Asking A Pelvic Floor Physical Therapist: Frequently Asked Questions
When it comes to our own bodies, it seems we can never know enough. The body is so weird─it does so many fascinating things! This is why I became a health care provider. I was so curious about my own body and how it functioned.
As a pelvic health specialist, I’ve delved into the depths of bowel, bladder, and sexual functions (& dysfunctions). This tends to come with SO MANY QUESTIONS! I hear ya, I was asking all the same things. So I thought I’d answer some frequently asked questions and probably some questions you never knew you had!
What is pelvic floor PT?
Pelvic floor PT is a specialty of physical therapy focusing on the functions and dysfunctions of the pelvic floor muscle group and its surrounding structures. We help patients with pelvic floor rehab mostly, as well as injury prevention.
Where is my pelvic floor, and what exactly does it do?
You’re sitting on it! Your pelvic floor is a hammock-shaped, 3-layer muscle group at the base of the torso, linking together the ring of bones that make up the pelvis… kind of like a trampoline. This muscle group is responsible for some really important things related to bowel, bladder, and sexual functions. It controls the sphincters, supports the pelvic organs, helps with blood and lymphatic flow through the lower body, stabilizes the pelvic ring so we can maintain a solid foundation for moving around, and helps achieve and maintain erections and orgasm for healthy sexual function.
How do I know if I have a pelvic floor problem?
There are many sneaky symptoms of pelvic floor dysfunction. Pelvic pain is an obvious one (during sex, while using the bathroom, exercising, or randomly!). We also see patients for urinary or fecal incontinence, constipation, post-op for abdominal or pelvic surgeries, pelvic heaviness/pressure and prolapse, difficulty or pain with emptying the bladder or bowels, core weakness or abdominal muscle separation, and sexual dysfunction. Even hip, groin, and back pain could be a pelvic floor problem.
What does a pelvic floor evaluation or treatment look like?
Many people are apprehensive about what treatment will include. I went in-depth about this in my last blog post. But in a nutshell… we take a whole-body approach! We assess how your pelvic floor is functioning with the rest of the body as you move and live your life. Sometimes this involves internal pelvic floor muscle work or assessment, but only within your comfort level! Usually, treatment includes a combo of hands-on therapy, education, stretching, and strengthening… all customized to YOU and what we discover during our evaluation.
Can I do pelvic floor PT when I’m on my period?
Yes! Very common question… internal therapy can proceed during this time. No problem on our end, however, everything we do is based on your comfort level. There’s always plenty we can do without going internal, too!
Do you see men for pelvic floor PT too?
Absolutely! Men have pelvic floors too. We see men for many similar symptoms as women: post-op abdominal or pelvic surgeries, incontinence, constipation, or pain! The list goes on.
Can my back pain or sciatica be a pelvic floor problem?
It can! The pelvic floor muscles attach to the tailbone which is the last bone of the spine. So you could imagine that any abnormal tugging on that tailbone would absolutely cause some low back pain. Some of these muscles even run adjacent to the sciatic nerve. Sometimes, if these muscles get too tight or irritated, it can put more strain and irritation on the sciatic nerve too causing some symptoms down the leg.
How does my respiratory system have anything to do with my pelvic floor?
This question usually comes up later on during treatment. We often give different breathing exercises or educate on different breathing sequences depending on our patient’s pelvic floor dysfunction… but why? Breathing actually has a huge influence on our pelvic floor! Did you know the number one comorbidity to incontinence is respiratory dysfunction?!
Our diaphragm is our main breathing muscle and is an arc shape that lies underneath our lungs. It is almost a mirror image of our pelvic floor and is considered to top off the core while the pelvic floor is considered to bottom off the core. As you breathe in, the diaphragm drops which increases the pressure in the abdomen and allows a gentle drop in the pelvic floor. When you exhale, the diaphragm lifts up, making more room in the abdominal cavity, reducing the pressure, and the pelvic floor gently lifts too. They work simultaneously like a piston in a car. In therapy we use this to our advantage to achieve whatever goal we’re going for: if we need more strength with a pelvic floor muscle contraction, we pair that contraction with an exhale. If we need more relaxation, we pair that relaxation with a big deep breath in. It’s all about pressure control!
What are some specific conditions that can be treated with pelvic floor PT?
So many conditions! Here are some common ones: pelvic pain, dyspareunia (pain with sex), urinary incontinence, fecal incontinence, pelvic organ prolapse, post-op for abdominal or pelvic surgeries, constipation, hemorrhoids, urinary frequency, urinary/bowel urgency, low back pain, groin/hip pain, and flank/abdominal pain.
I was told leaking urine during or after pregnancy and after menopause was just a normal part of being a woman; is it?
I get this comment often. The truth is, incontinence in women is common but not normal. And there are lots we can do to fix it! Sometimes it’s a strength issue or sometimes it’s coordination! An evaluation of your pelvic floor muscles can help us narrow down what’s going on but it is definitely not something you should have to live with!
Don't wait for things to get worse.
The topic of pelvic health can be an uncomfortable discussion for some, but don't let that stop you from getting your personal questions answered and your pelvic symptoms addressed. Appointments can be made in person or virtually via Telehealth based on your comfort level. Use our "Request An Appointment" tool at the top of this page to get started.
Watch Now: FORUM: Pelvic Pain and Physical Therapy
Our pelvic health team recently hosted a public forum on pelvic pain and the role of physical therapy in the rehabilitation of this muscle group for both women and men. For a more in-depth look on this topic, watch the recording of the session below:
Sarah Shaw, PT, DPT, is a physical therapist specializing in pelvic floor rehabilitation at Rehab United's Bonita and Kearny Mesa locations. She received her Doctorate in Physical Therapy in 2019 from San Diego State University and has since been continuing her education in pelvic pain, women's and men's pelvic health, and Applied Functional Science. While the pelvic floor is her specialty, Sarah also treats other orthopedic-related injuries, ensuring a more well-rounded and holistic approach to pelvic health.