What is Pelvic Floor Physical Therapy?
You, your physical therapist and/or doctor have come to the conclusion that your pelvic floor may need physical therapy. What does this mean? Your pelvic floor is comprised of muscles that form the foundation of your pelvis. It is a part of your deep core musculature and plays an important part in coordinating with other core muscles to hold you up while you sit, stand, lift, carry, walk…. The pelvic floor muscles also play an important part in force transfer from one leg to the other when you walk, run, dance. And, of course these muscles are important for sexual function, bladder and bowel function. The pelvic floor muscles in a healthy state should be able to contract and relax upon command, keep you from leakage (not normal…EVER) and generally keep your pelvis, hips and lumbar spine happy and functioning.
A pelvic floor evaluation entails a detailed medical history and a discussion of your pelvic floor function. During this time your therapist will invite you to talk about whatever you are comfortable sharing in order to gain a good understanding of your issues and your goals. Common goals that we have encountered include exercising, sneezing, jumping without leaking, pain free and enjoyable intercourse, comfortable and controlled bowel movements, improving strength to reduce pelvic organ prolapse, reducing pelvic pain in order to enjoy a hobby or sporting activity, urinating less frequently and/or reducing hip/pelvic/low back pain. Your therapist will then proceed to the physical evaluation.
Here is a YouTube video with anatomical review of your pelvis:
What does the physical therapy pelvic floor evaluation entail?
Your evaluation may start off with an assessment of your lumbar spine, pelvis/sacroiliac joints and hips before moving on to a more detailed evaluation of your pelvic floor. Your therapist may take you through a series of flexibility, functional mobility, special tests and strength assessments of these areas. Your pelvic floor is part of your core – important to see how efficiently it works together.
Your pelvic floor evaluation generally begins with a detailed external observation of the surrounding tissues and structures followed by an internal evaluation because of the location of the pelvic floor muscles. The intension of the internal evaluation is to assess the pelvic floor tissues for mobility, tenderness, trigger points and ability of the muscles to contract and/or relax in an efficient manner. The internal evaluation is done through either the vagina or rectum in females and through the rectum in males. You will be given a sheet or gown for draping for modesty and the therapist will be out of the room while you dress or undress, much like a regular physical exam at the doctor’s office. It is a good idea to empty your bladder before the exam and wear comfortable clothing.
Do I have to have an internal evaluation?
An internal pelvic floor evaluation gives important information about the state of your pelvic muscles. We understand that not everyone is comfortable with having an internal pelvic floor evaluation on your first visit or at all. Fortunately, there are techniques, information and education that your therapist can do and advise you about that will help your condition improve. We understand that it is important to establish a rapport with your therapist or even to reduce pelvic pain to be able to tolerate an internal pelvic evaluation or treatment. Your physical therapist will do everything possible to reduce pain or discomfort and even embarrassment that you may have. An internal evaluation is possible while a woman is having her period, and is determined by the comfort level of the patient. Your therapist will not perform an internal evaluation during an active local infection or during pregnancy.
How do physical therapy internal evaluations differ from what a doctor does?
Physical therapy pelvic floor internal evaluations are different from pelvic or gynecologic exams performed by your medical health practitioner. We evaluate the pelvic floor muscles, joints, ligaments and fascia for tension, strength, endurance and motor control. We do not use a speculum and we are not evaluating your reproductive, urinary or intestinal systems. We allow 60 minutes per treatment in order move intentionally and discuss what we are doing as we go. We are sensitive to any discomfort/pain you may experience or other issues you may have. PT’s look for what areas are painful, muscle spasms, strength of your pelvic floor, whether you can do a good pelvic floor contraction and also whether you can release your pelvic floor. With all the information gathered, your physical therapist will develop a treatment plan which may include further internal pelvic floor treatments, exercises to do at home and retraining activities in order to reach the goals you set.
If you believe you would benefit from pelvic floor physical therapy, please call 206 706 7500 to schedule with either Catherine Nutting or Izette Swan.
Also, look for future evening educational opportunities regarding the pelvic floor, women’s health and other interesting topics.