Pelvic Floor / Women's Health Rehab

What is Pelvic Floor PT?

The pelvic floor consists of muscles at the base of the pelvis that support our internal organs and control our bladder and bowel activity. Just like any other muscles of the human body, the pelvic floor can be evaluated, treated, and trained to perform optimally. PT in this area focuses on evaluating the muscle tissue and contributing factors that affect the pelvic floor's ability to function properly. Pelvic floor related conditions can be difficult to discuss and subsequently left untreated and ignored. At Southland, we understand the intimacy of these conditions and provide a welcoming and comfortable environment where you can receive personalized treatment that caters to your goals and overall well-being.

What conditions can be treated by PF PT?

Women's Health:
1. Urinary Incontinence
  • Decreased voluntary control of bowel and/or bladder function resulting in the involuntary loss of urine
    • Stress: Involuntary loss of urine with physical exertion (sneezing, coughing, laughing).
    • Urge: Involuntary urine loss accompanied by or immediately preceded by a strong urge to urinate.
    • Mixed
2. Frequent or Urgent Urination
  • The urge to urinate more than usual that can strike suddenly and cause discomfort due a sensation of a full bladder, or loss of control of your bladder. (Sometimes referred to as overactive bladder.)
3. Prolapse
  • Descent of internal organs (usually the bladder, rectum, or uterus) into or out of the vagina.
    • Cystocele: Prolapse of the urethra & bladder
    • Rectocele: Prolapse of the rectum
    • Enterocele: Prolapse of the small intestine
4. Pelvic Pain Syndromes
  • Pain in the area below your bellybutton and between your hips that lasts six months or longer. Pelvic pain can have multiple causes, or be secondary to other conditions.
    • Dysmenorrhea: Painful menstruation
    • Dyspareunia: Pain with vaginal penetration
    • Vulvar Pain (Vulvodynia): 3 (or more) months of pain without identifiable cause
    • Vaginismus: Inability to penetrate the vagina
    • Interstitial Cystitis/Painful Bladder Syndrome: Pain, pressure, or discomfort related to full bladder (associated with frequency/urgent urination)
5. Pre & Postnatal Wellness
  • Throughout the course of a pregnancy, hormones are released into the body in preparation for childbirth causing many changes in a woman's body that may induce pain or discomfort and limit her ability perform certain activities.
    • Sacroiliac Joint Dysfunction: Pain in the buttock area due to joint laxity
    • Low Back Pain: Muscle strain and tension
    • Pregnancy-related Sciatica: Nerve pain that travels behind the leg
    • Diastasis Recti: Separation of the abdominal muscle wall
    • Coccydynia: Pain in the tailbone
    • Exercise during pregnancy and/or postpartum return to exercise: Safe and appropriate exercise progression based on trimester, as well as safe return to exercises after delivery.
6. Post-Operative Care
  • Just as it is important to receive PT promptly after an orthopedic surgery, it is crucial to receive care following abdominal, gynecological, and oncological surgeries in order to facilitate proper healing of scar and muscle tissues to regain range of motion and strength.
    • Cesarean Section
    • VBAC (Vaginal Birth After Cesarean)
    • Hysterectomy
    • Mastectomy
Men's Health:
1. Incontinence (urinary or fecal)
  • Decreased voluntary control of bowel and/or bladder function resulting in the involuntary loss of urine and/or bowel movements
    • Stress: Involuntary loss of bowel or bladder movements with physical exertion (sneezing, coughing, laughing).
    • Urge: Involuntary urine loss accompanied by or immediately preceded by a strong urge to urinate or defecate.
    • Mixed
2. Frequent or Urgent Urination
  • The urge to urinate more than usual that can strike suddenly and cause discomfort due a sensation of a full bladder, or loss of control of your bladder. (Sometimes referred to as overactive bladder.)
3. Pelvic Pain Syndromes
  • Pain in the area below your bellybutton and between your hips that lasts six months or longer. Pelvic pain can have multiple causes, or be secondary to other conditions.
    • Prostatitis: Inflammation of the prostate that is associated with symptoms of difficulty with urination, and pain in the groin, pelvic area, or genitals.
4. Post-Operative Care (Post-Prostatectomy)
  • Just as it is important to receive PT promptly after an orthopedic surgery, it is crucial to receive care following abdominal, gynecological, and oncological surgeries in order to facilitate proper healing of scar and muscle tissues to regain range of motion and strength.
    • Post-Prostatectomy: Surgical removal of the prostate after cancer. Typically leads to urinary incontinence.
5. Related Orthopedic Conditions:
  • It is important to remember the critical function of the pelvic floor not only in bowel and bladder function, but in conjunction with the hip, back, and abdominal muscles that support our spine and pelvis. For both men and women, treatment of many orthopedic conditions revolves around core stability, and this includes the pelvic floor.
    • Low Back Pain
    • Hip or Groin Pain
    • Sacroiliac Joint Dysfunction
    • The Female Athlete

What to Expect on Your First Visit

Initially, you will have the opportunity to discuss your symptoms and past medical history with your therapist. They will take plenty of time to listen to you, your story, and your concerns. As part of the evaluation, your therapist may perform a minimally invasive internal pelvic exam by placing a gloved finger into the vagina (or rectum for male patients) to assess the strength and integrity of your muscle tissue. Each therapist qualified in pelvic floor examination has had these techniques performed on themselves as part of their training and will guide you through the entire examination, explaining what they doing and why, as well as what they need you to do. At any time, you can ask questions or request to pause or stop the examination. Your therapist may also examine related areas (such as your low back and hips) that may be contributing to your symptoms. After the exam you and your therapist will determine a treatment program specific to you based on the exam findings.

FAQs

Q. Can just anyone be a pelvic floor physical therapist?
A. No. Your therapist has received a Doctorate of Physical Therapy and has also received extensive training through additional courses and education from other pelvic floor specialists.
Q. How long will sessions be?
A. The first session (initial evaluation) takes 60 minutes and follow-up visits will be between 30-60 minutes, depending on your specific condition. This will be established on the first visit and you will be given a better idea of what to expect after the evaluation.
Q. Where will all of this take place?
A. All evaluations and treatments take place in a private room, behind a solid door.
Q. What should I wear? Will I have to take my clothes off?
A. For the internal examination and most manual pelvic floor treatments you will need to remove clothing from the waist down, otherwise you will be fully clothed. You may be doing various stretching or strengthening exercises of other parts of your body, so comfortable clothing that you can comfortably move in is recommended.
Q. Can I come to my evaluation or treatments if I am on my period?
A. Yes. Menstruation does not affect evaluation or treatment in any way. Understandably, some patients prefer to avoid coming on days of heavier flow, however disposable menstrual cups are available to wear during the session.
Q. I have urinary incontinence, what if I have to go to the bathroom during the exam or treatment?
A. There is a restroom in the clinic, and we can always stop at any time for a bathroom break.
Q. What is biofeedback?
A. A non-invasive procedure that measures the activity of your muscles. A sensor will be placed over your pelvic floor muscles externally (outside of the body) and attached via a wire to a computer screen. This allows you and the therapist to visually see your muscle activity every time you squeeze or relax your muscles. This is not only a measurement tool for the therapist but a learning tool for you.
Q. I am pregnant, is this safe?
A. Yes. Internal exams are not typically completed later in the pregnancy, but it is best to ask obstetrician/gynecologist prior to seeking pelvic floor therapy if pregnant. Biofeedback is 100% safe during pregnancy and treatments will be modified to accommodate your pregnancy.
Q. Will I need to exercise at home?
A. Yes, you will be given an individualized exercise program. Many exercises can be done anywhere, and can be fit into even the busiest schedule.
Q. I already know how to do Kegels, but I still have symptoms. How will this help me?
A. Pelvic floor training can involve strengthening exercises (Kegels), however many people have not been trained in how to do them correctly and can actually be training bad habits that cause more harm than good. Your therapist will be able to determine the optimal duration, rest time, and repetitions for you to have the most effective results. Your therapist is trained to teach correct form for both strengthening exercises as well as relaxation techniques which are just as important. This education and training will help you recover much faster then only doing Kegels at home.
Q. What if my issue is embarrassing and hard to talk about?
A. Your therapist is a professional and has only your best interests in mind. While it is sometimes challenging to talk about your symptoms, it is very important to tell them everything that you are experiencing so they can help you as best as they can. Your therapist is also your teammate and will do their best to create an environment that you are comfortable in. Keep in mind that they have seen, heard or experienced most of the issues that come through their office.
Q. What if I want someone else present during the examination?
A. You are welcome to bring a family or friend with you, or you have the opportunity to request a chaperone (typically another therapist or staff member) to be present with you during the examination.
Q. What if I am not comfortable with having an internal examination?
    Can I still receive treatment without it?

A. It is understandable that, for many reasons, patients may not want to have an internal examination performed, and you will not be examined without consent. If you choose to not have the internal examination performed, there are other methods of treatment and education that will help improve your condition. If you are unsure on your initial visit, the internal exam can always be deferred to subsequent visits as you develop a comfortable rapport with your therapist.

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