By Sarah Ellison, PT, DPT
If you have ever spoken to a pelvic floor therapist before, they will likely have said at some point “there is no such thing as TMI [too much information]!”
Pelvic floor therapists support their patients in improving symptoms that are often stigmatized or not considered socially appropriate to discuss in many settings. We did some of the heavy lifting and answered commonly asked questions to help you feel more prepared and knowledgeable about pelvic floor physical therapy prior to starting treatment:
What is the pelvic floor?
The pelvic floor is a group of muscular layers that form the underside of the torso. These muscles provide sphincteric control around the various openings of the pelvis (involved in urinary, bowel, and sexual function) and help create stability through the torso.
Does everyone have a pelvic floor?
Yes! The orientation of the muscles may differ based on anatomy, but the role of the pelvic floor in affecting trunk stability as well as sexual, urinary, and bowel functioning remains the same.
What does pelvic floor physical therapy entail?
Pelvic floor physical therapy is the assessment and treatment of pelvic floor related symptoms. These symptoms often involve urinary, bowel, or sexual functioning. However, pelvic floor dysfunction may also present as hip, abdominal, or back pain whose causes are not readily found with medical testing and treatment not fully responsive to medication or conventional physical therapy. As pelvic floor physical therapists, we are outfitted with a variety of strategies to improve the tension, strength, or coordination of these pelvic floor muscles for symptom resolution.
In order to improve pelvic floor functioning, we will typically take a comprehensive approach, having the ability to address the pelvic floor both directly and also indirectly. Pelvic floor specific treatment involves releasing increased pelvic floor muscle tension and reviewing pelvic floor strength and coordination (think kegel). A bigger picture approach involves addressing tension and strength of neighboring back, hip, and leg muscles through stretching, exercise, and massage techniques. The combination of strategies included in a person’s plan of care is uniquely designed based on individual preference and provider findings.
Does pelvic floor physical therapy have to include an internal pelvic floor exam?
As the pelvic floor muscles are an internal set of muscles, the most direct way to assess the strength and tone of these muscles is either vaginally or rectally. For this reason, the internal exam can be incredibly beneficial. As always, a person’s plan of care is individualized to them, so this component can be included if and when they are ready. As described above, there are so many different ways to improve pelvic floor conditions, so pelvic floor therapy can always be helpful!
Can pelvic floor physical therapy be done if someone is menstruating?
Pelvic floor physical therapy, including internal pelvic floor treatment, can absolutely be performed during menstruation. That being said, treatment is always catered to the individual. If someone would prefer to defer internal pelvic floor treatment during menstruation, alternative pelvic floor treatment, including stretches, exercise, breath work, or other manual therapy techniques to neighboring muscle groups can still be incredibly beneficial.
What is normal vs. What is not normal?
Many additional questions that arise in pelvic floor therapy also involve differentiating what is normal versus what is not normal as it relates to sexual, bowel, and urinary functioning. For instance, sex should never be painful. Bowel movements should generally have a certain consistency and frequency. As these bodily functions are not often discussed, people may feel uncomfortable asking these questions. However, asking questions can be helpful to identify what is not normal and when pelvic floor therapy can be helpful.
While asking questions is a welcomed component of pelvic health care, it is important to recognize that there is no need to ask these questions all at once or even at all. Pelvic health therapy is first and foremost about making a person feel comfortable. This allows the healing process to really begin. After all, muscle tension often contributes to pelvic floor conditions, so providing a safe space is integral to pelvic health care.
At Wellest Integrative Health, we know pelvic floor physical therapy is a journey, and our patients are always at the center of it. If you are struggling with pelvic floor pain, symptoms, or dysfunction, reach out to us today - we can help!
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