What is Pelvic Floor PT?

Author| Dr. Maureen O’Keefe, DPT

What is Pelvic Floor PT?

No worries if you’ve never heard of pelvic floor PT! We cannot tell you how many times we have heard “I never knew that this physical therapy existed.” In 2022 I am marking 25 years of being a pelvic health physical therapist! This is not a new field of physical therapy, it has been well established for decades. If you are interested in learning more about how pelvic PT can help your condition, reach out to us here.

Pelvic Floor PT resolves pelvic pain, bladder, bowel, prolapse and intimacy problems.

This is the most succinct way of describing what is pelvic floor PT. We solve all pelvic problems, including bladder & bowel troubles, pelvic organ prolapse, intimacy pain, and pelvic, hip, and low back pain. Sometimes the issues are directly related to pregnancy and childbirth, whereas other times the condition has nothing to do with pregnancy. In fact, we treat children who have troubles with bladder and bowel control and also treat men who experience pelvic pain or bladder/bowel challenges.

So, how does pelvic floor PT treat your pain? Help your prolapse? Improve your bladder & bowel struggles?

We restore your body’s ability to function without pelvic pain, hip pain, back pain, urinary, bowel and sexual challenges. We do this by assessing your whole body to determine where you may have issues that are contributing to your pelvic problem. We then create a customized treatment program that may include a combination of exercises and manual therapy. Our objective is to optimize your bladder and bowel, ease tension along the length of pinched nerves, improve blood flow to tissues, reduce muscle trigger points, fascial tension and scar restrictions in the abdomen, pelvic floor, hips, spine or elsewhere. We use joint mobilization and other techniques to balance your pelvis and spine to provide full and pain free movement at your joints. If you are interested in getting started, reach out to us here.

Pelvic Floor PT begins with an Evaluation to understand your goals & symptoms and determine the underlying contributions to your condition.

At Purple Mountain PT every appointment is private, with the same doctor of physical therapy and is upto 55 minutes in length. This allows us the time to provide you comprehensive care that gives you results. We begin your care with an evaluation, where we discuss in a comfortable, private treatment room your symptoms and goals. These things guide our next steps in the evaluation. We may be assessing and treating your posture, thoracic spine, low back, hips, knees, feet and abdomen. The pelvic floor muscles are a group of muscles that line the bottom of your pelvis. With your permission, we also assess and treat these muscles to determine their status. We check your core strength, including the integrity of your abdominal wall to look for diastasis recti abdominis or ongoing elongation problems often related to low tone or pregnancy disruptions. We assess the strength, coordination and effectiveness of all of your core muscles, including your low back, hips, pelvic floor and breathing. Research has found that with low back pain a person also has pelvic floor dysfunction, so we do address any low back problems, even if this is not your primary issue. Research has also found that with low back pain the low back muscles lack endurance, so your care will include specific exercises to re-train these muscles. If you are interested in learning more about our pelvic floor PT program, contact us here.

Research has shown us that the pelvic floor muscles commonly have a variety of problems such as being:

• Sluggish: they don’t contract as quickly as needed (Hence leakage)
• Stiff: they tend towards being short and contracted. When this is the case you can experience pain, leakage, bladder spasms, constipation or any number of other problems.
• Weak: because they are stiff and sluggish they cannot generate the power needed
• Lacking endurance: these muscles are postural muscles and should be working all day long for you. When you have pelvic floor dysfunction they get tired out quickly and you develop symptoms.
• Dis-coordinated: the muscles should be part of a symphony of muscular coordination with your low back, hip, abdominal and breathing muscles. Instead, these muscles get all mixed up.
• Stressed out. For REAL. These muscles have autonomic nervous system components in them, so they react to all stress.
• High Tone: with high tone pelvic floor, the muscles do not relax and lengthen effectively. If this is the case you may experience pain, urinary leakage, urinary frequency and urgency, nocturia, painful intimacy, constipation, hemorrhoids, prolapse or other symptoms.

Our treatment program have a goal of resolving this pelvic floor dysfunction and we do this by providing whole body care that effectively coordinates all of your muscles, so no one muscle group is over-burdened or strained.

You will feel supported, understood and cared for.

At Purple Mountain PT we provide trauma informed and therapeutic care. From the first moment you contact our office, we want to meet your needs. We answer your questions, explain what to expect and welcome you. Each appointment is upto 55 minutes in length, in a comfortable, private treatment room and with the same doctor of physical therapy. This is an important thing to note because not all physical therapy is set up for this level of success. Over many years of doing this work, we have learned that you need to establish a trusted relationship with your provider. And we need to work with you so we can learn what you need and adjust our treatment accordingly from week to week. If you bounce around from provider to provider some things are always lost in translation. To speak with our care coordinator and get your questions answered, call us at (616) 516-4334 or contact us here.

Pelvic Floor PT is Holistic

The holistic nature of this care means that we will be assessing and treating all of your joints, fascia, muscles, nerves, blood flow and all areas in the spine and abdomen that are related to bladder and bowel function. High quality pelvic PT truly assesses and treats your entire body. This is because the neck, feet, rib cage, posture, hips and lower extremities all affect your pelvic floor. Our patients are often surprised that we will be working their myofascial tissues of their shoulder blades because we know that the bladder can have regions near the shoulder blades that influence bladder control. Our treatment commonly includes myofascial mobilization, trigger point release, visceral mobilization, joint mobilization, stretching, strengthening, coordination exercises, breathing exercises and more. The hands-on treatment that we provide in conjunction with exercises that improve your muscle coordination, strength, endurance and flexibility are key to getting you feeling better. If you are interested in learning more, reach out to us here.

One recent patient, amazed at how much better she felt following an appointment, asked us “How do you know ALL OF THIS STUFF?” Well, this is our expertise and we’ve devoted ourselves to ongoing learning. Our team at Purple Mountain PT has been doing this for many years and we’ve learned a lot by working with people just like you. We continually keep up with research and pay attention to what works for our patients.

We also include neural calming strategies so that your autonomic nervous system can balance.

The pelvic floor muscles are unique in that they have autonomic nervous system fibers innervating them. This means that if you are stressed, anxious, excited, depleted, fearful, angry or experiencing emotional turmoil, your pelvic floor muscles can respond to these emotional states. Our pelvic PT methods include ways to calm and balance this aspect of your nervous system, so that your pelvic floor is not continually over-reacting to the stress of life.

Pelvic floor Rehabilitation provides treatment specific to conditions related to the pelvis: the joints, nerves, muscles, connective tissue, organs, and blood supply.

Everything that is housed in the pelvis and above and below the pelvis (abdomen, back/spine, thighs) are part of pelvic floor PT. We help people overcome problems related to a long list of conditions, such as:

• Bladder: urgency, frequency, overactive bladder, stress incontinence, bedwetting, urge incontinence, neurogenic bladder, incomplete emptying and painful urination.
• Bowel: Constipation, IBS, anal fissures, hemorrhoids, dyssynergic defecation
• Pelvic Pain: Abdominal pain, testicular pain, vaginal pain, anal pain, tailbone pain (coccydynia), pubic pain, hip pain, low back pain. We wrote an article about pelvic pain, you can check it out here.
• Sexual Health Conditions: Dyspareunia, vaginismus, erectile dysfunction, anorgasmia, persistent genital arousal disorder
• Nerve injuries or pain: Sciatica, Pudendal neuralgia, genitofemoral nerve pain, meralgia paresthetica and others
• Endometriosis
• Pregnancy
• Postpartum Recovery
• Prostatitis
• Hips, Back, SI joint, Pubic bones, tailbone
• Pelvic Floor Dysfunction
• Scars (hernia, C-section, hip surgeries, etc.)
• Abdominal wall: breathing, diastasis recti abdominus, elongated abdomen, poor engagement & strength.

If you have any of these problems, reach out to us here.

The pelvic floor muscles are just a small fraction of what might need treatment. This is the surprise of pelvic floor PT! It isn’t limited to just one set of muscles.

Physical Therapy, by its nature, is a movement based approach to rehabilitation. Pelvic PTs include exercise, movement, strength, conditioning, stretching, balance and dynamic movements into your program. We teach you how to get those pelvic floor muscles to be responsive. We don’t want them sluggish and dis-coordinated. We use a variety of exercises and biofeedback to teach you how to rehabilitate these muscles.

By treating all members of the team (your neck, back, feet, knees, hips, etc.), we can restore your pelvic floor.

Your pelvic floor muscles are always responding to and supporting other areas of your body. For example, when you walk, your feet hit the ground and send ground reaction forces up your leg into your pelvis. Therefore, if you lack foot or ankle mobility, you may be jarring your pelvis more than optimal. This is why a high quality pelvic floor PT program will treat your whole body. We have to evaluate and treat all of the “teammates”. These include your joints, ligaments, muscles and fascia of your back, abdominals, diaphragm and other breathing muscles, shoulder blade and upper back postural muscles, inner thighs, glutes and hips, quads and hamstrings. All of these things work together to allow you to move easily, to sit without pain, to pee freely, to hold your urine at will, to have a normal bowel movement, to experience sexual pleasure. If you are interested in getting started, reach out to us here.

Your Fascia is Continuous From Head to Toe. Therefore, if your pelvis isn’t feeling good, we must find fascial restrictions that are causing problems.

The connections, especially fascia connections from the pelvic floor muscles to the bony pelvis, tailbone/coccyx, sacrum, abdomen, rib cage, shoulders and legs are hugely influential on the function and status of your pelvic floor. In pelvic floor PT a lot of the care you receive is actually directed to fascia, tissues and joints that are far away from your pelvic floor, but are having a profound impact on the pelvic floor function. The pelvic floor muscles and pelvic fascia contribute to our pelvic stability so that we can walk, keep our balance, roll in bed, climb stairs and generally move smoothly. If the pelvic floor muscles are not functioning well a person may experience pelvic organ prolapse, sexual or urinary dysfunction, postural compromise and altered breathing mechanics.

Purple Mountain Physical Therapy is a specialty pelvic floor PT and TM joint disorder clinic located in Grand Rapids, MI. Our doctors of physical therapy provide expert care for pelvic floor dysfunction and bladder, bowel or intimacy related problems. Many of our patients come to us frustrated due to chronic pain, whether it is hip pain, back pain, neck pain, TM joint disorders or pelvic pain (such as abdominal pain, pubic, SI joint or deep inside). We have advanced training and experience helping individuals overcome chronic pain. There is not a formula to overcome chronic pain. Instead, we provide individualized and comprehensive care that is customized to each person’s findings. Our patients tell us finding our treatment has been the most important thing they’ve done to help their pain! We are honored to help you. Call 616-516-4334 to get your questions answered or reach out to us here.

Peace,

Dr. Maureen O’Keefe, DPT