“I had no idea pelvic floor physical therapy was a thing!”

“I didn’t know there was physical therapy for THAT!”

“What do pelvic floor physical therapists even do?”

I was first introduced to pelvic floor physical therapy during my second semester of PT school.

On the first day of one of the four courses we were taking during the Fall 2019 semester, our professor introduced herself as a pelvic floor physical therapist (PFPT).

After briefly introducing herself and her specialty, something stuck with me. I wanted to know more about it.

Without any rhyme or reason, I swore to my friends, family, and classmates I’d become a PFPT.

After speaking to my professor on multiple occasions, expressing my interest in this sect of the PT world and asking tons of questions, I counted down the days until I was a third year DPT student, eligible to take a level 1 pelvic floor continuing education course.

After having completed the course a few weeks ago, it’s hard to share my passion and all of the knowledge I’ve gained without being asked:

“What is pelvic floor physical therapy?”

It’s not as complicated as you may think.

As physical therapists, we treat muscles, tissues, and nerves to relieve pain, restore and/or optimize function, and improve quality of life.

Pelvic Floor Physical Therapists (PFPT) treat dysfunctions related to the pelvic floor.

What is the pelvic floor?

Everyone has one!

Your pelvic floor houses muscles, ligaments, nerves, and other tissues that directly affect your bowel, bladder, and reproductive function.

Pelvic Floor Muscles. Fig. modified from Gray’s Anatomy, Lea and Febinger 1918, Philadelphia, USA.

What is pelvic floor dysfunction?

Pelvic floor dysfunction looks different for every individual.

Pelvic floor dysfunction is typically due to an inability of your pelvic floor muscles to work in harmony due to pelvic floor muscle weakness, overactivity, imbalance, or incoordination.

Pelvic floor muscle weakness, overactivity, imbalance, or incoordination can cause a variety of dysfunctions, including urinary incontinence, overactive bladder, pelvic pain (i.e. pain during sex), bowel disorders (i.e. constipation), and more!

A patient with pelvic floor dysfunction can present with a variety of symptoms, including but not limited to:

  • Increased urinary urge/frequency
  • Constipation
  • Trouble controlling bowels or urine, leading to leakage
  • Pain during penetration
  • Erectile dysfunction

What can I expect in a Pelvic Floor Physical Therapy Session?

During your first session, your therapist will spend time getting to know you, by gathering information about your current symptoms, concerns, and past medical history. There will be a lot of talk about peeing, pooping, sex, diet, exercise, and other day-to-day activities.

The PFPT will then dive into an observation and assessment of posture, pelvic alignment, and breathing patterns. The therapist will also assess the abdomen and hip for strength, tone, tenderness, etc.

A PFPT session also includes an internal examination with the patient’s consent. Yup, you read that right. A PFPT can be performed through the vagina or rectum.

An internal assessment allows a PFPT to gain more information regarding your symptoms and concerns, and determine how to more effectively treat the problem at hand.

Depending on what information the PFPT gains during the initial evaluation, they will begin to plan future treatment sessions, which could include more internal work, exercises, and patient education.

The goal of PFPT is to address any pain, discomfort, or dysfunction to improve strength and function of the pelvic floor, and improve a patient’s overall quality of life.

Why is pelvic floor physical therapy important?

While PFPT may seem unusual and invasive at first glance, a variety of studies have shown PFPT to be an effective treatment for pelvic pain and related dysfunction.

No one should have to live with bowel and/or bladder dysfunction, painful penetration, or pelvic pain.

Talking to a healthcare provider about bowel, bladder, and other pelvic floor health related concerns is a conversation worth having.

Though it may seem embarrassing, or “TMI” for many individuals, leakage, pelvic pain, and other dysfunctions related to the pelvic floor should not be things we “learn to live with.”

Good bowel, bladder, and pelvic floor health starts with having the conversation about what is “normal,” and being open about what you are feeling and experiencing.

While all Pelvic Floor Physical Therapists undergo specialized training on internal and external pelvic healthy dysfunctions, examinations, and procedures, it’s important to find a provider who makes you, the patient, feel comfortable, respected, and heard.

After taking my first pelvic floor continuing education course, I’ve become even more aware of (and a strong advocate for) the importance of openly discussing not only pain, but also our bowel and bladder function with our healthcare providers– even if it feels like we’re sharing “too much information.”

The first step can be scary to take, but it’s worth it.

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