Pelvic Floor Physical Therapy

  • By:  Erin Glace

Imagine going to see your doctor for a bladder problem and the doctor says, “Well, I think we need to start with physical therapy.” Long pause. “Really, Doc? It’s my bladder, not my back!”

Many women are confused when their doctor refers them to PT for either a bladder control issue or pelvic pain. Rest assured, pelvic floor physical therapists are specially trained to help women and men regain bladder control and to treat many painful pelvic conditions.

The “core” of the problem often lies in the group of muscles that make up the floor of the pelvis. These muscles are critical for core strength, bladder, bowel, and sexual function. Most women who have had children are aware of Kegel exercises—the exercise you are told to do at your postnatal checkup when your gynecologist happily tells you all is well and you can go back to your “normal” sex life—but then adds, “Don’t forget those Kegels!” What? Oh, you mean those exercises I read about in What to Expect….? The Kegel is promptly relegated to an exercise you know you should do, but with a new baby, a messy house, and uncertainty about ever getting back your normal sex life, who really has time to figure that out?

Truly, a Kegel, or pelvic floor contraction, should be crowned the queen of all exercises. It is a powerhouse exercise that doesn’t even require athletic shoes to accomplish. You can prevent problems including prolapse (bladder or uterus falling down), urinary leakage, irritating bladder symptoms (frequency and urgency), pelvic pain syndromes, and decreased sexual sensations by doing Kegels correctly.

The key is learning to do the exercises correctly, and this is where the pelvic floor physical therapist comes in. Therapists are able to help women and men suffering from issues related to a dysfunctional pelvic floor. This means the muscles are too weak, too tight, or actually uncoordinated. An uncoordinated muscle can create bladder problems including bedwetting, leakage, and urinary frequency, even in young women who haven’t had children. A tight or hypertonic pelvic floor can create pain with sitting, urinating, or with sexual intercourse. A weakened pelvic floor can contribute to stress incontinence (the squirt of urine with sneezing or coughing), urinary frequency, and prolapse.

So, you decide to trust your doctor and head off to see the local pelvic floor physical therapist. At your first visit, you will complete a detailed questionnaire about your history, symptoms, and the conditions described above. A therapist will thoroughly explain pelvic floor anatomy and its many functions and will talk to you about the therapy to make sure you are comfortable proceeding with treatment. 

Don’t worry about being in a big PT gym like you were for your knee rehab. Patients are seen in private rooms. In a comfortable setting, you will learn to correctly perform Kegel exercises. You may also learn that you shouldn’t be doing Kegels just yet. Many patients need to learn how to relax and release the pelvic floor. The therapist will assess and guide you through a personalized program to get you on the road to good pelvic health. Therapy will include more than Kegels, but they may be a starting point. PT has been shown to be an effective form of treatment for bladder and bowel control and pelvic pain. Women and men with pelvic pain are especially relieved to discover these successful treatment options.

A quick word about the pelvic floor being a core stabilizer. Abs get all the glory in the gym, but really the pelvic floor is a key player in good core stabilization. This is very important for anyone, including athletes. Because of all the training of the abs, the pelvic floor is often over challenged and under-trained in athletes and thus groin pain and bladder control issues can develop. So, remember the queen should be the Kegel—done correctly!

Erin Glace, MSPT, is the director of physical therapy for Urology of Virginia, PLLC, 225 Clearfield Ave., Va.  Beach, VA 23462. For more information, call 757-466-3406.

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