think anything from leaking, to pain with peeing, to retention of urine)

  • Pelvic pain (Can be tailbone pain or SI joint pain in pregnancy etc)


But what about the not-as-well-known diagnoses? There's a lot of different avenues you can pursue out there when it comes to pain (massage, chiropractic, ortho PT, surgery etc), but when it comes to anything relating back to the abdominal-pelvic canister it's best to head to pelvic floor PT.


  • Example: you have a hip injury, nothing you've tried is helping, and it really hurts deep within and with specific movements. Did you know there's a specific hip rotator, the obturator internus, sitting right inside the pelvis? Maybe it's that muscle causing your pain, and it's only accessible through a pelvic floor muscle exam.

  • Another example: you've always had nagging low back pain. Not enough to sound the alarms, but you're wondering why it bothers you more with running. A component to consider is the deep core and pelvic floor relationship, are they the root cause of it?


How do I know I should go to pelvic floor PT?


Ask yourself these questions:

  1. Does the issue change with movement (either good or bad)?

  2. Does the issue impact your quality of life, or a vital & enjoyable function of life?

  3. Does the issue revolve around muscle, soft tissue, joint, or bone?

  4. Have your at home efforts to resolve it been unsuccessful? Or have other providers' answers been unhelpful?

  5. Does the issue revolve around the functions of peeing, sex, or pooping?

If you answered yes to any of the questions above, it's worth checking out pelvic floor physical therapy. As mentioned above, our unique set of skills can provide relief in unexpected areas and is unique to the profession of therapy.


What does a session of pelvic floor PT look like?


Similar to other medical sessions you may have had in the past, we start with taking your history. How long has it been going on, what aggravates it etc?

Next up is the assessment. While a pelvic floor muscle examination can be included, most of the time the exam starts by looking at your whole body. The pelvic floor isn't an island by itself, so it's unrealistic to ignore what your posture and mobility elsewhere might be doing to your pelvic floor.


Finally, the treatment is implemented. Depending upon what you're seeking help for, the treatment might be more focused on manual therapy or exercise. The treatment is completely unique to you and your needs, and should help you reach your goals.


What is a pelvic floor muscle examination?


This is very specific to the world of pelvic floor therapy, and is completely different than a pelvic exam that you'd receive at the gynecologist.


A pelvic floor muscle exam is specifically looking both externally and internally at the structure and function of your muscles, nerves, and soft tissue. While we do not give you your annual pap smear, we can determine how your pelvic floor is functioning as a whole.


An internal pelvic floor muscle exam is generally recommended when your specific complaint is coming from a muscle or structure that is only accessed internally through either the vagina or rectum. It's not required, but a highly useful skill to be able to help your unique needs.



TLDR:

  • Pelvic Floor Physical Therapy is practiced by PT’s who have advanced certification and training to treat the pelvic floor.

  • Your pelvic floor is all muscle and soft tissue, and is important in the stability of your trunk, maintaining continence, and providing sexual pleasure.

  • Pelvic Floor PT most commonly treats: bowel dysfunctions, pain, urinary incontinence, and hyper / hypotonic muscles.

  • Visits typically include: taking your history, full body assessment, pelvic floor assessment, manual therapy, exercise recommendations, and goal setting.



 

About the Author:

Caroline Gamwell, DPT is a Doctor of Physical Therapy specializing in Women’s Health and Orthopedics. Dr. Gamwell earned her doctorate at Northwestern University in Chicago, IL with a focus on chronic pain rehabilitation. Dr. Gamwell owns Worth It PT, LLC, a boutique physical therapy practice based in Denver, CO focusing on all things Women’s Health. She holds post-graduate certifications in Pelvic Floor Physical Therapy, as well as in treating pregnant and postpartum athletes. Her passions lie with helping others embrace body changes throughout the decades, whether it’s pregnancy and postpartum or simply aging well.



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