What Is Pelvic Floor Physical Therapy?

 
 

Maybe you’re reading this because you’re in pain. Maybe you’re reading this because you pee your pants on occasions that are too common and under circumstances that are less-than-convenient.

Maybe it hurts you or your partner to have sex. It’s possible that you’re here because you can’t sit for prolonged periods of time without being in pain, or you’re having trouble going to the bathroom.

Perhaps you are pregnant and hoping to prepare for giving birth, or you are postpartum and looking to guide your miracle-building body toward its optimal state of function. The list goes on and on. If there is one thing we know for sure, it’s this: whatever your reason for having landed on this page, you’re in the right place. There is hope and healing for whatever pelvic floor dysfunction you are facing. Know that we are here to help you.

Before diving into pelvic floor physical therapy, let’s first start with the pelvic floor. Namely—what is the pelvic floor, and what does it do? Walk through this page with us as we guide you through the answer to these important questions.

What is the Pelvic Floor?

Getting to Know Pelvic Floor Musculature

The pelvic floor is a group of muscles that attaches to the front, back, and sides of the pelvis and to the tailbone and sacrum. These muscles support the pelvic organs, including the bladder, uterus or prostate, and rectum, and wrap around the urethra, vagina (in women), and rectum. Coordinated contraction and relaxation of these muscles helps control bladder and bowel function.

What is Pelvic Floor Physical Therapy? The Pelvic Floor, Explained.

For your pelvic floor to perform optimally, these muscles must be able to lengthen to allow blood flow and mobility of your connective and muscle tissue.

Essentially, it helps to think of your pelvic floor as a group of muscles that sit inside your pelvic “bowl”. It has a variety of purposes such as supporting organs, aiding in sexual function, and providing a role in urine and bowel elimination (more on this in a minute). 

Now, what if we told you that your pelvic floor was an essential part of your core? Yeah, not like the 6-pack part of your core. This is a common misconception. If you thought your core was the sheet of abdominal muscles behind your belly button, think again. In reality, your core is more like a can of coke than a “6-pack” of them.

When we think of "core" we often think of our abs, but there's much more to your body's central trunk than meets that common misconception.

Your Pelvic Floor & the Core

We like to tell patients to imagine their trunk shaped like a can of coke. The lid of the can is your diaphragm, the front wall of the can is your abdomen, the back wall of the can is your spine, and the bottom of the can is your pelvic floor.

So, why is this important?

For one thing, think about your breath! The pelvic floor (bottom of the can) faces upward toward our respiratory diaphragm (lid). Think: parachute of a diaphragm, bowl of a pelvic floor. Ideally, when we take a relaxed breath, we take air in, our diaphragm should flatten (tummies out), the pelvic floor should relax and expand downward simultaneously. Then when we exhale, the diaphragm should go back up and the pelvic floor also pulls back up to resting position.

This is just one example of the many incredibly important functions of our pelvic floor, and how habits (such as faulty breath-holding) repeated over time can manifest as pelvic pain or pelvic floor dysfunction.

In fact, there are so many lifestyles, habits, hobbies, injuries and life events that lead to various pelvic floor symptoms that we literally label ourselves as pelvic floor detectives—we take on every unique case with a magnifying glass to determine your diagnosis and your (necessarily) unique plan of healing. 

 

What Does the Pelvic Floor Do?

At Sarton Physical Therapy, we like to say that the pelvic floor has 5 essential “S” functions: support, sphincter, sexual, stability, and sump pump.

SUPPORT FUNCTION

There are 3 layers to your pelvic floor. They hang sort of like a hammock, from front to back and from side to side. The two layers that are closer to the surface of your body tend to support the openings. The third, most inward layer which tends to support the organs, and stretches more toward the back of your pelvic floor. Think of this supportive layer as a basket that keep organs in place, particularly with impact.

SPHINCTER FUNCTION

This function ensures that things are kept closed when we want them closed (i.e. preventing leakage of urine and fecal matter), and that things open when we need them to (i.e. successful urination and bowel movement).

SEXUAL FUNCTION

The pelvic floor muscles help us achieve arousal and orgasm.

STABILITY FUNCTION

The pelvic floor itself creates a lot of stability across the pelvis and and transfers force, especially correlating to what’s happening in our legs and hips.

SUMP PUMP FUNCTION

The pelvic floor region helps to move lymph fluid and blood through the pelvis and up into the trunk.

 

Know the True Source of Your Pelvic Pain or Pelvic Floor Dysfunction.

Exploring the elusive pelvic floor musculature with Dr. Julie Carter Sarton, PT, DPT, WCS

Did you know that your low back pain, hip pain, lower quadrant pain, bladder urgency/frequency, vulvar pain or coccyx pain may actually not be coming from these sources? Rather, it may be rooted in pelvic floor muscular dysfunction. Why? The brain only perceives where the pain is felt and not the actual source of the pain. Fascinating, we know (we nerd out over all things pelvic floor).

So, part of your healing journey will include you being a detective, too—going to work with your practitioner to figure out any referral patterns that exist and are rooted in your pelvic floor musculature. You can then eradicate any underlying sources and causes of your pelvic pain, sexual pain and even orthopedic pain! 

 

So, What is Pelvic Floor Physical Therapy?

Our passion is to provide healing that lasts. Period.

How do we do that? Our strategic approach to helping people move optimally is to look at the person’s whole body as a system that works and functions together.

Healing is not a one-size-fits-all approach. With two cases are hardly the same, we believe in creating a customized healing plan unique to your pain capacity, medical history, daily pain patterns, and so much more. Our comprehensive evaluation will help to identify the causes driving your symptoms. An extensive medical history and physical exam reveals whether poor posture, faulty biomechanics, tight muscles, trigger points, weakness, or nerve disorders are part of your problem. Additionally, restricted scar tissue or adhesions, connective tissue and fascial restriction are always assessed.

Your individualized treatment program may include any or all of the following: 

  • Manual therapy including myofascial release, trigger point release, joint mobilization, muscle energy techniques and connective tissue mobilization

  • Pilates based therapeutic exercise

  • Visceral manipulation

  • Scar tissue adhesion release

  • Strain or counter strain

  • Nerve flossing and neural tension releases

  • Class IV warm laser therapy

  • Neuromuscular re-education techniques

  • Core stabilization training

  • Functional exercise and prescriptive therapeutic exercise

  • Physioball and foam roller exercise

  • Intramuscular trigger point therapy injections

  • Postural re-education

  • Patient and family education

  • Instruction in a home exercise program

  • Pelvic floor biofeedbac


 

Your Treatment plan is designed to fit your unique needs

For more information about our personalized treatment approach, take a look at our Sarton Physical Therapy Healing Heart® 

 

Always prioritizing the latest technology

Sarton Physical Therapy is excited to have a Class IV Warm Laser to help patients maximize their progress towards long term goals of decreased pain and increased function.


 

Pelvic Floor PT, Explained

+ Pelvic Pain

Manual therapy such as myofascial release, joint mobilization, nerve gliding/tension release and visceral manipulation creates the cornerstone of our treatment. Correcting abnormal movement patterns and posture via neuromuscular re-education, therapeutic exercises and core strengthening is an integral component of treatment as well. Additionally, utilizing pain reducing strategies combined with cutting edge modalities such as warm laser therapy facilitates faster healing.

+ Sexual Pain

Often misunderstood and mismanaged, many types of sexual dysfunction can be successfully treated with pelvic floor physical therapy. Women who experience pain during or after intercourse, diminished or absent orgasm, genital hyperarousal disorder and pain with arousal or orgasm routinely present with a muscular impairment of the pelvic floor. Many times sexual pain and/or dysfunction can be a result of neuromuscular dysfunction of the pelvic floor muscles, nerves, fascia and connective tissue. Manual therapy such as myofascial release, joint mobilization, nerve gliding/tissue tension release, visceral manipulation and stretching by our pelvic floor therapists can significantly improve and even eliminate pain and dysfunction.

+ Incontinence

Physical therapy can help all types of incontinence including stress, urge or mixed urinary incontinence. After a comprehensive physical therapy evaluation, it may be determined that weak or dysfunctional pelvic floor muscles or trunk (core) muscles are contributing to the problem. Other musculoskeletal issues such as trigger points, myofascial tightness, misalignment of pelvic, sacroiliac, spine, and/or hip joints may be a causative or perpetuating factor. Diet and behavior can also affect incontinence. Studies have shown that pelvic floor muscle exercises help with urinary incontinence. Using biofeedback enables the patient to understand the function of pelvic and low back muscles in bladder health. Your expert physical therapist will implement an individualized treatment program to address any issues found during the evaluation.

+ Pregnancy

Physical therapy during pregnancy can prove to be useful for remedying common discomforts like back pain and urinary incontinence or for enhancing your body’s ability to have an easier and smoother pregnancy and birth.

  • Physical Therapy can increase core muscle strength: including the pelvic floor, abdominal muscles and trunk muscles.
  • Improving breathing control.
  • Reducing fluid retention through lymphedema massage/ manual lymph drainage.
  • Reducing constipation.

How common is back pain during pregnancy?

Prevalence ranges between 50 to 70 percent of women who are pregnant. While the reasons for back pain vary from person to person, the majority of back pain concerns can be accounted for by one of the following reasons:

  • An increase in hormones.
  • A change of the body’s center of gravity.
  • Gaining additional weight.
  • Faulty postures utilized during pregnancy
  • Added stress

+ Post Partum

Physical therapy treatments following delivery include: manual therapy to regain lost range of motion, scar mobilization to prevent adhesions, abdominal and pelvic floor strengthening, correction of diastasis recti, education in proper posture and positioning, and treatment of vaginal and pelvic pain.

Physical therapy treatment can also address unresolved painful episiotomies and painful c-section scars.