Urologic Health and Pelvic Floor Physical Therapy
The pelvic floor refers to a group of muscles, nerves and connective tissue that sit in the seat of your pants. Both men and women have a pelvic floor. The pelvic floor assists with urinary function, bowel function, sexual function, and support/stability of the back and pelvis. This blog will discuss how the pelvic floor can contribute specifically to urologic symptoms and how pelvic floor physical therapy can help.
What is pelvic floor dysfunction?
The pelvic floor muscles, like any other muscle in your body, need to contract and be strong, need to relax and lengthen, and need to be coordinated, meaning they contract and relax at the proper time. When the muscles are lacking one of these actions, this is often referred to as Pelvic Floor Dysfunction. Symptoms that may seem like a bladder or urologic problem, can actually be due to pelvic floor dysfunction.
Common Urologic Symptoms Caused by Pelvic Floor Dysfunction
When the pelvic floor muscles are dysfunctional, men and women can experience any of the following urologic symptoms, sometimes similar to the conditions we treat at Pelvic Wellness Omaha. Some individuals experience only one of these symptoms, while others experience a variety of these symptoms in combination:
“Prostatitis”
Urinary Incontinence
Frequent or painful urination
Urgency of urination
Incomplete emptying of the bladder or “slow stream”
Post-Prostatectomy Incontinence
Pelvic pain
Overactive Bladder
Interstitial Cystitis/Painful Bladder Syndrome
Pelvic Organ Prolapse
Pelvic Pain
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a type of specialized physical therapy that treats pelvic floor dysfunction. Pelvic floor therapists specialize in evaluating the muscles of the pelvic floor, determining what is dysfunctional, and creating a treatment plan to optimize pelvic floor function to help relieve urologic symptoms. It is important to find a physical therapist who has specific training in treating the pelvic floor. This is not a skill that all physical therapists have because it does require advanced training. This blog post can help you find a specialist in pelvic floor physical therapy.
What to expect in pelvic floor therapy
A pelvic floor physical therapy evaluation typically involves a combination of assessment, education, manual therapy techniques, and exercises tailored to your specific needs. Here is a breakdown of what you can expect during a first visit with a pelvic floor therapist:
1. Initial Assessment:
At the beginning of your first session, the pelvic floor physical therapist will conduct a comprehensive assessment to gather information about your medical history, symptoms, and concerns. They may ask you questions about your pelvic health, previous treatments, and lifestyle factors. This assessment helps the therapist understand your condition and develop an appropriate treatment plan.
2. Physical Examination:
Depending on your specific concerns, the therapist may perform a physical examination of the pelvic region. This examination may involve external and internal (vaginal or rectal) assessments, including palpation of muscles and tissues, to assess muscle strength, tone, flexibility, and any areas of tenderness or tightness. The therapist will explain the examination process and ensure your comfort and consent throughout. The therapist will also examine the areas adjacent to the pelvic region such as the low back or hips. They will evaluate your posture and watch you perform functional movements that may be related to your symptoms. This will all help them to determine the root cause of your symptoms.
3. Education and Treatment Plan:
Following the assessment, the therapist will provide you with personalized education about your condition and the role of pelvic floor physical therapy in your treatment. They will explain how the pelvic floor muscles function, any dysfunction identified during the assessment, and how therapy can help address your symptoms. They will discuss your treatment goals and develop a customized plan tailored to your needs.
4. Manual Therapy Techniques:
Pelvic floor physical therapists often utilize various manual therapy techniques to address muscle imbalances, tension, or weakness in the pelvic floor. These techniques may include internal or external trigger point release, myofascial release, soft tissue mobilization, or joint mobilization. The therapist will use their hands to apply gentle pressure and movements to specific areas to help relax and restore optimal muscle function.
5. Therapeutic Exercises:
Exercise plays a significant role in pelvic floor physical therapy. The therapist will guide you through specific exercises designed to strengthen, stretch, or relax the pelvic floor muscles. These exercises may include kegel exercises, core strengthening exercises, breathing techniques, and postural exercises. The therapist will provide clear instructions on proper technique and ensure you perform the exercises correctly.
6. Home Program and Self-Care:
To complement the in-clinic sessions, the therapist will typically provide you with a home program consisting of exercises and self-care techniques. They may recommend specific exercises, stretches, or relaxation techniques to be performed at home between sessions. Following the therapist's guidance and consistently practicing your home program will enhance the effectiveness of the therapy and contribute to your progress.
Each pelvic floor physical therapy session should be personalized to address your unique concerns. The number of sessions and the frequency of visits will depend on your condition and treatment goals. Building a trusting relationship with your therapist and maintaining open communication about your progress and any concerns will help optimize your therapy experience.
Success Stories
John
John is a 67-year-old male presenting to his urologist with pain in the perineal area and urgency and frequency of urination. His urologist completes a thorough workup and rules out any infection or other cause. Upon palpation of the pelvic floor muscles, John has extreme tenderness and his pain was reproduced. His urologist recommends pelvic floor physical therapy for his symptoms.
John completes a series of visits with a pelvic floor physical therapist. His therapist discovered significant muscle tension and increased nerve sensitivity in the left side of his pelvic floor. John’s therapist starts him on a home stretching program and also modified his fluid and food intake temporarily to help calm down his bladder. In session, they work on manual techniques to relax and stretch his pelvic floor, as well as retraining his body to let these muscles rest.
After a series of 5 visits, John is 90% symptom-free. He still will have an occasional flare of his symptoms, but with his home program, he can manage the symptoms independently.
Lauren
Lauren in a 24-year-old female presenting to her urogynecologist with recurrent feelings of a UTI, including burning, frequent urination, and lower abdominal pain. Her urine cultures continue to come back negative for bacteria. She is referred to pelvic floor physical therapy.
Upon evaluation by a pelvic floor therapist, it is determined that Lauren has extreme tightness of the muscles of the pelvic floor that work around the urethra, as well as the abdominal muscles that work closely with the bladder.
Lauren’s pelvic floor therapist reviews her current gym routine and helps her modify what she is doing to not make things worse. She also works on a home program to address the tightness of the muscles surrounding the bladder and urethra. While in session, Lauren’s physical therapist uses a form of manual therapy called dry needling to help decrease the tightness of the muscles. They also work on her lifting mechanics at Crossfit to help her pelvic floor and core function more optimally.
After a series of 6 visits spread out over 3 months, Lauren has been symptom-free and is no longer having UTI-like feelings. She can complete her full gym routine without any flare of her symptoms.
In conclusion
Pelvic floor physical therapy is an extremely effective treatment option for many urologic symptoms. The first step to getting relief is discussing your symptoms with your urologist, urogynecologist or primary care physician. Although these symptoms can be embarrassing, there is help.
For questions on whether pelvic floor therapy might help with your urologic symptoms, reach out to Nicole Niu, Doctor of Physical Therapy and Board Certified Pelvic Floor Physical Therapist in Omaha, NE.
Learn More about Adult and Pediatric Urology and Urogynecology
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