Pelvic Floor Physical Therapy
The pelvic floor is a group of muscles, ligaments, and tissues that support the bladder, rectum, and, in women, the uterus. These muscles play a critical role in core stability, urinary and bowel control, and sexual function. Pelvic floor dysfunction, which can manifest as incontinence, pelvic pain, or prolapse, can significantly affect quality of life. Pelvic Floor Physical Therapy (PFPT) is a specialized branch of physiotherapy aimed at diagnosing and treating these issues.
Pelvic Floor Physical Therapy is a non-invasive, evidence-based treatment approach that focuses on improving the function of the pelvic floor muscles. It involves exercises, manual therapy, and education to address issues such as:
Urinary or fecal incontinence
Pelvic organ prolapse
Pelvic pain (including conditions like vaginismus, vulvodynia, or prostatitis)
Postpartum recovery
Pre- and post-surgical rehabilitation (e.g., after prostatectomy or hysterectomy)
Sexual dysfunction
Improved muscle strength and coordination: PFPT helps retrain weak or tight pelvic floor muscles.
Pain relief: Techniques like myofascial release and trigger point therapy can alleviate pain.
Enhanced quality of life: Resolving symptoms can restore confidence and daily functioning.
Preventative care: PFPT can prevent worsening symptoms or complications, especially postpartum or post-surgery.
PFPT is tailored to the individual’s needs and typically begins with a thorough evaluation. Here’s what to expect:
1. Initial Assessment
The therapist will take a detailed medical history and inquire about symptoms, lifestyle, and goals. They may assess posture, breathing patterns, and core strength as these are closely linked to pelvic floor function.
2. Internal and External Examination
External Examination: The therapist may evaluate the abdominal area, hips, and lower back for tension, alignment, or signs of dysfunction.
Internal Examination: For a more accurate assessment, a vaginal or rectal exam might be conducted to check muscle tone, strength, and coordination. This step is always performed with patient consent.
3. Treatment Techniques
Manual Therapy: Includes internal or external soft tissue mobilization, trigger point release, and myofascial techniques to reduce pain and tension.
Biofeedback: Sensors are used to provide visual or auditory feedback to help patients learn how to contract or relax their pelvic floor muscles effectively.
Therapeutic Exercises: Exercises like Kegels (for strengthening) or reverse Kegels (for relaxation) are commonly prescribed. Other exercises may include:
Core stabilization movements
Diaphragmatic breathing
Hip and lower back strengthening
Electrical Stimulation: In some cases, gentle electrical stimulation may be used to activate weak muscles or relax overactive ones.
4. Education and Lifestyle Modifications
The therapist will provide advice on:
Bladder and bowel habits
Postural adjustments
Proper lifting techniques
Stress management strategies
PFPT is beneficial for:
Women: During pregnancy, postpartum, or menopause
Men: After prostate surgery or with chronic pelvic pain
Individuals with chronic constipation or irritable bowel syndrome
Athletes: Who often experience stress-related pelvic floor issues
Kegel Exercises
Identify the pelvic floor muscles (e.g., by stopping urine flow midstream).
Contract these muscles for 3-5 seconds, then relax for an equal duration.
Perform 10-15 repetitions, 2-3 times a day.
Diaphragmatic Breathing
Lie down with one hand on your chest and the other on your abdomen.
Inhale deeply through the nose, allowing the abdomen to rise.
Exhale slowly, feeling the abdomen lower.
This helps relax the pelvic floor and improves coordination with breathing.
Bridge Pose
Lie on your back with knees bent and feet flat on the floor.
Lift your hips toward the ceiling while squeezing your glutes.
Lower back down slowly. Repeat 10-15 times.
Child’s Pose
Kneel on the floor, sitting back on your heels.
Extend your arms forward and rest your forehead on the floor.
Hold for 20-30 seconds, focusing on deep breathing.
Consider PFPT if you experience:
Chronic pelvic pain
Frequent urination or difficulty emptying your bladder
Pain during intercourse
A feeling of heaviness in the pelvic area
Persistent lower back or hip pain
Hagen, S., & Stark, D. (2011). Conservative prevention and management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, (12).
Dumoulin, C., et al. (2018). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews, (10).
Bo, K., & Sherburn, M. (2005). Evaluation of female pelvic-floor muscle function and strength. Physical Therapy, 85(3), 269-282.
Fitzgerald, C. M., & Kotarinos, R. K. (2003). Pelvic floor physical therapy for the treatment of pelvic pain. Obstetrics and Gynecology Clinics of North America, 30(4), 777-798.