The ultimate guide to pelvic floor physical therapy: everything you wanted to know about pelvic floor PT but were afraid to ask

Mar 4

Has anybody ever advised you to "just do your Kegels"? Have you considered a better solution than Kegels? Your search ends here! Discover pelvic floor physical therapy's potential for your wellness journey. Read on to find out if pelvic floor physical therapy is for you.

What is Pelvic Floor Physical Therapy:

Pelvic Floor PT is a physical therapy specialty that focuses on the pelvic floor dysfunction and the pelvic floor muscles.

The pelvic floor muscles are the base of your core. They make a hammock in your pelvis and run front to back from pubic bone to tailbone and side to side from the hip bones.

What is the Function of the Pelvic Floor?

The pelvic floor muscles provide support for your bladder, uterus and rectum and keep these organs from falling out (more on pelvic organ prolapse later).

The pelvic floor also provides stability to your spine and hips as it is an integral part of the core.

The pelvic floor is also responsible for sphincteric function. This means it keeps your urethra and anus closed until you can make it to a restroom for elimination.

Finally, the pelvic floor is responsible for sexual function. The pelvic floor muscles are involved in orgasms and pelvic floor dysfunction can interfere with the ability to orgasm.

Why is the Pelvic Floor Important?

The pelvic floor works in conjunction with the diaphragm and the abdominal muscles.

The diaphragm is your breathing muscle that sits under your ribcage

Your abdominal muscles include the rectus abdominis (6 pack muscles), transverse abdominis (deep abs) and your internal and external oblique muscles (lateral abs). Your diaphragm, abdominal muscles, and pelvic floor make up the core.

These three structures work as a canister. When you inhale, the canister moves down and relaxes the pelvic floor. When you exhale, the canister moves back up and contracts the pelvic floor. Knowing this basic function is extremely important for pelvic floor PT, and why it’s important for your pelvic floor physical therapist to look at more than just the pelvic floor. If your upper back is tight, it can affect your breathing which can affect the function of your pelvic floor.

Who Are Pelvic Floor Physical Therapists?

At Cappuccino Physical Therapy, our pelvic floor physical therapists are Dr. Rachael Cappuccino, Dr. Aubrey Smith, and Dr. Julie Watkins. All of our doctors are passionate about and fully specialized in treating pelvic floor dysfunction. You can read more about them here.

*Dr. Rachael Cappuccino and Dr. Aubrey Smith*

If you are not local to the Conejo Valley, you can use one of these sites to find a pelvic floor physical therapist near you:

https://pelvicguru.com/directory/

https://pelvicrehab.com/

https://aptapelvichealth.org/ptlocator/

What Kind of Training Does a Pelvic Floor Physical Therapist have:

A pelvic floor physical therapist typically has a doctorate degree in physical therapy with advanced training in the pelvic floor. This means they have attended 3 years of graduate school and after graduate school, attended more courses to receive pelvic floor certifications. Herman and Wallace and APTA Pelvic Health are two reputable educational courses for pelvic health providers.

Please note, it is important to make sure that your pelvic health therapist is actually trained in treating the pelvic floor. Many people claim to be pelvic floor therapists, but have not actually taken the appropriate coursework, so make sure to do your research. At Cappuccino Physical Therapy, all of our Doctors of Physical Therapy have been trained through Herman and Wallace.

What Can Pelvic Floor PT Do For You?

There are many conditions that can be addressed with pelvic floor physical therapy. Here is a list of some of the things a pelvic floor PT can help you with, but please note this list is not exhaustive.

PREGNANCY RELATED ACHES AND PAINS

Round Ligament Pain
- The round ligament is a ligament that attaches your uterus to your pubic bone. You have two round ligaments. These ligaments stretch during pregnancy and when it stretches too quickly can cause sharp, stabbing pain in the groin area.
Pelvic Pain

The growing fetus puts increased pressure on the pelvic floor and pelvic bones which can contribute to pelvic pain.

Symphysis Pubis Dysfunction

Your symphysis pubis is located in the front of your pelvis and is where your two pelvic bones meet. During pregnancy, the ligaments that hold these bones together stretch which can cause instability in the front of the pelvis. Symptoms include pain in the front center of the pelvis that is usually worse with single leg activity such as walking, climbing stairs, or lunges.

Low Back Pain

Low back pain is extremely common during pregnancy. The growing fetus causes your center of gravity to shift forward which can increase the curve of your lower back and contribute to low back pain.

BIRTH PREPARATION

Perineal massage
- Perineal massage is the massaging of the pelvic floor muscles that need to stretch 1-3 times their resting length in order to deliver the baby. It has been shown to reduce the risk of tearing when performed prior to delivery.
Labor and delivery positions

Did you know that you don’t have to push on your back when delivering a baby? There are actually better positions that allow for more pelvic mobility to allow the baby to come out more efficiently to reduce pelvic floor injury.

Breathing and pushing

Your pelvic floor physical therapist can perform an internal exam while teaching you how to push to make sure your pelvic floor muscles are relaxing. The pelvic floor muscles need to relax to make room for the baby.

Optimize hip, spine and pelvic mobility

Your hips need to be mobile in multiple directions in order for the baby to engage. Your pelvic floor PT will perform a comprehensive evaluation to discover where you could benefit from increased mobility to optimize your delivery.

For a more detailed overview of how pelvic floor PT can help with birth preparation, check out this blog here.

POSTPARTUM REHABILITATION

C section Recovery
- C-section is major abdominal surgery in which 7 layers of tissue are cut through. These layers can develop scar tissue which can adhere down to each other and limit abdominal mobility, strength and contribute to scar pain and pain with sex. Scar tissue mobilization is a vital part of C-section recovery and something we do extensively at Cappuccino PT. You would be prescribed physical therapy after a major hip or knee surgery and the same should be true of major abdominal surgery.

Diastasis Recti

Diastasis recti is the thinning of the linea alba, which is the connective tissue that connects the two sides of your 6 pack muscles. This abdominal separation is normal and necessary in the third trimester of pregnancy in order to create space for the fetus. Usually, the gap closes by 8 weeks postpartum, but if not, pelvic floor physical therapy can help with this.

Pelvic Organ Prolapse

Pelvic organ prolapse is descent of either the bladder, uterus, or rectum into the vagina. This is more common after an instrument assisted vaginal delivery (vacuum or forceps). Symptoms include pelvic heaviness, pressure in the vagina, or feeling like something is falling out of the vagina.

Core and pelvic floor strengthening

Regardless of how you delivered, your core and pelvic floor will be significantly weaker after delivery. It is important to strengthen both and learn how to coordinate them.

URINARY SYMPTOMS

Stress Urinary Incontinence
- Stress urinary incontinence is the accidental leakage of urine during activities such as running, jumping, coughing and sneezing. This is very common, but not normal after having a baby. Surprisingly, Kegels are not always the way to fix this. For tips on how to reduce leaking with jumping jacks, click here.
Urge Urinary Incontinence

Urge urinary incontinence is the accidental leaking of urine because you could not get to the bathroom on time.

Overactive Bladder/Urinary frequency

Frequent trips to the bathroom, specifically less than 2 hours apart, is something pelvic floor physiotherapists can help with. In fact, overactive bladder can be treated with improving bladder habits and pelvic floor function.

PELVIC PAIN

Vaginismus
- Vaginismus is when the pelvic floor muscles spasm, making penetration difficult or impossible due to pain. The most common symptom of this is pain with penetration. Learning how to relax the pelvic floor muscles is an integral part of pelvic PT for vaginismus.

Vulvodynia

Vulvodynia is vulvar pain that lasts for longer than 3 months. Symptoms include burning, irritation, itching and achiness of the area. A common complaint is pain with wearing tight fitting clothing. Again, addressing tightness in the pelvic floor and surrounding musculature can help with pelvic pain conditions such as vulvodynia.

Endometriosis

Endometriosis occurs when uterine-like tissue grows outside of the uterus. Symptoms include painful periods, bloating, gas, abdominal pain, low back pain. Endo is multifactorial so addressing nutrition, lifestyle, stress and sleep in addition to pelvic floor dysfunction is imperative for treating it.

Interstitial Cystitis (IC)

Interstitial cystitis, also known as painful bladder syndrome, causes pressure and pain in the bladder and pelvis. A common complaint is painful urination. Pelvic Floor Physical Therapy is the number 1 line of treatment for IC as recommended by the American Urology Association. You can click this link here for more information.

Dyspareunia (Painful Intercourse)

Pain with sex is common, especially after having a baby. Learning how to relax the pelvic floor in addition to treating any hormone deficiencies is key for treating dyspareunia.

Sacroiliac Joint Pain

Your sacroiliac joint is where the lower part of your spine meets your hips. Many pelvic floor and hip muscles attach to the sacrum, so it is important to address these muscles to reduce SI joint pain.

Pudendal Neuralgia

The pudendal nerve runs through your pelvic floor muscles and can become entrapped due to tightness in the pelvic floor. This can cause sharp, stabbing or burning pain in the pelvis.

PERIMENOPAUSE AND MENOPAUSE

Perimenopause is defined as the transitional period before menopause when your estrogen levels start to decrease. Estrogen is an extremely important hormone for vaginal health and decreased symptoms can increase pelvic floor symptoms such as pain with sex, frequent UTIs and urinary incontinence-all of which pelvic floor PT can help with. For more information on pelvic floor PT and menopause, check out this article here.

What to Expect at Your First Visit

Going to your first pelvic floor physical therapy session can be intimidating if you don’t know what to expect, so we will break it down here.

First, your therapist will sit and ask questions about any symptoms you may be having, any pertinent past medical history, and general health history. This may include questions about your menstrual cycle, pregnancies, birth, exercise, eating habits, sleeping habits and stress levels.

Then, your physical therapist will observe your standing posture, watch the way you walk, and ask to perform any movements that may be symptomatic. She will also watch the way that you are breathing and ask how you activate your core.

She will then have you lay on the table and perform a physical exam which may include hip strength and mobility, upper and lower back mobility, core function and more.

Finally, with your consent, she will perform an internal pelvic floor examination to assess if the pelvic floor muscles are tight or weak, and how the pelvic floor is functioning within the system of the core.

After, your PFPT should explain her findings and tell you what is contributing to your symptoms and come up with a treatment plan that is specific and individualized based on your goals.

Do I need an internal examination?

An internal examination is an important part of pelvic floor physical therapy as we need to know if the pelvic floor muscles are tight or weak, but will only be performed with your consent. If you feel uncomfortable about having an internal exam, be sure to voice your concerns to your pelvic floor physical therapist.

How long should my visit be?

The pelvic floor is extremely complex and your visit should be at least one hour long, and one on one with your physical therapist the entire time. At Cappuccino Physical Therapy, our sessions are an hour long in a private treatment room. You will receive one-on-one, individualized care. We do not utilize aides or assistants like some traditional physical therapy settings do. We want to make sure you are getting the best quality care possible.

How many sessions will I need?

This depends on many things including how long you have had your symptoms, how consistent you are with attending your visits and your home exercise program. If you are regularly attending your visits and doing your homework, you will see progress much quicker than if you are not consistent. Most pelvic floor conditions take a few months, but some chronic pain conditions can take longer to treat.

Why Kegels aren’t always the answer.

How many times have you heard the phrase just do your Kegels? While this advice has good intentions, it is not good advice. More often than not, women have tight pelvic floors. Tightening an already tight pelvic floor can make symptoms such as pelvic pain, pain with sex and urinary incontinence worse. This is why it is imperative to see a pelvic floor PT to find out if you actually need to do Kegels.

What results can I expect from PFPT?

At Cappuccino Physical Therapy, our goal is to get you back to the activities you love without symptoms. After you have completed your sessions with us, you can expect:

a stronger ability to activate your core, allowing you to get back to Pilates or HIIT training.
no leaking with activity/coughing/sneezing, allowing you to get back to running and jumping without peeing.
improved scar tissue mobility around C-section scar, allowing you to hold your children without pain.
decreased pain with sex, allowing you to enjoy intimacy with your partner
and so much more!

If you are wondering if you have pelvic floor dysfunction? This screening tool was designed to identify if you could benefit from seeing a pelvic floor physical therapist.

Screening Tool

Pelvic Floor Physical Therapy is a great option if you are experiencing any of the symptoms listed above, or if you just want to optimize your prenatal and postnatal journeys. At Cappuccino Physical Therapy, our goal is to get you back to the activities you love without symptoms.

Rachael D'Angelo