Pelvic Floor Physical Therapy is the assessment and treatment of the pelvic floor and pelvis. A comprehensive pelvic floor PT session includes the evaluation of total body posture, body alignment, pelvic alignment, muscle strength, muscle coordination, sensation, the perineal area externally (looking at the health of the vulvar tissues), treatment of the internal pelvic floor and core muscles.
Internal assessment and treatment is done through a single finger digital exam vaginally or rectally. Internally the PT will ask you to Contract also known as a Kegel, Relax and Bulge your pelvic floor. This will tell the PT your ability to relax and contract the muscle and will generally tell them what the resting tension of the pelvic floor is as a whole. Once they assess that, they will look at the organ positioning of the cervix, anterior wall and posterior wall. They will assess the organs with cues to “bear down” this so they can assess the type and degrees of pelvic organ prolapse. They will then begin mapping the pelvic floor muscles and tissue. They will assess all three layers of the pelvic floor. In our clinic we look at everything on 1 side and then move to the other side. The 1st layer contains superficial muscles (ischiocavernosis, bulbocavernosis, superficial transverse perineal muscles) The Second Layer contains fascial connections (Sphincter urethra, deep transverse perineal, urethrovaginalis) The third layer contains muscles that most people are talking about when they say “pelvic floor muscle” or “levator ani muscles.” The third layer contains Coccygeus, iliococcygeus, pubococcygeus, obturator internus, puborectalis and some fascial and ligamentous structures). In a comprehensive Pelvic Floor PT evaluation, all of these muscles will be mapped and the health and function of the muscles will be evaluated for tone, blood flow, scar tissue, adhesions and coordination and strength. There will be tender points identified and treated to the patient’s tolerance.
A comprehensive pelvic floor PT session will include an indepth look at your abdominal region, including the muscles and fascia of the abdomen, the presence of scar tissue, the ability of the muscles to contract, relax and move. The abdominal assessment will also look at your organ movement.
A Pelvic Floor PT session will look at your spine (back, mid back and neck) and hip mobility and flexibility. Strength of the muscles in the area will be looked at, as well as palpation, so the amount of tenderness, tightness and tension that are in the back area and buttocks will be important to assess. The buttocks tend to be an area of tension and tightness and can oftentimes be directly correlated to the amount of tightness and problems within the pelvic floor muscles themselves.
At the end of the Pelvic Floor PT session, the PT will come up with a plan to establish the treatment that the patient will need to heal their issue or diagnosis. A Pelvic Floor PT can also come up with a plan to develop a prevention based treatment plan where the main focus is to prevent pelvic floor issues later in life, like incontinence or painful sex. But also to prevent c-sections and to optimize the body for delivery during pregnancy. This has been shown clinically to reduce the rates of c-section and pelvic floor trauma and injury when Pelvic Floor PT is used during pregnancy.
Pelvic Floor PT is used as a natural and holistic way to treat urinary incontinence (bladder leaks), Urinary Urgency (feeling like you have to go to the bathroom all the time, or going more than 1x every 3 hours, or waking up in the middle of the night to pee).
Pelvic Floor PT is also used to treat constipation, hemmroids, anal fissures, diarrhea,, Irritable Bowel Syndrome.
Pelvic Floor PT is used to treat Polycystic Ovarian Syndrome (PCOS), Endometriosis, pelvic pain, low back pain, sciatica, piriformis syndrome, vulvar pain, Vaginismus, Vulvodynia, dyspareunia (painful intercourse), anorgasmia (difficulty or inability to orgasm, or painful orgasm).
Pelvic Floor PT is used to treat pubic symphysis pain during pregnancy, low back pain and pelvic pain during pregnancy. It is used during pregnancy to prevent diastasis and prepare the vagina and pelvis and pelvic floor for the stretching that will occur during labor. It can be used to improve someone’s success in having a vaginal birth after delivery (VBAC).
Pelvic Floor PT is used to heal from a cesarean birth, vaginal birth, rectus abdominis separation, restore strength and rebuild the core postpartum. It is used to help guide people who are postpartum back into an exercise program. It is also used to help people return to intimacy safely and without pain.
Pelvic Floor PT is used to promote fertility. It is used to improve the health of the pelvic floor muscles and soft tissue and improve the blood flow to these tissues and area. It is also used to establish normal visceral motility. Meaning that it will be used to help improve the movement of the organs inside the body. Important organs to address in the fertility or infertility process are the uterus, fallopian tubes, ovaries, liver, colon and small intestines. These are essential organs in the fertility progress and the ability of these organs to move “eb and flow” normally in the abdominal cavity can have a profound effect on fertility and infertility.
(About 10 years ago, I discovered a very strong connection between infertility, fertility and the holistic treatment of the pelvic floor. I started noticing if people were not careful or truly trying to prevent a pregnancy, that many of the clients going through pelvic floor PT were conceiving unintentionally. This started to spark my interest clinically and I dove into working with people experiencing infertility and those who had not conceived through more invasive methods like IUI and IVF).
Essential, Pelvic Floor PT is the absolute best gift you can give yourself as a women to help get pregnant, prepare for delivery, heal postpartum, maintain through midlife and prevent decline during and after menopause.