Pelvic Floor Physical Therapy

By: Dr. Erin Weber, PT, DPT.

Pelvic floor physical therapy involves the treatment of pelvic floor 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.

Postpartum Pain And Weakness

One of the most commonly treated conditions within my practice is postpartum 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 pelvic floor 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 at any given time in their lifespan. 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 physical therapy as well as the inability to tolerate tampons and GYN exams. Scar mobilizations and trigger point release with gentle stretching helps reduce tension in the tissue. These patients are instructed to avoid Kegels and work on down-training their muscles to reduce the tension and pain.

Pelvic Floor Muscles And Their Functions

Pelvic Floor Physical Therapy in New York City

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.

A 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 pelvic floor physical therapy program can be initiated.

FAQ’s about 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).

I have a hard time doing Kegels. What should I do?

Start by lying down on your back with your knees bent. This position eliminates the forces of gravity and will allow you to be more aware of your pelvic floor muscles. Next, draw up and in, narrowing the space between your SIT bones, and closing the space from your coccyx bone to your 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. Patients often 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 I seek additional help from a physical therapist?

If you are experiencing any pain, incontinence, sexual dysfunction, or other pelvic floor dysfunctions, or simply have a question; you should seek help from a physical therapist or medical doctor. I would recommend that all post-partum women do at least one physical therapy 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.

If you’re interested in learning more about Pelvic Floor Physical Therapy, schedule an appointment with a Physical Therapist. If you’re in the New York City area, you can schedule an appointment with one of our Physical Therapists at Physio Logic. Just fill out the form below or give us a call.

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