Service Highlight: Pelvic Floor Therapy
The pelvic floor is the bottom of the “core”. The “core” is the central part of your body and consists of the muscles of your back, the abdominal muscles in the front, the diaphragm (your breathing muscle) on the top and the pelvic floor muscles on the bottom. The core muscles work together to control the pelvis and the spine and thereby influence the legs and upper body. As a group, pelvic floor muscles stabilize the lumbopelvic region. These muscles are under voluntary control and give us the ability to regulate our bodily functions. They contract to keep things in (such as urine, gas, stool), and relax to let things in or out (such as a tampon or a baby). The focus of working your core is less about building a six pack and more about the subtleties of maintaining ideal posture to offload joints and promote ease of movement and optimal stability to prevent injuries and dysfunction.
What is Pelvic Floor Therapy and who can benefit from it?
The pelvic floor consists of muscles that span the bottom of the pelvis. They support the organs of the abdomen and pelvis, such as the bladder and uterus. The muscles of the pelvic floor can be overactive, or under active, creating pelvic floor dysfunction. Overactive pelvic floor muscles do not relax as needed and are associated with voiding problems, constipation, sexual dysfunction, pelvic pain, low back pain, and hip pain. Underactive pelvic floor muscles do not contract as needed or on cue and are associated with urinary, gas or stool leakage, pelvic organ prolapse and low back pain/sacroiliac instability. One of the most common issues, urinary incontinence, affects 40% of all women and 60-70% of women over the age of 65. Additionally, most women will have some degree of pelvic organ prolapse (where the uterus descends into the vaginal canal and may extrude from the body) in their lifetime. Yet these issues are rarely discussed with health professionals or even by women with their friends. A whopping 65% of female athletes have urinary stress incontinence and/or urgency, and 52% have chronic pelvic pain. Perhaps the most shocking figures: 90% of primary care providers do not refer out for urinary incontinence and most do not screen for pelvic organ prolapse. Sadly, more than 50% of primary care providers believe that pelvic organ prolapse is rare and 71% of women are unaware that vaginal delivery increases the risk for pelvic floor dysfunction. Clearly, more awareness and frank conversations are needed.
What causes pelvic floor dysfunction?
There are a large variety of things that can cause or contribute to pelvic floor dysfunction. These include, but may not be limited to: postural deficits, childbirth trauma, surgical trauma, adhesions, lumbopelvic joint malalignment, sexual abuse, pelvic inflammation/disease, hemorrhoids, bowel/bladder disorders, chronic increased intra-abdominal pressure (cough, asthma, heavy lifting, constipation, high impact exercise), surgery, obesity, and aging.
Urinary incontinence may present as stress incontinence or urge incontinence. In stress incontinence, there is leakage with increases in intra-abdominal pressure such as coughing, sneezing, laughing, lifting, jumping. If you’ve peed your pants laughing or jumping on a trampoline, you fall into this category. Urge incontinence is a strong urge to urinate, but is not necessarily associated with a full bladder and can often be paired with low volumes. Weak pelvic floor muscles are unable to stop the bladder from voiding and the sufferer may not be able to make it to the bathroom before voiding starts. Those who suffer from urge incontinence often void more than 8 times a day.
So what is pelvic floor therapy and how does it help?
Pelvic floor therapy is a specialty in physical therapy that focuses on the rehabilitation of the muscles of the pelvic floor. The goal of this therapy is to restore a higher level of function to reduce leakage and reduce pain through non-invasive treatment approaches. We work with patients to retrain the pelvic floor muscles through exercises incorporating strengthening, as well as relaxation. Treatments focus on the muscles of the pelvic floor, the core, and hips.
What can you expect from your first therapy session?
Pelvic floor dysfunction is highly personal and you may feel nervous about what your therapy session will entail. At your first exam we will assess your posture, breathing pattern, strength and flexibility of your spine, abdomen and hips. There will be an extensive interview to discuss your symptoms as well as what worsens them and what relieves them. You will be asked to move around to allow the physical therapist to see your posture, function and strength with certain activities. Some pelvic floor specialists have been trained to perform internal exams although we do not offer that at this clinic at this time. We utilize external manual therapies and treatment tools to increase the mobility of skin, muscle and fascia. You will be introduced to strategies to gain improved awareness and activation of your pelvic floor muscles to gain improved control, strength and mobility.
The good news is that pelvic floor exercises can help to control urine leakage, protect against prolapse and reduce pain! If you are interested in scheduling a consultation for pelvic floor therapy, please call our front desk at (530)572-1566.