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Published on November 17, 2018

Pelvic Floor Physical Therapy, Demystified

Like most things, you don’t realize how crucial your pelvis is until you experience problems with it. You need a healthy pelvic region to move comfortably, control urination and bowel movements, give birth and enjoy sex, among other things.

According to a National Institutes of Health study, 15 percent of women and a small percentage of men experience pelvic pain that interferes with their lives. If you’re one of those women or men, you have options other than medication and surgery; pelvic physical therapy can help.

Pelvic Pain Symptoms

Let’s define your pelvic region: Your pelvis often gets confused with your abdomen. It is located below your belly button (umbilicus) down to where your thighs crease, and around the back where your legs meet your bottom. It also includes your tail bone up to the lower back. Pain from pelvic issues can occur anywhere from the lower ribs down to the knees.

Pelvic pain can be constant or come and go. It can occur with activity, while you’re still or when voiding your bladder or bowels. The type of pain varies widely and can include heavy aching, sharp or shooting pain or burning anywhere in the pelvic region. It may also feel like menstrual cramps. Other symptoms can include: urinary and bowel urgency or frequency, leakage of urine or stool, flatulence with coughing, laughing or sneezing and significant constipation or diarrhea.

“If you’re having symptoms of pelvic dysfunction, ask your doctor for a physical therapy appointment,” says Linda Gutowski, Physical Therapist at Wayne UNC Health Care.

Physical Therapy for Pelvic Pain

“Pelvic floor treatment varies and is customized to the patient’s needs. I take a whole body approach to the pelvic floor. Chances are, people are using their pelvic floor to gain stability because they are weak somewhere else. Unless they’ve had a surgery, I’d estimate that 85% of patients are holding muscles too tight in part of their pelvic floor,” Gutowski says. “Of course, treatment requires a team approach that includes your doctor and a physical therapist.”

The process starts with an evaluation by your physical therapist, who will take a medical history to determine what might be contributing to your pain, including any relevant surgeries or injuries. If you’ve had physical therapy in the past, your therapist will discuss what worked and what did not. Your therapist will also ask questions about your lifestyle, including diet, fluid intake, toileting habits, exercise, sleep and daily activities including work, stress and stress management. This will be followed by an external physical assessment.

“During the physical assessment, I examine joint and muscle mobility of the lower back, hips and knees,” says Gutowski. “I test muscle strength and coordination around those joints and the pelvic floor. I will press on areas to look for pain, stiffness or too much mobility. Where you hurt and how your muscles function will tell me a lot about what is going on. If necessary, I will do an internal assessment of the pelvic floor.”

Overcoming Hesitation about Therapy

For many women, the only doctor who has performed a pelvic exam is their OB-GYN specialist, but a physical therapist’s assessment is different from one you receive from a gynecologist. If an internal assessment is needed, this will be done in a private room with a chaperone available for the patient.

Pelvic physical therapists do not do not use a speculum or stirrups or take tissue samples. A physical therapy assessment focuses on muscle integrity and coordination when coughing or drawing in. The focus will be on the three layers of pelvic floor muscles, checking for tightness, tenderness or trigger points. The PT will assess if the patient can tighten the muscles, and how long they can hold the muscles tight, testing control, strength and endurance.

Biofeedback may be used. This involves placing a sensor internally to digitally collect data on muscle contractions. “This data can be used to teach down-training, a type of treatment,” says Gutowski. “But again, PTs will only use internal assessments and treatments when conventional PT doesn’t address the patient’s issue.”

Every physical therapy session is individualized. Internal work may or may not be required, depending on the specific needs of the patient.

Physical Therapy Treatments and Results

Linda Gutowski, Physical Therapist at Wayne UNC Health Care

Typically, when you start pelvic floor physical therapy, you will see your therapist once a week until your body starts responding to therapy. Then your appointments may be increased to two times a week or spaced out to once every two to four weeks.

“A patient’s treatment plan is customized to that individual’s needs,” says Gutowski. “Once we know more about the cause of the pain, the severity and how long you have had the pain, the plan can change.”

Gutowski explains: “It may take just a couple of sessions or as many as 20 to fix the problem. Once the patient has the tools to help themselves, we can customize a home care plan for discharge so they can do what needs to be done at home.”

The majority of patients find some relief, either complete or partial. All patients leave physical therapy with more education about how to manage their symptoms moving forward.

“I teach everyone about their body, how it works and how to help make it function better,” Gutowski says. ”I consider myself a partner with my patients, so that they can leave the clinic empowered to manage their condition on their own.”

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