pelvic floor physical therapy

Your pelvis might need physical therapy.

pelvic floor physical therapy
photo: Nano Stockk

The pelvic floor is the whole region of the body that sits between the belly button and the bottom of the pelvis. It supports core stability and bowel, bladder and sexual function. When it’s out of alignment, it can lead to back and hip pain, muscle weakness or overactivity, pain during intercourse, urinary incontinence, constipation, uncomfortable pressure and more.

“Pelvic floor dysfunction is highly common in women postpartum, but there is a misconception that you have to have a baby to have issues with the pelvic floor,” says Blair Green, physical therapist and founder of Catalyst Physical Therapy in Dunwoody. “Both sexes can get it from several other causes, such as a sedentary job, sports injury, hamstring injury or trauma like a car accident. You may be predisposed to it, too.”

Hormones also play a role. Whether a woman has kids or not, pelvic floor problems may arise as she approaches menopause because of lower estrogen levels. “Estrogen, and to some degree testosterone, helps maintain muscle integrity including strength and lubrication. The tissue starts to change in menopause, similarly as it does during nursing after childbirth,” Green says.

Addressing all of the above issues is pelvic health physical therapy, a specialized niche that combines exercises with manual therapy in addition to other treatment strategies and patient education utilizing models and pictures. It’s focused on the muscles, nerves and soft tissue structures in the pelvic floor, including the abdominals, lower back, diaphragm and, yes, the vagina and rectum. The only way to reach and work on some of these areas is internally.

“Some people from day one say, ‘I’m here and ready.’ Others might be fearful, so we would wait to do internal therapy until they are comfortable,” Green says.

For those who just can’t get comfortable, pelvic health physical therapists can teach at-home techniques using silicone pelvic floor wands.

Breathwork and mindfulness exercises are also helpful. “Through breathing techniques, we teach people how to relax their pelvic floor and calm down the nerves,” she says.

So why aren’t more people—and their health care providers—talking about pelvises and pelvic health physical therapy? “I think it’s partly because it’s embarrassing to discuss things like leaking when you exercise or pain during sex,” Green says. “There’s a lot of shame and fear attached to this area of the body. But though it’s common, it’s not normal, and there’s a lot you can do to fix it.”

Green highly recommends going to see a pelvic health physical therapist when you are pregnant to learn pelvic mobility exercises, breathing techniques and other delivery-room strategies to minimize the risks of childbirth injuries. Then visit your PT again within one to two months of giving birth. “Even though symptoms might not present themselves right away, waiting five, 10, 20 years later, which women often do, creates more problems.”

For more chronic issues, expect frequency of visits to be once or twice per week for six to eight weeks initially. Then a monthly or bi-monthly check-in might be needed.

When looking for a qualified professional, know that not all physical therapists do pelvic health, just as not all technicians and nurses who do pelvic floor therapy do PT. You’ll want someone who has been comprehensively trained and a practice that offers a private room, advises Green. APTA Pelvic Health (the Academy of Pelvic Health) is a trusted resource to find a provider near you.



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