Pelvic Health Physical Therapy: What is it? Do you need it?
A lot of the time, pelvic health physical therapy is associated with Kegels. Many of us have heard of Kegels. A lot of the time, the message is: “you have pelvic floor issues? Do your Kegels!” (FYI: Kegels aren’t actually for everyone and there’s A LOT more you can do for your pelvic floor). On the other hand, fewer of us have heard of pelvic health/floor physical therapy. So what is it? And how do you know if you need it? Let’s dive in!
The basics of physical therapy and the niche of pelvic health rehab
Physical therapists are the pros of improving the function of our bodies. That may address your muscle strength, muscle endurance, flexibility, stability, balance, cardiovascular function, etc. So how does that work with the pelvic floor? Well, your pelvic floor is just like the muscles of the rest of your body. They can get injured and rehabbed just the same. And it’s not just your pelvic floor that can be addressed with this niche of therapy, it’s also your surrounding body parts too (think abdomen, hip, low back, groin, even down to your ankles!). Both physical and occupational therapists can be trained to treat pelvic health disorders. Most often, these practitioners receive extra training following graduation from physical therapy school as most programs don’t delve too deeply into niche practices.
How do you know if you need this specialized form of therapy?
Any form of the following symptoms may mean you should seek out therapy (this goes for anyone with a pelvis, not just for vagina owners which is a common thought):
Urinary symptoms: leakage of urine, feeling like you can’t fully empty the bladder, frequent urination including feeling the need to urinate minutes after you already have, pain or burning with urination, strong urge to urinate, and difficulty starting or stopping urine stream.
Bowel symptoms: loss of bowel control, difficulty fully emptying the bowels, straining or pain with bowel movements, or having a bowel movement less often than every three days.
Pelvic pain in genitals, perineum (area between the vaginal and rectal opening), pubic or bladder area, or pain with urination.
Tailbone injury, even as far back as your childhood (you may have fallen on your tailbone, buttocks, or low back).
Frequent urination (more than twice) at night.
Feelings of falling out or pressure at the vaginal or rectal opening.
Pain or discomfort during or after sexual activity, orgasm/climax, and penetrative intercourse (this is true for both vagina or penis owners), or sexual activity increases other symptoms.
Low back, hip, groin, or tailbone pain, or history of sciatica that has not gotten better.
Prolonged sitting increases any of your symptoms.
What might cause needing pelvic health rehab?
A lot of the time, injuries to the pelvic floor occur with childbirth. Did you know that injuries post-childbirth are about the size of a dinner plate internally? A LOT is going on there, and it’s a pretty traumatic experience for the body. With vaginal deliveries, folks may experience tearing, whether that be natural or tool-induced (use of vacuum or forceps), or receive an episiotomy. This causes the muscles not to function properly, and through time can lead to incontinence, pelvic organ prolapse, and pain with intercourse. Those who have had C-sections may also experience dysfunctions, too. These may not be as directly related to a pelvic floor injury and can be due to abdominal weakness that can lead to other issues (low back or hip pain, incontinence, or pain with intercourse just to name a few).
Haven’t had a baby? Contrary to popular belief, many folks who need pelvic health therapy HAVEN’T had a baby! You can still have muscle imbalances or dysfunctions that are causing issues. This can be due to hormonal changes that occur with menopause or with gender-affirming surgeries or transitions, heavy lifting, running or high-impact sports such as gymnastics, history of sexual abuse or trauma, cycling, abdominal, pelvic, or lower back surgeries, and that’s just to name a few.
What to expect during your first visit
During a pelvic floor evaluation, your therapist will be looking for a number of different things. This will be found via a thorough subjective examination to learn about your medical history and symptoms. A hands-on examination may or may not be completed on the first visit, and may include external and internal pelvic floor examination to assess muscle tone, strength, endurance, coordination, presence of pain, or presence of a prolapse. Other assessments may be geared towards breathing patterns, muscle length, and strength of the abdominals, hip, and low back musculature. Each evaluation will vary based on practitioner and patient, and your therapist will explain the details during your first visit. How many appointments you will need and how often you will be seen will also vary depending on your presentation and how you are progressing with therapy.
How to start pelvic health physical therapy
This will vary by state and country, but most often in the U.S., you will need a referral from a medical provider to go to physical therapy (this can include GP, OBGYN, urologist, GI specialist, neurologist, physiatrist, pain specialist, to name a few). Some states do have direct access, and their policies will vary. There is also the option of cash pay where you can pay out of pocket instead of going through insurance. To find a pelvic health physical therapist near you, you can simply do a Google search, ask your medical provider, or check the following sites:
This blog was created by Dr. Katie Ouillette-Harrington, PT. She practices as a pelvic health physical therapist in Michigan.
Do you have any burning questions you want answered? Email us at enlightenedhw@gmail.com for requests for blog topics!
