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Pelvic Floor Physical Therapy Explained!

Hi everyone! I’m Dr. Katie Ihlenfeldt and I am an orthopedic and pelvic floor physical therapist at the St. Petersburg and Clearwater Fyzical Therapy locations.

I get asked all the time what a pelvic floor physical therapist does and what is involved in pelvic floor physical therapy so I have answered some of the most common questions below. Please feel free to reach out to our offices with any more questions or for more information!

Where are the pelvic floor muscles and what do they do?

Your pelvic floor muscles are a group of muscles that are situated like a sling at the bottom of your pelvis and include both internal and external muscles. These muscles have 5 main functions which include:

1. Support: Your pelvic floor supports your internal reproductive, urinogenital, and gastrointestinal organs against gravity and during increased abdominal pressure (like when lifting, sneezing, coughing, etc)

2. Sphincter control: Your pelvic floor muscles wrap around urethra, vagina, and anus allowing you to choose the appropriate time to use the bathroom and keeps urine, gas, and feces from escaping at the wrong time.

3. Sexual function: Your pelvic floor muscles are responsible for maintaining an erection and contract/relax during orgasms.

4. Stability: Your pelvic floor muscles work hand in hand with your abdominal and hips muscles, helping to create stability throughout your core/back/hips when moving your legs and arms.

5. “Sump pump”: Your pelvic floor muscle also aid in helping pump lymph fluid and blood from your pelvis back to your heart

What are the signs and symptoms that you may have an issue with your pelvic floor?

Some common signs and symptoms that your pelvic floor may have some dysfunction include:

- Any type of involuntary loss of urine or feces (this includes when jumping, running, sneezing, coughing, and laughing)

- Frequent or constant feelings of needing to use the restroom

- Feelings of pelvic heaviness or pressure

- Painful urination or defecation

- Painful intercouse and orgasms

- Inability to completely empty your bladder

- Constipation

- Abdominal bloating and pain

- Low back, pelvic, hip pain

What can pelvic floor physical therapy help with?

First I’d like to point out that if you are someone who pees, poops, and procreates (AKA everyone) you can benefit from seeing a pelvic floor physical therapist if experiencing any of the above mentioned signs and symptoms. Pelvic floor physical therapy can help you gain control and coordination over your pelvic floor and surrounding hip, core, and back muscles to help reduce urinary and/or fecal incontinence and reduce pelvic/low back/hip pain and pressure.

Pelvic floor physical therapy is also beneficial as a measure of pre-habilitation for a prostatectomy surgery, preparation for childbirth, or any pelvic, hip, abdominal, or back surgery.

What should I expect during my first pelvic floor physical therapy session?

Your first session with a pelvic floor therapist is very similar to any physical therapist evaluation. Your pelvic floor physical therapist should examine not just your pelvic floor but your entire body as a whole. When we interview you we’re not just asking about pelvic floor symptoms, but also asking about any orthopedic injuries or pain, diet, fluid consumption, and other medical conditions/history. I’ll take a look at how you breathe, how your hips and spine move, strength of your hip and leg muscles, posture in standing and sitting, how you move to squat, jump, or pick up things depending on when you experience most of your issues. And then yes, when indicated and with patient consent, an internal pelvic floor muscle exam is performed to determine strength, endurance, coordination, and muscle tone of the pelvic floor. This internal exam gives the therapist a lot of information but does not have to be performed to start treatment.

Won’t kegels just solve my problems?

No! Kegels alone are never the answer! Depending on what is found in the exam your pelvic floor physical therapist might give you some stretches or exercises, perform internal/external myofascial release on your pelvic floor and associated structures, educate you on breathing strategies, give you general education on bowel, bladder, sexual health and yes, sometimes will advise you to perform kegels, or pelvic floor muscle contractions, if appropriate. Kegels are not the only answer, but are largely given to patients without a pelvic floor exam. Based on how your pelvic floor presents, kegels could actually make your symptoms worse so make sure to get your pelvic floor actually assessed for trying these out!