By Dr. Lyndi Payne, PT, DPT
To answer this question, we need to first ask, what is your pelvic floor? Your pelvic floor are the muscles in your pelvis that hold up all of your organs—not just the organs in your pelvis. These muscles assist with breathing, urinating, sexual functions, reproductive functions, and they help hold in your urine and manage pressure while doing activities of daily life.
How do you know if you need pelvic floor physical therapy? Here is a pelvic floor screening protocol to see if you need pelvic floor physical therapy: Cozean Pelvic Floor Screening Protocol
If you check 3 or more of the boxes in the Cozean Pelvic Floor Screening Protocol, you need to find your nearest pelvic floor physical therapist to have an assessment as you most likely have significant pelvic floor dysfunction. We would also argue if you check any of them, you should also see your pelvic floor physical therapist.
What will that look like? First we assess how your body is moving: can you squat, go up the stairs, balance on one leg? Then we perform a lumbar (back) and hip evaluation. This includes looking at your range of motion, feeling how your joints move (including your pelvis), muscle testing and assessing for any tenderness to touch. If we find anything concerning we will perform further testing. We will also perform a breathing assessment to see how your rib cage and stomach move as you breathe.
Then we assess your pelvic floor. We have you do a kegel (lifting your pelvic floor up and in) and bare down (as if you are having a bowel movement.) After asking for permission/consent to perform an internal muscle assessment, we feel the outer layer of your pelvic floor-typically on/near your vulva and perineum. Then we insert a finger into your vaginal canal and have you again do a kegel and bear down; this helps us assess your strength. Then we palpate (gently push down on the muscle) and assess for tension and/or tenderness. Tenderness in your pelvic floor can feel like a deep ache, a burning sensation, a strong urge to pee, or increased tension/pain. If you experience any of these feelings, we treat the area through manual therapy. This can be done a few different ways: dry needling, trigger point release and myofascial mobilizations.
If you are curious about dry needling is watch this video: What is Dry Needling?
One of the most important parts of any physical therapy is changing movement patterns so all of the manual therapy has lasting effects. If we don’t change movement patterns and strengthen areas that are weak, your symptoms will likely never subside. Two areas that we focus on heavily on are strengthening the glutes and core. You might ask, “Why?”
Think of your abdominal cavity like a can of soda. At the bottom of the can, you have the three layers of pelvic floor muscle. On the top you have your diaphragm—that’s the muscle that helps you breathe. On either side you have your abdominal muscles and your back & glutes. We need all four of these areas functioning optimally, when one of them is either too tight or too weak it will cause dysfunction throughout the chain and system. For example) if your back is tight, it tilts your pelvis forward, making it more difficult to engage glutes which puts more pressure on your pelvic floor which can then make it tight.
So how do we get your body to function optimally? As I mentioned before: dry needling, trigger point release and myofascial mobilizations are the first step. The next step is to strengthen! We put a greater emphasis on glutes and abdominals; these two muscle groups work together to help you with everyday functions.
In conclusion, pelvic floor physical therapy is a specialized treatment approach aimed at addressing issues related to the muscles in your pelvis that support your organs and are vital for various bodily functions.
If you are experiencing symptoms such as urinary incontinence, pelvic pain, or discomfort during intercourse, it is time to seek the expertise of a pelvic floor physical therapist. Through a comprehensive assessment and personalized treatment plan, you can alleviate symptoms, improve function, and enhance your overall quality of life. Don’t hesitate to reach out to a pelvic floor physical therapist today to start your journey towards better health.