What is pelvic floor therapy?
Pelvic floor therapy is an effective method for treating urinary and fecal incontinence. It involves evaluating muscle strength and coordination, then combining manual techniques and exercise to address the problem, and beyond incontinence, it can help with a range of other pelvic health issues.
Exercises
Whether you're dealing with bladder control problems or want to improve sexual function, the right pelvic floor exercises can help. They don't require special equipment and can be done anywhere, standing, sitting, or lying down, as long as you can focus and relax your body, and most people do them at least three times a day, with up to 12 repetitions per session, to see the best results.
These are also known as Kegel exercises, and they target the deep pelvic muscles to strengthen them and reduce the risk of incontinence. It's best to avoid engaging your thigh muscles during Kegels, since that only increases the risk of leakage, and to avoid doing them while urinating, which can cause incomplete bladder emptying and raise the risk of urinary tract infection.
Manual techniques
Physical therapists are trained in a variety of manual techniques for pelvic floor therapy, including massage, myofascial release, stretching, soft tissue mobilization, and trigger point therapy, often used alongside other treatment methods to reduce pain. Pelvic floor manual therapy has been found to increase range of motion and muscle flexibility in the pelvic floor and to improve muscle timing.
These techniques can be applied internally or externally, external approaches include skin rolling and nerve release, and a vaginal dilator can be used externally to help relax the pelvic floor. Internal techniques for pelvic pain may include injecting anesthesia into trigger points, or a therapist using specialized instruments to apply pressure to specific points.
Movement coordination
During pelvic floor therapy, the physical therapist combines education, manual therapy, and biofeedback to improve how the pelvic floor functions, enhancing bowel control, bladder control, and coordination of the pelvic muscles, and helping patients recover from childbirth, surgery, or the effects of aging. It's often recommended as the first line of treatment for many pelvic disorders.
Pelvic floor dysfunction occurs when these muscles aren't able to relax; since they support the vagina and hold the rectum in place, muscles that stay tense can lead to straining during bowel movements and incontinence. Treatment for incontinence and pain during intercourse may use techniques such as anal sphincter work, trigger point therapy, and skin rolling to relax the pelvic muscles, along with biofeedback and behavioral training.
Evaluating muscle strength and coordination
There are several ways to evaluate pelvic floor strength and coordination. Electrical stimulation is one of the most common, and beyond alleviating pain, it can also help decrease urinary urgency. Biofeedback is another method, placing a pressure sensor in the vagina to measure the contraction of the pelvic floor muscles and relay that information back to the patient.
A trans-abdominal ultrasound probe can also be used to evaluate pelvic floor contractions non-invasively, which is useful for patients who are uncomfortable with an internal exam, with the results displayed on a screen. The Laycock PERFECT assessment scheme uses a 6-point scale and a series of fast contractions and relaxations to evaluate pelvic muscle strength.
Treating urinary and fecal incontinence
Dealing with urinary and fecal incontinence can be difficult, but there are treatments that can help improve quality of life, including physical therapy, medication, and surgery. A physical therapist can assess your situation, run tests to identify the underlying cause, and build a personalized treatment plan to help strengthen your pelvic muscles.
Pelvic floor therapy, combining physical therapy, manual myofascial release, and biofeedback, helps strengthen the pelvic muscles and improve anal sphincter control, and it's also effective for treating pelvic organ prolapse. Pelvic floor muscle control can be tested through hands-on and intrarectal testing, and biofeedback measures the strength of contractions to track progress over time. If you're ready to get started, contact our team to schedule an appointment.