A medical provider or friend may have recommended that you see a physical therapist for evaluation and treatment for your pelvic floor and you may be wondering why. Many people are familiar with physical therapy, but not physical therapy for the pelvic floor. The intent of this blog post is to help answer common questions and concerns regarding physical therapy for this region by introducing you to its anatomy, identifying typical problems related to pelvic floor dysfunction, summarizing the purpose and components of the physical therapy evaluation, and reviewing common treatment techniques for pelvic floor muscles.
Many muscles comprise our pelvic floor, which spans the bottom of the pelvis between the pubic bone and tail bone (coccyx). It is similar to a hammock, consists of three layers of muscle, and helps to support our pelvic organs (bladder, bowel, and uterus) as well as the spine and pelvic bones. The pelvic floor muscles help with bowel and bladder control and enhance sexual pleasure. For more information regarding these muscles, please see other posts on this blog: “Pelvic Floor Muscle Dysfunction” and “Postpartum Abdominal Wall and Pelvic Floor Muscle Dysfunction”.
Common diagnoses related to pelvic floor muscle dysfunction include:
* Pelvic pain
* Pregnancy and postpartum complaints (i.e., pain, incontinence)
* Urinary Incontinence
o Stress or urge incontinence
o Overactive bladder syndrome* Constipation
* Fecal or gas Incontinence
* Pelvic organ prolapse
* Pudendal neuralgia/entrapment
* Levator ani syndrome or myalgia
* Vulvodynia
* Vaginismus
* Vestubulodynia
* Dyspareunia (painful penetration)
* Low back pain
* Sacroiliac (SI) pain
* Hip pain
* Pubic symphysis pain
* Coccyx (tailbone) pain
* Abdominal wall pain
* Diastasis rectus abdominis
A physical therapy pelvic floor evaluation will help determine if pelvic floor muscle dysfunction contributes to your symptoms.
During the evaluation, we will discuss your medical history and pelvic floor function. Depending on your symptoms, questions pertaining to your musculoskeletal health may be asked.
The purpose of the pelvic floor muscle evaluation is to:
* Assess your skin condition (i.e., episiotomy scars and adhesions).
* Assess your pelvic floor muscle strength, endurance, and automatic use of the muscles.
* Assess the symmetry of the pelvic floor muscles’ tone and strength.
* Evaluate muscle and fascia support in relation to prolapse in the vaginal walls.
* Evaluate tenderness or painful trigger points in the muscles.
* Assess the position and mobility of your tailbone (“coccyx”), if symptomatic. If so, associated pelvic floor muscles will be evaluated to see if they are contributing to tailbone alignment and mobility dysfunction.
* Help you learn correct pelvic floor muscle contraction and relaxation techniques.
The pelvic floor muscle evaluation has two parts:
1. External observation and palpation of the skin and pelvic floor muscles: Muscle spasm, trigger points, skin condition, skin mobility, and muscle tone along with the ability to contract and relax the muscles will be assessed. Severe prolapses of the bladder or rectum will be noted. Reflex and sensation testing as well as a gentle cotton swab test for pain may be performed.
2. Internal vaginal and /or rectal assessment of the pelvic floor muscles and tailbone: This assessment is different than a pelvic exam performed by a medical provider. Stirrups and a speculum are not used. The three muscle layers of the pelvic floor are assessed for symmetry, strength, length, endurance, tone, trigger points, soft tissue restrictions, and contraction/relaxation ability. The positions of the pelvic organs are noted. If indicated, tailbone (“coccyx”) position and mobility will be evaluated.
The evaluation may also include a physical therapy musculoskeletal assessment, including: posture; alignment; and examination of your back, SI joint, pelvis, hips, and legs. A movement screen may be performed to assess your symptoms with movements that are meaningful to you (i.e., squatting, forward bending, lifting, etc.).
With the clinical findings from your pelvic floor muscle evaluation, a physical therapy treatment plan is designed and tailored to help normalize your specific impairments, retrain the pelvic floor muscles to better support the pelvic organs, pelvis, back, and hips, and to help you meet your individual pelvic health and musculoskeletal-oriented goals.
Physical therapy treatment for pelvic floor muscle dysfunction may include: patient education; pelvic floor and associated muscle activation and/or inhibition techniques and exercises; biofeedback training; soft tissue mobilization and trigger point techniques; joint mobilization and muscle energy techniques; manual traction; bladder diary and training; movement and posture retraining; and a progressive therapeutic exercise program, including home exercises. Orthopedic physical therapy treatment may also be included for associated low back, pelvic, SI, and hip pain.
Many patients’ pelvic floor muscle-related pain and/or symptoms have been resolved or diminished with pelvic floor physical therapy. If you are suffering from any of the above-mentioned symptoms, please don’t hesitate to schedule an evaluation with a trained pelvic floor physical therapist.
