Pelvic floor rehabilitation is a form of physical therapy that helps to address pain, weakness, and dysfunction of the pelvic floor muscles. The pelvic floor muscles run along the base of the pelvis, from the pubic bone to the tailbone, and play an important role in supporting pelvic organs, continence, and sexual function. Muscles of the pelvic floor (such as the levator ani, obturator internus, and coccygeus) are no different than any other muscles found in the body. Therefore, they too can develop impairments such as tightness, weakness, poor coordination, and lack of endurance. Physical therapists specialize in the treatment of neuromusculoskeletal dysfunctions and some PTs are clinically trained to apply these skills specifically to rehabilitate the muscles of the pelvic floor. While both men and women have pelvic floors, in this article, we will focus on the various types of pelvic floor dysfunction and treatments available specifically to females.
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction includes any impairment of the muscle function of the muscles in and around the pelvis. The presence of pelvic floor dysfunction can result in a significant reduction in a woman’s quality of life. Pelvic floor muscles are necessary for optimal basic body functions, like bowel/bladder elimination and sexual activity. If the muscles become overstretched or weakened, a woman may experience difficulty controlling her urine flow, or lose urine when coughing and/or sneezing. This may result in feelings of shame and embarrassment. On the flip side, if the muscles become overly tight a woman may experience pain during vaginal penetration which may negatively impact her ability to engage in sexual intercourse and consequently may affect her intimate relationships. The good news is that specialized treatment can restore and improve tone, strength, and functionality in this critical area of the body.
What Can Cause Pelvic Floor Dysfunction?
One of the most common causes of pelvic floor dysfunction in women is pregnancy and birth. Both vaginal and C-section births can result in pelvic floor dysfunction. Your pelvic floor works in conjunction with your abdominal muscles, and if your abdominal muscles aren’t functioning well, chances are your pelvic floor isn’t either. A C-section birth involves cutting through abdominal tissues which compromises their function and thus the function of the pelvic floor as well (read more about how C-section births can impact your pelvic floor here). During vaginal delivery, many women experience over-stretching of pelvic floor muscle tissue which unfortunately at times results in tearing. It’s no wonder that research now supports childbirth to be comparable to a major athletic event. In effect, prenatal and postpartum women are prone to pelvic floor issues that can worsen over time if not addressed.
Other factors that can contribute to pelvic floor dysfunction include regular heavy lifting, chronic straining during bowel movements, age, presence of respiratory conditions, obesity, history of endometriosis, anxiety, lack of exercise, and poor posture. A woman can also experience an injury to the pelvic area secondary to medical procedures or even sexual trauma that leaves the musculature weakened, in spasm, or painful. No matter the cause, pelvic floor dysfunction can have a significant impact on your everyday activities and affect your quality of life.
What Are Common Signs of Pelvic Floor Dysfunction?
Common signs and symptoms of pelvic floor dysfunction include constipation, frequent urination, and/or painful sex. There may be a feeling of pressure in the pelvic region or rectum or pain in the genital area. Sometimes, women feel accompanying lower back or hip pain. Leakage of feces or urine is a red flag indicating that there may be an issue related to the pelvic floor. In general, unexplained pelvic pain or any new symptom associated with bowel, bladder, or sexual functioning warrants further evaluation by a medical professional.
Pelvic Floor Exercises
There are many exercises that activate and strengthen the pelvic floor that you can perform in the comfort of your own home. Here are several to consider:
Kegels are the cornerstone of pelvic floor exercises and are essentially a voluntary contraction of your pelvic floor muscles. To perform a Kegel, first, you need to identify your pelvic floor muscles. You may do this by finding a private space and taking a mirror to look at your anus and vulva. Attempt a Kegel and notice how the perineum (the space between your vaginal opening and anus) moves up and away from the mirror. Relax the muscles and watch the tissues return to their starting position. If you do not know what a pelvic floor contraction feels like, pretend to stop your urine midstream. That sensation is a pelvic floor contraction. Note that therapists do not recommend that you perform Kegels repeatedly while urinating; this is just an identification exercise.
To perform Kegels as an exercise, contract these muscles and hold for 5 seconds, then release for 5 seconds. Repeat for 10 reps, 3 times a day, and you will be well on your way to a stronger pelvic floor. Depending on your symptoms, a physical therapist may recommend you perform many different variations of this exercise.
It is important to note that not all pelvic floor dysfunction conditions benefit from Kegels, especially if performed incorrectly. Those with a tight pelvic floor, for instance, can make their restrictions worse with Kegels. Please consult with your physical therapist before performing Kegels to ensure it is an appropriate exercise for you.
Adductor Ball Squeeze
Lay on your back with your knees bent, your feet flat and resting on the floor. Place a ball or pillow in between your knees. Squeeze your legs together against the object of choice while at the same time engaging the muscles of your abdominals and pelvic floor. Hold 3-5 seconds. Do 10 reps, making sure you are not holding your breath.
Stand in an upright position with feet slightly wider than shoulders, and toes slightly turned outward. Inhale, bend your knees and send your hips and buttocks back as if you are about to sit in a chair. As you keep your weight back in your heels, drop down until your knees are parallel to the floor (if your knees remain pain-free). Hold for a second and exhale while squeezing your pelvic floor as you press back up into standing. Repeat 10 times.
Again, lying on your back with your knees bent and your feet flat resting on the floor. Inhale to prepare, and exhale, pushing through your heels to lift your buttocks off the ground by engaging your glutes, hamstrings, and pelvic floor. Hold for 1-2 seconds while keeping a steady breath. On an exhale slowly lower back down. Relax and repeat 10 times.
As with any exercise program, if your symptoms increase, or you experience any unusual pain, stop the exercises, and consult a medical professional.
Physical Therapy and Pelvic Floor Dysfunction
As experts of the musculoskeletal system, some PTs have specialized training in treating women’s health and pelvic floor dysfunction. If you are concerned about symptoms that you are experiencing related to your pelvic floor, consulting with an experienced therapist sooner rather than later is recommended. Your physical therapist can offer modalities such as biofeedback, low voltage electrical stimulation, or manual therapy to mobilize and activate the pelvic floor. In addition, you can receive a customized exercise program, specific to your condition, which can help to decrease pain, improve flexibility, and strengthen your pelvic floor.
What to Expect During a Pelvic Floor Evaluation?
Your pelvic floor evaluation begins with a thorough review of your medical history and symptoms followed by a full physical examination to assess the muscles of the pelvic floor as well as other areas of your musculoskeletal systems that may influence the function of your pelvic floor. Your pelvic floor evaluation will help your therapist determine the most effective, targeted program that can help you achieve the best outcomes for your specific case.
Both an internal and external examination is typical of a pelvic floor examination. The external examination involves gentle palpation and visual assessment of tissues around the pubic bone and sitting bones to assess pelvic floor activity and inspect for dysfunction. An internal examination by insertion of a gloved lubricated finger into the vagina and/or rectum may also be recommended by your therapist for some conditions. During the internal exam, you may be asked to cough or to perform a Kegel exercise to assess muscular functioning. Your therapist will check in with you every step of the way to ensure you are comfortable and in agreement with each part of the assessment. Please note that the internal pelvic floor examination is NOT required. Internal examinations are only conducted if the patient gives informed consent. Your comfort level remains the number one priority, and you have every right to say no to the internal examination.
The Importance of Pelvic Floor Therapy
In many cases, pelvic floor therapy is a highly effective intervention to improve the quality of life for women experiencing pelvic floor dysfunction. A strong, balanced pelvic floor is a key component in the proper long-term function of the urinary, bowel, and sexual systems.
If you are concerned that you may have pelvic floor dysfunction, consult with a provider you trust. A comprehensive evaluation by a skilled physical therapist is the first step towards improving your quality of life for years to come. If you’re in need of Pelvic Floor Therapy in Brooklyn, NY, or the surrounding area, reach out to our Physical Therapists at Physio Logic. Just give us a call or start by filling out the form below.