Can I Benefit from Pelvic Floor Physical Therapy

Pelvic floor physical therapy (PT) is a specialized therapy that focuses on the muscles, ligaments, and connective tissue at the base of your pelvis. These muscles support the bladder, bowel, and reproductive organs, and they play a role in everything from core stability, to going to the bathroom and sexual activity.

Like any other muscle group in your body, they can become too tight, too weak, or uncoordinated. A pelvic floor therapist is trained to assess and treat these issues. Many people have never heard of this specialty, which can improve problems that impact the bowel, bladder, sexual function and pelvic pain.

Why Consider Visiting Pelvic Floor Therapist?
People visit a pelvic floor therapist for a wide range of reasons, not only for severe pain. Common reasons for seeking therapy include:

• bloating
• constipation
• incontinence when you sneeze, cough, or exercise
• pelvic or hip pain
• pain during sex
• urination urgency
• recovery after childbirth or pelvic surgery

Pregnancy-related discomfort, i.e., pressure, hip pain, pubic bone pain are treatable with therapy, as well as birth preparation. Many diseases including:
Crohn’s Disease

•  (Ehlers-Danlos syndrome) EDS
•  Endometriosis
•  Gastroparesis
•  Irritable Bowel Syndrome (IBS)
• (Interstitial cystitis) IC
• (Polycystic ovary syndrome) PCOS

What is an Initial Evaluation?

The first visit includes a physical assessment and conversation about your medical history, symptoms, and relevant medical and surgical history, daily habits like fluid intake, diet, exercise. The physical exam includes a review of posture, range of motion, and the muscle function around hips, low back, and pelvis. If warranted, an internal exam, done vaginally or rectally depending on the issue, is offered to directly assess the pelvic floor muscles. This is always optional. You will leave this visit with a clear explanation of the findings and a treatment proposal.

What do Follow-up Visits Entail?

Follow-up visits are hands-on and specific for your needs. We may release tension in tight muscles, strengthen muscles that are too weak, and/or improve coordination, so muscles fire at the proper time. Manual therapy – hands-on treatment to your muscles and soft tissue – is a big part of what we do, externally and around hips and pelvis, vaginally or rectally. We spend time on education, because understanding why something is happening is a big part of addressing the issue. Every visit is tailored to where you are in your recovery journey, what your concerns are, and what your end goals are.

There is Work to do on Your Own

“Homework” is important, because improvement happens between visits, not just during visits. We provide exercises to meet individual needs, which could include stretching, strengthening, breathing, coordination drills and teaching how to perform your self-release and manual therapy. We may recommend lifestyle adjustments to your exercise, fluid intake, bathroom habits and the taking of supplements. Kegels are the most well-known pelvic floor exercise, but they’re not appropriate for everyone. In fact, for some conditions, they can make things worse.

The Hip and Pelvic Floor PT

The hip muscles and the pelvic floor are deeply connected; they share attachments and work together constantly. When the hip muscles are weak, overworked, or tight, the pelvic floor often compensates, which can contribute to pain, leaking, or other symptoms. For example, the obturator internus is a hip rotator muscle that also connects directly to the pelvic floor, so tension there can directly affect how the pelvic floor feels and functions. That’s why pelvic floor PT often includes hip assessment and treatment, not just internal work. Treating the hip and the pelvis together gets better results than treating either one in isolation.

The Sacroiliac (SI) Joint and Pelvic Floor PT

The sacroiliac joint, or SI joint, is where your sacrum (the triangular bone at the base of your spine) connects to your pelvis on each side. It’s a joint that needs to be stable but also has some natural movement, especially during walking, pregnancy, and childbirth. SI joint dysfunction is extremely common and often causes pain in the lower back/ buttock region, sometimes mistaken for a disc problem or hip issue. The pelvic floor muscles attach to the sacrum, so when the SI joint is irritated or unstable, the pelvic floor is affected too. During pregnancy especially, hormones loosen the ligaments around this joint, which is why it can become easily injured causing that sharp stabbing pain in the buttocks or occasionally locking and clicking sensations with transitional movements such as rolling over in bed or getting out of a chair.

The Tailbone and Pelvic Floor PT

The tailbone, coccyx, is a small bony structure at the very bottom of your spine, and it’s more important than most people realize. Several pelvic floor muscles and ligaments attach directly to it, so if the tailbone is injured, bruised, or misaligned, which can happen from a fall, childbirth or even prolonged sitting, it can create significant pelvic floor tension or pain. Tailbone pain (called coccydynia) can make sitting, bowel movements, and sex uncomfortable. In pelvic floor PT, we can assess the position of the tailbone and use internal and external manual therapy techniques to reduce the tension around it and relieve pain.

Pelvic Floor PT is for Males AND Females

The basic structure of the pelvic floor is the same in all bodies, a group of muscles in the shape of bowel at the base of the pelvis that support internal organs and control bladder and bowel function. The main differences come from anatomy: females have a vaginal opening in addition to the urethra and rectum, which means there’s more complexity and more potential for injury, especially around childbirth. Males have a longer urethra and a prostate gland that sits directly against the pelvic floor, below the bladder, and surrounding the urethra. This makes the male pelvic floor extremely relevant to prostate health, as well as urinary and sexual function. Both males and females can experience pelvic floor dysfunction (i.e., leaking, pain, constipation, and sexual dysfunction). Pelvic floor PT is appropriate and effective for all bodies.