What is Pelvic Floor Physical Therapy
…and how do I know if I need it??
Before I get into the physical therapy side of things, I want to demystify what the pelvic floor even is!
The pelvic floor is a layering of muscles, nerves and connective tissue that essentially make up the base of your core. Now, I’m not talking about the outer layering of core muscles that you might automatically think of, but instead, I’m talking about your deep core. The deep core works to stabilize your center and provide support. Many picture the deep core as a cylindrical shape - similar to a pop can - with the diaphragm representing the top (like an umbrella shape), the pelvic floor at the bottom (picture a hammock) and multiple other deep core muscles working together to support the front, back and sides of the pop can. All of these muscles are underneath your larger and more surface level muscles that we may typically think of in regards to the core.
So, we’ve got what it is and where it’s located, now let’s unpack a little bit more about what its purpose and function are. The pelvic floor is, in many aspects, very similar to other muscles in our body. It can contract/shorten, it can relax/lengthen, and it can even just hang out at rest and be in a neutral position. I think the thing that throws everyone is the fact that they are internal muscles, so we can’t see them working in the same way that one might be able to see the bicep muscle working. The cool thing about the pelvic floor is that it doesn’t just provide support, but it actually helps to assist in bladder, bowel and sexual function…so it’s a very unique set of muscles to be able to do all of these different tasks!
But let me back up a little bit..let’s dive back into the function of the pelvic floor. I mentioned earlier that it sits like a hammock. This is purposeful in that it provides support and a solid barrier between our organs (bladder, uterus and rectum) and the outside of our body. The pelvic floor must relax or lengthen and open up in order to allow anything to exit (urine and stool, but also for birth) and must contract or shorten (firm up) in order to hold things in (gas, urine, stool). As far as sexual function, the pelvic floor must also relax in order for penetrative intercourse to occur.
Now, you may NEVER think about your pelvic floor…until something goes wrong with it. This is where pelvic floor physical therapy comes into play.
I would like to say that it would be ideal if everyone had pelvic floor physical therapy preventatively…but that might be asking for too much at this time. More typically, pelvic floor PT is utilized when the pelvic floor starts to act up and it no longer is doing its job as effectively as you might like. This can look like several things, but common symptoms or issues that a pelvic floor physical therapist might treat can include…
Incontinence (bowel or bladder)
Urge - a strong, sudden and often uncontrollable urge to use the bathroom. Sometimes will even happen when you know your bladder isn’t full.
Stress - the type of incontinence that may happen when a strong stressor is placed on the pelvic floor like jumping, sneezing/coughing or running.
Pelvic pain
Unexplained pain
Postpartum pain
Pain with pregnancy
Pain with sex
This could be from a traumatic event or…
Unexplained pain
Pelvic organ prolapse (POP)
Prolapse of the bladder
Prolapse of the rectum
Prolapse of the uterus
Now, this list is NOT all-inclusive. There are many different versions, combinations, or potentially something not listed that a pelvic floor physical therapist may be able to help address. If you are struggling with something and you’re not sure if pelvic floor PT can help, don’t be afraid to reach out, chances are they will either be able to address it themselves, or they can at least point you in the direction of someone who can help!
So, why don’t all physical therapists address the pelvic floor??
The short answer, because it’s not covered in depth in most physical therapy programs. Typically, there is a short section on pelvic floor PT, some generic education and treatments, but otherwise, most are told that if they want to get into that area, it would be wise to take continuing education courses after graduation to pursue that particular specialty.
To go into a little more detail on that, pelvic floor physical therapy is not something that every physical therapist is interested in. Some may be uncomfortable with it, others may not be able to pursue the required continuing education training that you really need to have in order to specialize, and others may just have different interests that they would like to specialize in.
What this means for you is that you must do your homework if you would like to be seen for pelvic floor physical therapy! Not all clinics offer that service or some offer it at a very basic level - which often means their therapists have some training and education, but are not offering internal examinations or are not set up at their clinic to offer all of the treatments that may be necessary for some pelvic floor patients. You may see it listed as a service on the clinics website, but I would recommend calling the clinic and doing your due diligence to check on the capacity of that service. Some questions you may consider asking…
Are your pelvic floor therapists trained in internal examinations?
What type of continuing education has the therapist pursued for their pelvic floor knowledge?
Do they treat your particular symptom/diagnosis (if you’re not sure, just explain your symptoms and what’s been going on).
What type of equipment do they have available to use for pelvic floor patients (ie. ultrasound machine, biofeedback units, electrical stimulation, private treatment rooms, pelvic wands etc.)
The answers to these questions will give you a good idea on what type of pelvic floor PT clinic you are considering and what the therapist’s background knowledge is.
I may be biased, but I truly believe that every person could benefit from pelvic floor physical therapy - whether that be preventively, just for more education on how your body works, or to treat a symptom. My goal is to increase awareness of what pelvic floor physical therapy is, what it can do for you, and empower you with knowledge and confidence in pursuing the treatment you need and deserve!
I’m also aware that it is not possible for every single person who needs pelvic floor physical therapy to be able to attend in-person treatment. Which is why I created Mind Body Core! If you’re looking for guidance with healing your pelvic floor and core and are pregnant or postpartum, my program is for you! Click the button below to learn more.
If you found this helpful, feel free to spread the news and share with your friends! And if this blog brought up any questions for you, do not hesitate to send me a message directly or check out my Instagram for all things pelvic health!
In Health and Fitness,