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A Guide To Pelvic Floor Therapy: Part 1

by Amanda Olson, DPT, PRPC

What is Pelvic Floor Physical Therapy?

Pelvic physical therapy is a highly specialized form of rehabilitation conducted by a physical therapist who has undergone training in examination and treatment of pelvic floor dysfunction and addresses issues of the pelvic floor muscles and abdomen.

Pelvic physical therapy has been a form of rehabilitation for over 40 years. Due to stigmatization of pelvic health issues, in the past many men and women experiencing pelvic floor dysfunction did not seek help and did not openly discuss their issues and rehabilitation process, thus for many years pelvic physical therapy was widely unknown as a viable treatment option to the general public. This has changed over the past few years and pelvic physical therapy services have been more openly discussed in various media channels, in magazines and online.

Pelvic Floor Physical Therapy addresses various issues of the pelvic floor muscles (PFM) and abdomen. The pelvic floor is a group of muscles, tendons, ligaments, and fascia tissues that form a sling-like hammock from the pubic bone to the tailbone and out to the “sit bones” (the bony protuberances that you sit on). They support the abdominal and pelvic organs (the bladder, uterus, and rectum) and assist in maintaining upright posture. They are noted for their role in control of the bladder and bowel and in sexual activity.

The PFM can become stretched, weak, or lose coordination after certain life events. These include pregnancy, delivery, or surgery. The muscles can also be injured with repetitive straining, such as with chronic constipation, repetitive heavy lifting, and in with some impact sports such as gymnastics, tennis, basketball, volleyball, and running. When the pelvic floor muscles become weakened, urinary incontinence, fecal incontinence, and pelvic organ prolapse (POP) can occur.

Conversely, if the PFM becomes overactive, or overused, the result can be pelvic pain and decreased function of the muscles. Pelvic floor muscle dysfunction (PFMD) includes a variety of issues that occur when the muscles of the pelvic floor are not functioning properly. In the case of overactivity, they become too tight. Oftentimes trigger points or tender points develop in the muscles that contribute to pain and loss of function. These are the same “knots” that you might find in your neck or back, that when pushed upon are tender, and when you massage them, it relieves you of your pain.

Due to the complex nature of the anatomy and musculoskeletal functioning in this area, a detailed medical history, thorough examination, and unique plan of care is developed by a pelvic physical therapist to treat the underlying issues. This care is delivered often in conjunction with other treatments, and as a team approach with primary care physicians, nurse practitioners, OB-GYN providers, midwives, gastroenterologists, oncologists, and other members of the health care community.

What treatments are available in Pelvic Physical Therapy?

Pelvic physical therapists evaluate and treat a wide variety of pelvic floor and abdominal conditions in men, women, and transgender people. The diagnoses treated specific to women include but are not limited to:

  • Bladder Disorders
    • Urinary Incontinence
    • Urinary Urgency, Frequency, Hesitancy
    • IC (Interstitial Cystitis)
    • Bladder Pain Syndrome
  • Bowel Disorders
    • IBS (Irritable Bowel Syndrome)
    • Constipation/incomplete emptying
  • Pelvic Pain Conditions
    • Levator Ani Syndrome: pressure or ache in the sacrum, coccyx, rectum, and vagina caused by overactivity of the levator ani muscles
    • Dyspareunia (Pain with intercourse)
    • Anorgasmia (Difficulty achieving orgasm)
    • Pudendal neuralgia
    • Vulvodynia
    • Vulvar vestibulitis
    • Vaginismus
    • Pelvic congestion
    • Lichens Sclerosis & Lichens Planus (skin conditions associated with pelvic pain)
    • Coccydynia (pain in the tailbone region)
  • Post-Surgical Conditions
    • Hysterectomy
    • Hernia
    • Laparoscopy including endometriosis excision
    • Caesarean section
    • Appendectomy
  • Post Cancer Treatments
    • Lymphedema
    • Post radiation pelvic pain

Read A Guide to Pelvic Floor Therapy: Part 2 for more information on what to expect at your first visit and how to find the right pelvic floor physical therapist for you.

Written by Amanda Olson, DPT, PRPC, Certified Pelvic Floor Physical Therapist
President and Chief Clinical Officer at Intimate Rose:

Dr. Amanda Olson is a dedicated and passionate Doctor of Physical Therapy specializing in pelvic floor health. She is also the pelvic expert behind Intimate Rose, a women’s health brand working to improve the health of women worldwide. She is the author of the book Restoring the Pelvic Floor for Women.