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What Exactly is Pelvic Floor Physical Therapy?

Pelvic Floor Physical Therapy is the evaluation and treatment of the pelvic floor and pelvis. Your pelvic floor is a group of muscles that cradles the pelvis area. While everyone has a pelvis and pelvic floor muscles, men usually do not have the same issues as women based on body anatomy and mechanics. Therefore, physical therapy in the pelvis region looks a little different depending on gender. 

 For women, a comprehensive pelvic floor PT session includes a brief internal exam in addition to assessment of the outer body mechanics. This includes the evaluation of total body posture, body alignment, pelvic alignment, muscle strength, the fascial (connective tissue) system, sensation and the assessment of the internal pelvic floor and core muscles.

Who would benefit from Pelvic Floor Physical Therapy?

The fast answer is all women. Your pelvic floor is connected in one way or another to most areas of the body (stubborn back or hip pain?? SI or sacroiliac pain? TMJ problems or headaches anyone?? The pelvic floor is usually a missing link!). Therefore, all stages of womanhood would benefit from pelvic floor physical therapy.

Pre-pregnancy – Developing a strong core and pelvic floor area can aid in fertility and helps prepare the body for pregnancy. If the pelvic floor is dysfunctional due to tension or weak muscles, the surrounding area is not getting the blood flow and nutrients needed and that can affect fertility. Physical therapy can assist with building a strong core resulting in a strong body.

Pregnancy – During pregnancy, the abdominals stretch to make room for baby. As the baby grows, the pelvic floor muscles may become overstretched or feel weakened from the added weight of the baby. Continuing to strengthen the pelvic floor during pregnancy will make postpartum recovery easier. Also gently stretching and releasing the muscles and connective tissues of the pelvic floor at just the right timing during pregnancy helps greatly to increase the ease of delivery. And if urine leakage or back/hip/pelvic pain problems come up, we can help with that right away too! Pelvic floor physical therapy can make all the difference during this exciting time.

Postpartum –  Your pelvic floor goes through a lot during pregnancy and delivery and it’s very common for these muscles to be weak and uncoordinated on the other side. If they are not firing properly, your post pregnancy recovery will likely take much longer and may very well not be fully completed (even decades later) until this important piece is finally addressed with specialized physical therapy. If your pelvic floor is struggling postpartum, you may experience incontinence (leakage) of urine or feces, pelvic organ prolapse (descent of the pelvic organs), diastasis recti, and plenty of joint pain all over (especially hips/back/pelvis but also knees/feet/shoulders/neck/jaw/headaches; our core & pelvic floor is responsible for supporting and protecting all our joints, acting as a ‘shock absorber’. Additionally, many women ask “why do I still look pregnant after I have given birth”?  It is all about the pelvic floor and core and those muscles. Any or all of these can be successfully treated with physical therapy.

Menopausal and Postmenopausal – As you transition into the menopausal phase of womanhood, your pelvic floor has aged and spent many years supporting your pelvis and surrounding organs. You may experience weight gain in your middle section which can put increased pressure on your pelvic floor causing increased strain to sometimes already weak muscles. Estrogen and progesterone levels are decreasing which can weaken muscles (yes, even your pelvic floor muscles). If these muscles are weak and not firing properly, you may experience incontinence, sexual dissatisfaction, prolapse and/or joint pain throughout the body. Pelvic Floor Physical Therapy can reduce (and often eliminate!) the worry of accidents and help your maneuver through the menopausal stages of life feeling strong and active without worrisome joint pain holding you back from being active.

What does Pelvic Floor Physical Therapy Treat?

  • Urinary Incontinence (Bladder Leaks – Pelvic Floor PT is a natural and holistic way to treat urinary incontinence (bladder leaks). Many women will leak with running, jumping, coughing, sneezing, lifting or even just daily activities and while this is super common, it’s not normal and pelvic floor PT can help!
  • Urinary Urgency – (aka feeling like you have to go to the bathroom all the time, or going more than 1x every 3 hours, or waking up in the middle of the night to pee). It’s actually relatively easy to fix this with strengthening the pelvic floor muscles to block the flow of urine and teaching the individual how to retrain their bladder with some of their different bathroom habits, behaviors, how to stop the bladder from squeezing at inappropriate times.
  • Constipation, Hemorrhoids, Anal Fissures, Diarrhea and Irritable Bowel Syndrome –  Addressing ease with relaxing the pelvic floor, releasing any tight/restricted areas of the fascial (connective tissue) system in these regions, working with behaviors and schedules and mechanics (pooping with the proper technique is a real thing!) as well as ensuring proper strength and coordination of the pelvic floor helps greatly to reduce pressure on the GI system, bowels and sphincters to assist with easing these troublesome issues. 
  • Pelvic Pain, Tailbone Pain and Pain with Intimacy (Dyspareunia) – Specialized Pelvic Floor PT is highly successful in treating pain or discomfort during intercourse. This is often caused by tightness in the pelvic floor muscles and fascia and often occurs due to weakness of the abdominals, hip stabilizers and pelvic floor muscles as well as poor pelvic alignment. Whenever muscles are weak, the muscles and connective tissue/fascia will try to tighten up to create stability (anywhere in the body). Tight tissues and learned holding patterns of tension often creates pain when sensitive structures like nerves are compressed. Of course there are often many more factors, but addressing these pieces is usually of huge importance. 
  • Painful Periods and EndometriosisOftentimes, tightness in the connective tissues surrounding the uterus and ovaries can contribute to pain with these conditions. The uterus has to expand just before we have our monthly period to accommodate for the growth of the uterine lining and if there’s not enough space for it to do so, then there can be quite a bit of discomfort especially as the uterus intermittently contracts during our period.
  • Treating Pain During Pregnancy Including Low Back Pain As a pregnancy progresses, our bodies release more and more of the hormone relaxin which causes laxity in all of our ligaments. That means that we are more prone to pain and problems since our body is getting less support. It’s easier for our pelvis and spine to get out of alignment when this happens and this is when having the proper core and muscular support/stabilization is super important for our bodies (especially the hips, back and pelvis) to feel good late into the 3rd trimester. .
  • Healing From a Cesarean (or C-section) Birth, Vaginal Birth, Diastasis Recti (Rectus Abdominis or Abdominal Separation, Restoring Strength and Rebuilding the Core Postpartum – Any pregnancy causes the abdominals to stretch greatly, eventually to the point of them no longer being able to work effectively. Pregnancy also places a lot of pressure on the pelvic floor and then during the process of delivering a baby, the pelvic floor stretches even more, potentially with trauma. In many women, these muscles lose their strength & coordination after pregnancy/delivery and this can cause all sorts of problems for them. 

Most women are surprised that Physical Therapy can be helpful for these conditions. It’s really a shame this isn’t talked about more. Imagine all the things our patients could enjoy in their lives without these annoying problems… no pads, worrying about leaking, planning their lives around the nearest bathroom, worrying about pain with intimacy with their partner, struggling with annoying hip/back/pelvic pain that limits their ability to be active… Instead, just enjoying life and not worrying about any of these things. 

And the good news is that we have a ton of success resolving these issues with natural treatments… No surgeries, pain meds or pads which just treat the symptoms! Just highly specialized Physical Therapy to address the ROOT CAUSE of the problem.



Doctors Jereme and Sarah Trunk

Balance Within Integrative Physical Therapy

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