Pelvic Floor Physical Therapy - Benefits for Urinary Incontinence and Beyond
Pelvic floor physical therapy is a treatment applied to the pelvic floor muscles. This is a subspecialty of a physical therapist and most pelvic floor PTs have special training allowing them to work on the pelvic floor. The pelvic floor, a group of muscles running from the pubic bone to the tailbone, serves several purposes including supporting the pelvic organs, controlling the bladder and bowels, and allowing for healthy sexual arousal and orgasm.
CONDITIONS ADDRESSED BY PELVIC FLOOR PHYSICAL THERAPY
Patients are referred to pelvic floor physical therapy for a number of conditions, including:
Women:
Urinary incontinence
Bladder pain
Difficulty with urinary or bowel movements
Chronic pelvic pain
Painful intercourse
Vaginismus
Endometriosis
Public bone or tailbone pain
Pelvic organ prolapse (i.e. when an organ such as the uterus or the bladder slips down from its original position and bulges into the vagina)
Men:
Urinary incontinence
Bladder pain
Post-prostate removal surgical urinary problems
Prostatitis
Erectile dysfunction
Premature or painful ejaculation
Public bone or tailbone pain
Rectal prolapse (i.e. when the rectum slips from its normal position and into the anus)
WHY IS THE PELVIC FLOOR IMPORTANT?
The pelvic floor serves several purposes. For men, the pelvic floor muscles support the bladder, bowel, urethra, and rectum. For women, this group of muscles holds the bladder in the anterior part of the pelvis, the uterus at the top, and the vagina and rectum in the posterior part of the pelvis. Openings from these organs pass through the pelvic floor muscles.
Pelvic floor muscle tone can become compromised when the muscles are stretched or loosened - often from childbirth, weakening with aging, hormone changes, or surgical intervention like prostate removal surgery - or become too tight and restricted - often due to stress or trauma. When the pelvic floor becomes compromised, this can lead to the common chronic issues listed above.
PELVIC FLOOR PHYSICAL THERAPY
Pelvic floor physical therapy is aimed at treating pelvic floor muscle tightness or weakness and typically involves pelvic floor muscle strengthening, relaxation, and coordination. This kind of PT aims to help patients regain normal tone, strength, and feedback so that the pelvic floor can adequately support and control regular urination, bowel movements, and sexual function.
PELVIC FLOOR PHYSICAL THERAPISTS MIGHT USE SEVERAL TECHNIQUES:
Education. Physical therapists may help patients learn about their pelvic anatomy and how different components work. They may also educate patients about how hygiene or habits affect their symptoms.
Pelvic floor exercises. Patients may be taught how to contract and relax pelvic floor muscles in relation to other muscles. Breathing and timing techniques may also be explained to enhance the effectiveness of exercises.
Manual therapy. Depending on the patient’s ailment, a physical therapist may use stretching or hands-on massage to help with blood circulation, posture, and mobility.
Pelvic floor biofeedback. Biofeedback can help patients “see” how the pelvic floor muscles are working. To perform biofeedback, the physical therapist inserts a probe into a woman’s vagina or a man’s anus and shares the results which are displayed on a computer screen.
Electrical stimulation. A physical therapist may use a low-voltage electrical current to teach patients how to coordinate their muscle contractions.
Vaginal dilators. A physical therapist may suggest the use of these tube-shaped devices to help women learn to relax their pelvic muscles, allowing for easier penetration. These may also prove helpful for women needing vaginal rehabilitation following treatment for gynecological cancer.
Clinical studies find that pelvic floor physical therapy is an effective, minimally invasive treatment option that should be used as a first-line method for treating various types of pelvic floor dysfunction. The best candidates for pelvic floor PT are those looking for a conservative approach or those who do not want or need surgery.
BEYOND PELVIC FLOOR PHYSICAL THERAPY
In our office, we refer out for pelvic floor physical therapy. However, some patients are good candidates for adjunctive therapies to treat urinary dysfunction and sexual health. Depending on their concern and age, patients may be a good candidate for hormone therapies, shockwave therapy, or pelvic floor strengthening therapy like BTL Emsella. This FDA-approved treatment for incontinence uses focused, high-intensity electromagnetic (HIFEM) technology to stimulate the deep muscles of the pelvic floor, causing them to contract. A single Emsella session is equivalent to doing 10,000 kegels and, for many patients with pelvic floor issues, is becoming an attractive alternative to pelvic floor PT. Emsella has shown significant results for both men and women - you can read more about Emsella for women here and Emsella for men here.
FREQUENTLY ASKED QUESTIONS
Q: HOW MANY SESSIONS OF PELVIC FLOOR PHYSICAL THERAPY ARE REQUIRED?
A: The number of sessions is dependent on what a patient is being treated for. One visit per week for six to eight weeks is a common starting protocol for pelvic floor physical therapy. The length and duration of therapy will depend on the patient’s diagnosis.
Q: WHAT DOES PELVIC FLOOR PHYSICAL THERAPY INVOLVE?
A: Pelvic floor physical therapy may include education, manual therapy, pelvic floor exercises, pelvic floor biofeedback, electrical stimulation, and more.
Q. IS PELVIC FLOOR PHYSICAL THERAPY PAINFUL?
A: Trained pelvic floor physical therapists work at a patient’s own pace and should not be painful. Pelvic floor PT sometimes includes manual techniques or movement coordination and occasionally therapists may do internal work during therapy sessions. Some of these techniques may be uncomfortable, but pain is not to be expected.
Q. WHAT ARE COMMON CONDITIONS TREATED BY PELVIC FLOOR PHYSICAL THERAPY?
A: Common conditions include urinary incontinence, pelvic organ prolapse, pelvic pain, vaginismus, public or tailbone pain, rectal prolapse, and sexual dysfunction.
Q. WHO IS A GOOD CANDIDATE FOR PELVIC FLOOR PHYSICAL THERAPY?
A: A good candidate for pelvic floor physical therapy is generally someone who is interested in a conservative treatment approach and whose condition does not immediately require surgery or is not a good candidate for surgical intervention.
Q. WHAT ARE ALTERNATIVES TO PELVIC FLOOR PHYSICAL THERAPY?
A: Alternatives to pelvic floor physical therapy can vary widely depending on the condition being treated. Several options might include in-office pelvic floor strengthening therapy such as Emsella, at-home muscle stimulation devices, home kegel protocols, surgery (potentially required for prolapse conditions), medications, shockwave therapy, etc.
PLEASE CONTACT US AT 425-657-3745 IF YOU WOULD LIKE TO DISCUSS URINARY INCONTINENCE OR SEXUAL FUNCTION CHALLENGES AND WOULD LIKE MORE INFORMATION ABOUT EMSELLA TREATMENTS.
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