Pelvic Physical Therapy
Updated: Dec 2, 2019
This topic is very interesting to me for several reasons. One, I never learned about pelvic physical therapy in medical school or in residency as an OB/GYN! I learned about it when I opened my very first private practice office in Crestview, FL. A lovely, English lady, Ruth Jenkins, came to see me, as I was setting up my office, to introduce herself to me. Everything I know is from Ruth. Two, I have witnessed Ruth and her colleagues do amazing things for women, and three, not many women are interested in going to get pelvic physical therapy which surprises me because it is such a great intervention that doesn't require medications or surgery!
Pelvic physical therapy work involves the muscles of the pelvic floor. In the above picture, you can see where those are located. They are very much like a hammock on which your pelvic organs sit. For women, the vagina, rectum, and urethra (opening from your bladder) runs through those muscles. Therefore, these muscles help with preventing leakage of urine and stool. They also are involved in sexual arousal and orgasm.
Looking at the picture, you can understand how dysfunction of these muscles can lead to incontinence, pain, and prolapse of your rectum, vagina, or uterus. Prolapse is like a hernia. It's when these structure begin to protrude from their openings. These muscles are also helpful for pelvic stability. Weak muscles of the pelvic floor can contribute to an increased risk of falls. Women with urinary incontinence are 30% more likely to fall than women who have a strong pelvic floor, and if you break a hip from a fall, especially when you are elderly, it can carry a 40% chance of death from complications from the fracture!
Some reasons I have sent patients to Ruth and her colleagues, who work for Fyzical Therapy & Balance Centers, are for incontinence of urine, prolapse, pelvic pain, especially in my runners or extreme exercisers; I've also sent patients who could not have sex due to pain issues. The one thing I have learned is Kegel's exercises don't fix everything. Even in incontinence and prolapse, Kegel's may not be the correct exercise that you need. These patients all benefitted from intervention with pelvic physical therapy.
Some other reasons I have seen listed for a pelvic physical therapy consult would be some of the following:
chronic low back pain/sciatica
C-section/episiotomy scar pain
Pregnancy stretches and weakens the pelvic floor muscles tremendously, especially if you have a vaginal delivery. You can see a pelvic physical therapist during the pregnancy to give you help on what to do to minimize the trauma to the muscles of the pelvis. Once you are delivered, you can begin to work with them at about 6 weeks after delivery to begin the strengthening process and to address any other issues you may have like diastasis recti (where the abdominal muscles separate to each side of the abdomen, and your stomach protrudes between the muscles). They can also help with that episiotomy scar or scar from a laceration.
When you go for a visit, usually the first visit is getting to know you and your history. Pelvic floor physical therapy can be an intimate type of therapy because it's done through the vagina or anus. You can have it done without going through the vagina or anus, but it's not as effective. It can be a little unsettling until you get to know your therapist. The therapists are very professional and help walk you through the exam and therapy sessions. Also, for women, you are given a female physical therapist. There can be between 6-12 visits needed depending on what is found during your initial exam. Insurance may or may not pay for pelvic physical therapy. You would need to check with your insurance provider to see if it's covered and for how many sessions. Your doctor also may need to refer you. Usually, it would be your OB/GYN if there is a pelvic floor physical therapist in your area. Unfortunately, they are not everywhere.
If you are pregnant or have ever been pregnant, you may benefit from seeing a pelvic physical therapist. If you have pelvic pain from adhesions, endometriosis, exercise, you may benefit also. If you are having difficulty with intercourse, a pelvic physical therapist may very well help solve your problem. Consider this as an option to your care. Discuss it with your doctor, and have her refer you if you both feel there would be a benefit. Fortunately, for those of us living in Okaloosa and Walton Florida counties, we have Fyzical. They are located in Crestview, Niceville, and Defuniak Springs Florida!
Disclaimer: While I am a doctor, I am not your doctor. The information in this blog post is for information and entertainment purposes only and are not intended as medical advice!