Pelvic Floor Physical Therapy Q & A

We know a lot of women consider pelvic floor physical therapy (PT). In fact, we recommend nearly all women talk with a pelvic floor therapist especially if you are an athlete, are pregnant or had children, or if you’ve noticed changes as you’ve gone through menopause. Here are some of our frequently asked questions to give you more information about pelvic floor PT and what to expect. We look forward to meeting you soon! 

What is Pelvic Floor PT?

Pelvic floor physical therapy is a specialized area of physical therapy that focuses on dysfunctions that affect the pelvic floor muscles or nerves. The pelvic floor muscles are the muscles that create a bowl at the bottom of the pelvis (see pictures below). These muscles function to support all the abdominal contents and organs, stabilize the pelvis and spine, aid in labor and delivery, control the bowel and bladder, and aid in sexual function.

Here are three views of the pelvic floor muscles. All the red areas you see are the pelvic floor muscles!

  (Looking straight on to the pelvis)      (Looking into the pelvis from the top)      (Bottom up view of the pelvis)

How do I know if I need pelvic floor PT?

If you answer yes to any of the following questions, you would benefit from pelvic floor PT:

  1. Do you leak urine (even just a little) or feces or accidentally passing gas while exercising, playing a sport, jumping, laughing, coughing, or sneezing?
  2. Do you need to hurry to the bathroom and/or do you worry you may not get there in time?
  3. Do you take frequent trips to the bathroom (more than 8 times per day) that disrupt your activities throughout the day or your ability to sleep?
  4. Do you experience feelings of heaviness or pressure on the pelvic floor or in the vaginal area? Or do you have a history of pelvic organ prolapse?
  5. Do you experience pelvic pain, vaginal pain, tailbone pain with sitting, pain with walking/exercise, or pain with intercourse?
  6. Do you have feelings of constipation more than 2 times per month?
  7. Do you know you have an abdominal separation or a diastasis recti? 

If you’d like to read more about your pelvic floor issues check out our FREE guide HERE!

What treatment does pelvic floor PT include?

Treatment can include exercise, stretching, body mechanics and posture retraining, breath training, and internal or external manual therapy (sometimes vaginally, but also throughout the body). During a PT evaluation we will identify what specific areas of treatment will best help you to get back to the best you possible! There is no cookie cutter approach for pelvic floor PT. What is key with pelvic floor PT is to address the body as a whole. This is so the body can come and work together to solve the dysfunction that is occuring, because everything is connected right?

Internal Treatment? That sounds scary, uncomfortable, and AWKWARD!

In order to fully understand the specific pelvic floor dysfunction that you are experiencing an internal pelvic floor assessment may be necessary. An internal assessment is only performed if you are comfortable with it, and we stop at any point that you experience intense pain or aren’t comfortable with the assessment. 

An internal assessment really is not as scary as it sounds. Luckily, we don’t use a speculum or the crazy table that you have to scoot down to the bottom of. We use our typical treatment tables, and you get to relax. We can vaginally assess the three different layers of the pelvic floor, assess for scar tissue (possibly from tearing with a vaginal delivery), check for prolapse, and assess the strength and coordination of the pelvic floor muscles. With having a complete internal pelvic floor assessment, we can then narrow down what specific treatment you may require as doing more kegels isn’t always the answer. But there’s good news! Pelvic floor PT doesn’t only involve or require an internal assessment. There are many other areas of the body that we assess. 

What if I have my period?

If you have your period, it is completely up to you and how you’re feeling. If you feel really crampy or uncomfortable we can always wait until a follow up appointment to assess the pelvic floor, but your period does not limit anything that we do!

What should I wear?

We want you to feel as comfortable as possible! It can be helpful to wear loose athletic clothing that we can easily access the area of your body that we are treating and perform simple exercises, but we can make do with any outfit.

How often do I come to PT?

How often you come to PT depends on the issue you are dealing with. Most frequently we start treatment one time per week. If you experience severe pain, we may recommend starting at two times per week. In any scenario, when symptoms start improving, and as we see fit, we will lessen the frequency to give more time for exercise progression between sessions. 

How soon after having my baby should I come?

Realistically, you can come to physical therapy at any point after having a baby. If you are having new or recurring pain that lasts longer than 2 weeks, you can come right away! If you would like an internal pelvic floor assessment you can wait until after your 6 week postpartum visit, however we can do all other assessments (externally) prior to the 6 week mark. Download our FREE guide for simple steps on your postpartum recovery.

Is it better to start during pregnancy or wait till after the baby?

If you are having pain that lasts longer than 2 weeks, yes! Come while you are pregnant. It can also be helpful to have a pelvic floor assessment during pregnancy, as it is common to develop “tight” pelvic floor muscles during pregnancy that can be addressed prior to delivery. Best case scenario, you can get a pelvic floor assessment prior to pregnancy, during pregnancy, and after to help fully understand how pregnancy affects your pelvic floor and identify issues before they become a problem.

Is it worth it to do PT if I’m not done having kids?

YES! Having a proper recovery between pregnancies/deliveries is key. If an issue, such as an abdominal separation or diastasis, occurs during pregnancy it is important to recover the abdominals to help prevent this issue from getting worse. Addressing pain and pelvic floor issues early can improve results long term. If you have pain in one pregnancy you are more likely to develop the same pain in subsequent pregnancies (and often sooner in the pregnancy and more intense!), so you’re better off to get help sooner than later. We hear “I wish I would’ve got help sooner” at least once per week from our clients. 

I’ve had this pelvic floor issue for years, can PT still help?

Yes. Because the pelvic floor issues are so rarely talked about comfortably, many women we see suffer with these issues anywhere from 2 weeks to 40+ years! Even if pelvic floor PT can’t 100% resolve the issue (this can sometimes be the case with severe prolapse), the pelvic floor muscle function and coordination can likely improve to help the symptoms you experience. The great thing is the pelvic floor is made of muscles which can always improve! 

I know I will probably get surgery, so why PT?

Many times we see women considering surgery, such as for a severe abdominal separation or severe prolapse, and we encourage pelvic floor PT prior to a procedure. If your pelvic floor and surrounding areas can function to their best capability prior to a procedure, your recovery will be easier and faster since you won’t be recovering from such a weakened and dysfunctional state. 

We hope this helped to answer some of your pelvic floor PT questions. Feel free to contact us with more questions at revitalize-pt.com/contact/. We look forward to helping you get back to what you love doing without pain, leakage, or abdominal weakness getting in the way!

Leave a Reply

Your email address will not be published. Required fields are marked *