Why see a pelvic floor therapist?
Many pelvic floor conditions can be managed and healed without surgery. Seeing a physical therapist (PT) or an occupational therapist (OT) who is trained as a pelvic floor therapist may help you better understand your symptoms and design a personalized program to help alleviate your pelvic discomfort or pain through retraining and strengthening your muscles. Some people will see a pelvic floor therapist just once or twice to assess their strength and flexibility, to get assistance with learning a specialized exercise and self-care program (which may include learning to do Kegel exercise correctly), assist with learning to do Kegel exercises correctly, and receive personalized guidance for maintaining pelvic floor health. Others may need more sessions for their condition(s) to be sufficiently treated.
Pelvic floor issues are rarely isolated—it is common for symptoms to emerge together or for one problem to cause a cascading effect. Some conditions treated by a pelvic rehabilitation therapist include:
- Bladder and bowel issues
- Painful sex or an inability to have penetrative sex
- Vulvodynia (pain of vulva) and genital skin conditions
- Musculoskeletal aches and pains (involving the back, hips, SI joint, groin, abdomen and sometimes limbs)
- Pregnancy & postpartum recovery
You might need to seek care from multiple specialists to address related issues such as back pain and skin issues. Sometimes putting together an integrated treatment plan including a PT/OT, other specialists, and complementary medicine services such massage, yoga, bodywork, and nutritional guidance is the best approach. Your primary care provider or OB/GYN may be able to help you with this.
How to find a pelvic floor therapist
Most major hospitals and large clinics have PTs or OTs on staff who have been trained to offer pelvic floor therapy services. Providers will have a range of focus and experience; it’s worth asking around for recommendations, interviewing different people, and looking for someone who has some knowledge of and experience in treating your condition. You might need a referral from your primary care provider or OB/GYN to make an appointment, though some physical therapists offer direct access or self-referral. Either way, talking to you primary care provider about your pelvic pain or discomfort is a good first step to understanding your situation and determining the best treatment plan.
However, if your physician does not give you a referral or does not provide you with specialized help or resources, this does not necessarily mean that pelvic floor therapy wouldn’t be appropriate for you. Not all health care providers are trained or knowledgeable about pelvic floor health and related resources.
Sometimes getting a second opinion and/or bring in any information or articles you have about pelvic floor health to your next appointment can be helpful.
Depending on where you live, some private physical therapy clinics and practitioners may offer pelvic floor therapy services as well. In some cases these option can be more expensive, but it is worth some research to get the care you need.
What to expect during appointments
The first appointment should include a careful interview and discussion about your experience, including an account of symptoms as well as medical history and lifestyle. Pelvic floor therapists are trained to be sensitive to how personal and intimate these topics and this part of your body can be. The therapist will then evaluate your posture, back, and hips, and they should also explain along the way what they are noticing and how physical therapy can help.
To complete the assessment, your PT/OT may need to conduct an internal exam. Internal examination helps a PT/OT get a full sense of the strength and flexibility of your pelvic floor muscles, ligaments and fascia. For women, this will be through the vagina (though not with a speculum like a standard pelvic exam). For men and some women, the exam is done rectally. In some cases an internal exam is not necessary or possible, such as when your condition involves pain during penetration.
Often a biofeedback examination will be part of the complete evaluation. The therapist will use an internal sensor in your vagina or rectum or external sensors over your skin. These sensors do not do anything to you; they read the electrical activity in your muscles so that you and your therapist can see your pelvic floor muscles at work on a monitor.
If you are on your period or not comfortable doing this part during your first visit, the internal exam can wait until the second appointment. The PT/OT should be sensitive to any pain or discomfort that arises. Be sure to speak up and know that you are in control–nothing should happen without your full consent.
The Take-away: Treatment plan, goals, and timeline
During the first appointment, you may receive some initial advice and education. After the second appointment, you should have a more complete treatment plan. This plan may change based on how your body responds, and may include internal soft tissue work and exercises to do at home. Below are some things that your PT/OT might recommend. Some may require the purchase of a tool and/or lubricant for use.
- Pelvic floor exercises to do at home with or without a biofeedback tool (egg or wand)
- Trigger point massage to release muscle tension
- Insertion and use of a silicone dilator or vibrating wand
- Massage of other parts of the body
- Stretching and yoga
- Other gentle strength-building exercises
- Nutrition and lifestyle
- Mindfulness, breathing techniques and other pain management methods
You may need to have frequent appointments, especially at first, depending on your condition. Your PT/OT should be able to give you an approximate timeline, though rehabilitation and healing is not always predictable. We recommend collaborating with your therapist to set specific treatment goals, such as having comfortable sex, alleviating back pain, managing incontinence, etc.
Heal Pelvic Pain by Amy Stein, MPT
The Better Bladder Book by Wendy Cohen (for folks with Painful Bladder Syndrome)
The information above was adapted from the following sources:
Heal Pelvic Pain by Amy Stein, MPT
Special thanks to Jane Walter for reviewing and contributing input from her experience as a PT.