Many of the patients that pelvic floor physical therapists see for leaking or weakness have…
How do you know if you need a pelvic floor physical therapist? The answers to this will be different for every person. Let’s start by asking, what are you experiencing? What are you having difficulty with? What is your goal?
There are some things that challenge our pelvic floor throughout our lifetimes.
· Pregnancy is of course the first one that comes to mind. A pelvic floor PT will ask the right questions to get a picture of how your pelvic floor was affected by pregnancy and delivery. These may include how big your baby was, whether you had a c-section or vaginal delivery, and if you had a perineal tear? How long did you push? Did you need help with forceps or a vacuum extraction?
· Chronic constipation, occupations requiring repetitive heavy lifting, and chronic coughing. With each of these, you have chronic increased pressure on the pelvic floor and supporting structures. This strain from larger stools, increased straining, or holding your breath to go poop or lift things, causes dysfunction in the muscles of the pelvic girdle.
· Being overweight, especially increased tummy weight. This too causes increased pressure on the pelvic floor muscles and organs. Physical therapy can address the muscle dysfunction but we also spend time on weight loss strategies and nutrition recommendations.
· Prolonged steroid use. Oral steroids can accelerate the breakdown of connective tissues. This maybe prescribed for allergies, asthma, rheumatoid arthritis, lupus, and cancers. Weak connective tissue can lead to quite a few issues with the pelvic organs and muscles that support them. Some common ones are urinary incontinence, pelvic organ prolapse, bowel dysfunction and joint pain.
· Diabetes. Longstanding or poorly managed diabetes can affect the motor and sensory nerves in the pelvic floor. This can contribute to constipation and urinary leaking, spinal and hip instability.
· Menopause. Decreases in estrogen increase the mobility of connective tissues and can lead to increased urinary leaking or pain with intercourse. This is also when we may see bone loss and sleep disturbances. A good pelvic floor PT should be addressing bone health as well as sleep hygiene.
Surgery. Any pelvic or abdominal surgery can cause the muscles of the pelvic girdle to guard, and recovery generally requires some purposeful strengthening of the core musculature to ensure safe return to daily and recreational activities. Pelvic floor PT will address scar tissue, adhesions and muscle imbalances that can arise after surgery.
While considering some of these challenges that our pelvic floors can have, you can ask yourself some screening questions. A YES to any of these questions can indicate that pelvic floor physical therapy may benefit you and help you meet your goals.
· How often do you go pee? Is it more than every hour? Less than every 4 hours?
· Do you leak urine if you cough, sneeze, or exercise?
· Do you feel like you can’t make it to the bathroom in time?
· Do you have pain during or after intercourse?
· Do you feel pressure or heaviness in your pelvis?
· Do you feel like something is “falling out” of your vagina?
· Do you have pain or difficulty inserting a tampon or having a well-woman exam?
· Do you have pain in your hips, tailbone or pelvis while sitting, standing, or moving from different positions?
Pelvic floor physical therapy can help to improve your symptoms to these questions or other symptoms that you are experiencing. We also can partner with your other health care providers to help you have a team approach to your health care. We are licensed PTs so are skilled at treating the whole body (we aren’t just limited to the pelvic floor) and looking for the root cause of dysfunction.