What is the pelvic floor?

The pelvic floor is a group of skeletal muscles that sit at the bottom of your pelvis. These muscles have five major roles: 

  • Sphincteric: They control both the urethral and anal sphincters, which are responsible for control of our bladder and our bowels.
  • Support: These muscles act as a basket to support the organs that sit in our pelvic area, including the bladder, rectum, and uterus. 
  • Sexual: For men, the pelvic floor muscles help to achieve and sustain an erection and allow for penetration. For both men and women, sufficient strength of the pelvic floor muscles is necessary for orgasm, and excessive tension or sensitivity of the pelvic floor can also contribute to pain during or after intercourse.
  • Stability: Pelvic floor muscles are primary stabilizers of the pelvis and sacroiliac joints.
  • Sump-pump: The pelvic floor muscles pump lymph fluid and blood from the pelvic region. If these muscles are not working correctly, you may experience swelling or pelvic congestion.
  • The pelvic floor muscles can be negatively affected by pregnancy, childbirth, treatment for gynecologic and colorectal cancers, stress, or direct trauma to the pelvic floor muscles, though there are many other sources and causes of pelvic floor muscle dysfunction. At Premier Spine and Sports Medicine, we want patients to know that with pelvic floor physical therapy, there is hope for you, whatever pelvic symptoms you may be experiencing.

    What conditions do pelvic floor physical therapists treat?

    Pelvic floor muscle dysfunction can mean many things. The muscles of the pelvic floor may be weak, stretched, tight, or painful. The condition of pelvic floor muscles typically determines the kinds of symptoms you are experiencing. If the muscles of the pelvic floor are weak, you may experience urinary or fecal incontinence, pelvic and/or lower back pain, pelvic organ prolapse, or sexual dysfunction. If the muscles of the pelvic floor are tight, you may experience myofascial pain, difficulty urinating, constipation, or painful sexual intercourse. The following is a list of common conditions that can often be treated with pelvic floor physical therapy:

    • Sacroiliac joint pain
    • Urinary and/or fecal incontinence
    • Vulvodynia
    • Vaginismus
    • Coccyx pain
    • Constipation
    • Pelvic organ prolapse
    • Painful intercourse
    • Chronic pelvic pain

    These conditions are only a few of the many that a pelvic floor physical therapist can help you manage. 

    What to expect at your first visit

    The first portion of your examination will include a detailed history of your condition. You will discuss specific symptoms that you are experiencing, your bowel and bladder habits, sexual health, lifestyle, and diet. It is important to be as detailed and as thorough as you can when talking to your physical therapist. The information that you give your therapist helps them to guide you through the rehabilitative process.

    The second part of your examination will include thorough medical screening and an assessment of your lower back, sacroiliac joints, abdomen, and hips. It is common for individuals with pelvic floor symptoms to have range of motion, strength, or flexibility issues in these specific areas.

    With your consent, the last part of your examination with include a pelvic floor muscle examination. For males, this involves going through the anus, and for women, this involves going through the vagina or the anus. You will be covered almost entirely by a drape sheet for privacy, and you may choose to have a chaperone present for your comfort.

    The pelvic floor muscle examination will assess the following:

    • Resting position of the pelvic floor 
    • Reflex contraction of the urethral and anal sphincters
    • Ability to voluntarily contract the pelvic floor muscles
    • Endurance, strength, and power of the pelvic floor muscles
    • Tenderness or trigger points in the pelvic floor muscles
    • Health of skin and tissues in the perineum
    • Scar mobility from previous surgeries or trauma
    • Ability to fully relax the pelvic floor muscles

    Your physical therapist will guide you through the entirety of the examination. Findings from the examination will help your physical therapist determine a plan of care to help treat your symptoms.

    What kind of treatments do pelvic floor physical therapists use?

    As with all physical therapy, your treatment plan will be personalized to meet your specific needs. There are different kinds of treatments that will be utilized depending on your symptoms. The following is a list of a few common types of treatment that can be used:

    • Bladder, bowel, and food diaries
    • Postural re-education
    • Biofeedback
    • Manual therapy to release trigger points or scar tissue
    • Core strengthening
    • Education for appropriate toileting techniques
    • Electrical stimulation
    • Behavioral strategy education

    If you or anyone you know can relate to any of the symptoms described above, please know that there are individuals specially trained to help you. To learn more about the pelvic floor physical therapy program at Premier Spine and Sports Medicine, call our office in Hagerstown, Maryland, or request an appointment online. 

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