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What to Expect from Pelvic Floor Physical Therapy

Pelvic Floor Physical Therapy. What is that? I didn’t even know there was such a thing! What do you even do in pelvic floor physical therapy? How do you get involved with something like that?

These are just some of the many responses I hear when I explain my profession as a pelvic floor physical therapist. It is understandable. For many years there has been little information about this niche practice of physical therapy. Even some providers in the medical field are unaware of our existence to this date. And while social media and word of mouth have done a lot to increase our visibility in the public eye, there is still a lot of confusion about what to expect from pelvic floor physical therapy.

What We Are

We are physical therapists. Movement experts. This means we use our understanding of muscles, bones, connective tissue, nerve, joints, etc to provide conservative interventions that improve symptoms related to those structures. We believe in using movement as medicine. It could mean releasing a tight muscle, strengthening a weak one, improving range of motion at a joint, or providing input to the nervous system, among other things, all to lessen pain or dysfunction and return an individual to activities that matter to them.

What We Do

Pelvic floor physical therapists have the same perspective as other physical therapists in regards to healing, using the movement as medicine; however, our training is more specialized

in regards to the muscles and structures interplaying with the pelvic floor. Because the pelvic floor muscles are the guardians of bowel, bladder, and sexual function, pelvic floor physical therapy can almost feel more medical in nature. We are interested in how the pelvic floor may be involved in how a patient is peeing, pooping, engaging in sexual activity, eating, drinking, sleeping, etc, so our line of questioning often feels similar to what your primary care physician might ask.

The conversations you can expect to have in pelvic floor physical therapy are more private and sensitive in nature than those you might have in general outpatient physical therapy to rehabilitate the shoulder for instance. For this reason, we adamantly believe that pelvic floor physical therapy should always be conducted one on one, meaning one provider and one patient, in a private space away from other patients and providers to respect comfort and build trust.

We assess and diagnose symptoms in much the same way as other physical therapists, testing muscle function, evaluating range of motion, and screening how the nervous system is functioning; however, it is likely to feel much different to the patient because of where these muscles live. The pelvic floor exists at the bottom of the pelvis and surrounds the genitalia and anus. The gold standard for pelvic floor muscle evaluation is digital vaginal or rectal evaluation, or one gloved, lubricated finger inserted into the vagina or anus and then placed onto the muscle belly itself. These exams sound intimidating, but these exams are generally well-tolerated because a physical therapist is going to address any symptoms as they arise. If anything is painful, we are not going to ignore it, we are going to treat what we find as we find it. Nonetheless, you should never be made to feel like you have no alternative to this procedure. We can always approach therapy from an external lens, assessing muscles through visualization of the perineum, over clothing, or not at all. I have treated several patients by adjusting our treatment approach based on what they tell me about their response. So it is possible to still achieve results without direct examination if this is your preference.

However you choose to be evaluated, the next step in your therapy should be to discuss your goals, what you want to get out of the experience. And then designing a plan with your provider that you are comfortable with to meet those objectives. The process should make you feel respected, heard, and hopeful.

At Core Moves we describe a four step process to providing care:

1. Assess the Situation

We want to identify what movement patterns, structures, or conditions may be responsible for the symptoms of concern.

2. Create a Glimmer

We want to foster hope by making a change. Our aim is that patients feel some change on their very first visit. Maybe this is a reduction in pain or leakage. Maybe it is simply feeling heard and optimistic about the journey ahead. Everyone’s journey is different, but we commit to being there for the duration.

3. Make the Glimmer Grow

Once a patient is experiencing symptomatic improvement and we are pretty certain we are on the right track to healing, we want to continue to foster that improvement through education, movement retraining, and symptom-reduction strategies.

4. Make the Glimmer Last

Finally, we want our patients to experience lasting results that do not feel like a chore to maintain. We work together to find self-care solutions that are enjoyable and effective. We offer fitness classes designed from a pelvic health perspective through our Wellness Studio as one option. The path to long-term relief may look different for each patient, but we try to facilitate conditioning that is greater than the demands of daily life. This way patients can move through their life feeling more confident, capable, and comfortable.

To Sum Up:

-Pelvic floor physical therapy is not different in principle from standard physical therapy.

-It looks at the pelvic floor in relation to the rest of the movement system to identify the cause and facilitate the reduction of symptoms.

-It feels a lot different from standard PT because of where the pelvic floor lives and what physiological processes the pelvic floor mediates.

-It may involve sensitive discussions and so privacy should be respected.

-It may involve a pelvic exam with one gloved lubricated finger in the vagina or rectum.

-You should be provided with several options for examination and should never feel pressured into giving consent.

-You and your therapist should work together to design a treatment plan that you feel comfortable with and that addresses your goals.

-You should feel heard, respected, and hopeful. If you do not, consider seeking a second opinion.

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