Physical Therapist, Dr. Erin Weber, explains the conditions associated with pelvic dysfunction and how the Physical Therapy team at Physio Logic use Pelvic Floor Exercises to treat these types of conditions.
Pelvic floor physical therapy involves the treatment of pelvic dysfunctions through rehabilitation of the many muscles, ligaments and nerves within the pelvis. These conditions can range from minor to severe. Common concerns include pain, bladder, bowel and sexual dysfunction.
Post-Partum Pain And Weakness
One of the most commonly treated conditions within my practice is post-partum pain and weakness. After enduring the athletic event of childbirth (both vaginal and cesarean delivery), one’s body might not feel back to “normal” after six weeks of healing. Injuries sustained during labor and delivery can leave a lasting impact; such as painful scarring and an overall feeling of weakness. Other after-effects can include organ prolapse, nerve entrapments, and reduced sensation/inability to achieve orgasm.
Women who deliver via cesarean section also experience dysfunction secondary to load sustained by the pelvic floor to accommodate the growing baby for 40 weeks. The uterus can weigh up to 15x more, not including the weight of the baby. It can also hold up to 500x more, putting a large demand on these tiny muscles and ligaments to maintain the support. Cesarean section scarring can lead to lower back pain and increased tension across the anterior pelvis, creating difficulty with proper abdominal engagement.
Urinary And Bowel Incontinence
Urinary and bowel incontinence (ranging from mild leaking while exercising to full on loss of control) is a widespread concern. This can affect both men and women across the life span. Incontinence products line entire aisles of drug stores, making it a huge industry. Pelvic floor physical therapy addresses the exact muscles that control our sphincters, improving one’s control and reducing or eliminating incontinence. Treatments include strengthening (Kegels- specific to each individual) as well as behavioral approaches.
Sexual Dysfunction
Hypertonic pelvic floor muscles and scarring can lead to pain. Dyspareunia (painful intercourse) can be addressed with pelvic floor PT, as well as the inability to tolerate tampons, and GYN exams. Scar mobilizations and trigger point release with gentle stretching help reduce tension in the tissue. These clients are instructed to avoid Kegels and work on down-training their muscles to reduce the tension and pain.
Pelvic Floor Muscles And Their Functions
The pelvic floor muscles function to support our organs, control our sphincters and are responsible for sexual function. They deserve some attention and fine tuning when there is a problem. Pelvic floor muscles are a group of muscles located on the lowest aspect of our pelvis, the bottom of our core. They consist of 3 layers of muscles running from the pubic bone in the front to the SIT bones and coccyx posteriorly. The pelvic floor muscles synchronize with other core muscles to stabilize our pelvis and lumbar spine, reducing load to our surrounding joints.
The physical therapy evaluation consists of a typical orthopedic assessment of the pelvis and lumbar spine. It also includes an internal pelvic floor muscle assessment. This can give information regarding muscle tone, weakness and painful trigger points or scarring. Once we reach a diagnosis, an appropriate rehab program can be initiated.
FAQ’s On Kegel Exercises And Pelvic Floor Physical Therapy
What conditions are Kegels most successful in helping? How do they help?
Kegel exercises target the pelvic floor muscles, which makes up the lower portion of our core. These muscles are responsible for controlling our sphincters, sexual function, and supporting our organs. When they are weak, one might experience incontinence, lower back/pelvic pain due to poor stability, or even organ prolapse. Performing appropriate Kegel exercises will increase your pelvic floor strength, creating improved urinary and bowel sphincter control, improving sexual function (achieving orgasm more easily), and improving pelvic organ support (especially after childbirth).
When patients have a hard time doing Kegels, what do you tell them?
I usually have patients start by lying down on their back with their knees bent. This position eliminates the forces of gravity and allows patients to be more aware of the pelvic floor muscles. I cue them to draw up and in, narrowing the space between their SIT bones, and closing the space from their coccyx bone to their pubic bone. Try to keep your inner thighs and your gluteals relaxed. Imagine that these muscles are an elevator, close the door and begin to lift.
What are some common mistakes women make when attempting Kegels on their own?
Women usually have trouble getting all three layers to contract together. They often requiring verbal cuing to better facilitate proper coordination. On the other hand, some women present with hypertonic (tight) pelvic floor muscles, this group should not be performing Kegels. I have them work on ‘down-training’ these muscles with relaxation techniques and breathing exercises.
How soon should a woman see results from doing Kegels?
If done regularly (daily for a few times a day), expect to see results pretty quickly. I often have patients who notice a reduction in urinary incontinence after a week of performing the exercises. Once you are able to isolate the contraction properly, you can better facilitate your pelvic floor muscles with daily activities.
When should she seek additional help from a PT?
If you are experiencing any pain, incontinence, sexual dysfunction, or simply have question; you should seek help from a PT or MD. I would recommend that all post-partum women do at least one PT visit to learn how to better facilitate their pelvic floor muscles. People often assume that because they did not have a vaginal delivery and had a c-section that their pelvic floor muscles are fine. These muscles are put under a ton of stress to support the growing fetus and uterus throughout 40 weeks of pregnancy and deserve some attention to fully recover.
Erin Weber, PT, DPT