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The Role of Pelvic Floor Physical Therapy in Pelvic Floor Dysfunction

What is the pelvic floor?!


The pelvic floor muscles are a group of muscles that act like a sling or hammock at the base of the pelvis. They span from the pubic bone in front to the tailbone in back and from sitz bone to sitz bone. There are three layers of pelvic floor muscles and a front, middle, and back of the pelvic floor.


Here is an image for a good visual of these muscles:


The pelvic floor muscles are not talked about as much as the rest of the muscles in our body and not many people spend time training or focusing on the pelvic floor until a problem arises!


The pelvic floor muscles play an important role as part of the deep core system, which is made up of the diaphragm, deep abdominals (transversus abdominis/TA), and the pelvic floor. It's important for all of these pieces to be working together properly with proper coordination and strength of each component for proper function.


Pelvic floor therapists (PTs or OTs) are specialized in treating the pelvic floor muscles as well as the rest of the body because it's all connected. However, pelvic floor therapy is a specialization within physical therapy that focuses on treating urinary, bowel, and sexual symptoms, pain in or around the pelvis, pelvic organ prolapse, and pregnancy and postpartum issues.


Here is a quick screen of questions that can help you determine if you would benefit from seeing a pelvic floor therapist:

  • During the daytime do you urinate more than once every 2 hours?

  • Does the urge to urinate wake you more than once per night?

  • Do you experience urine/stool leakage with sneezing, coughing, laughing, running, jumping?

  • Do you ever experience such a strong urinary urge that you leak or worry that you will leak if you do not make it to the bathroom in time?

  • Do you experience hesitation to initiate urination?

  • Do you feel chronically constipated, despite trying to address dietary/lifestyle changes?

  • Do you often need to strain to initiate or pass a bowel movement?

  • Do you ever need to brace in order to fully evacuate a bowel movement?

  • Do you experience a feeling of heaviness, pressure, or falling out in the vagina?

  • Do you experience pain or discomfort with sitting, standing, urination, bowel movements, sex, or in the tailbone?

  • Do you feel like you may be experiencing a urinary tract or yeast infection, but cultures are negative?

  • Do you experience unexplained low back, pelvic, or hip pain that hasn't resolved with other forms of treatment?


If you answered YES to any of the above questions, I would recommend reaching out to your local pelvic floor therapist to discuss options for setting up an assessment! I offer both in-person and virtual sessions for my patients.


What does a pelvic floor therapy session look like?!


A pelvic floor therapy assessment is always tailored to the patient in front of me depending on their symptoms, concerns, goals, etc. It may or may not include an internal pelvic floor assessment, depending on the patient's comfort level, etc. It is always your decision what we do and do not include in the examination!


I always perform a thorough movement assessment where I look at things such as posture/alignment, breathing strategies, pressure management, function of the deep core and pelvic floor, mobility of the spine and hips, strength testing, functional movement patterns, and more!


If an internal pelvic floor assessment is performed, the pelvic floor muscles will be examined externally first and then internally. For the internal portion, a clean, gloved finger is inserted with lubricant and the three different layers of muscles are assessed. I am looking for areas of tension, tenderness to palpation, strength testing, the ability to release the pelvic floor, relaxation of the anterior and/or posterior vaginal walls, and more.


Questions?!?


Please don't hesitate to reach out to me - message me on instagram (@restore.physicaltherapy614) or email me at restore.physicaltherapy614@gmail.com!


Be sure to check out my other blog posts for more prenatal, postpartum, and pelvic floor education!


Here's to a happy & healthy pelvic floor!


Dr. Kaitlin Hartley, PT, DPT, PPCES

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