About Pelvic Floor Therapy
What are the functions of the pelvic floor muscles?
The pelvic floor is comprised of a number of muscles that are responsible for providing support of the pelvic organs. The pelvic organs include the urinary bladder, intestines, and for women – the uterus. The pelvic floor controls the release of urine or excrement. Although pelvic floor dysfunction can occur in both men and women, this condition is far more common in women, especially those who are pregnant or have given birth.
What is pelvic floor dysfunction?
The muscles that make up your pelvic floor function similarly to other muscles in your body. They contract and relax to assist in digestion while also keeping your pelvic organs in the right place. Unfortunately, these pelvic floor muscles can also get injured or suffer from over or under use. For instance, if your muscles are constantly tight and contracted, you may find yourself dealing with constipation. If your muscles are underused and weak, you may not be able to control your bowel movements and suffer from incontinence.
Pelvic Floor Dysfunction in Women
Although pelvic floor dysfunction can affect both men and women, it is far more common in women. This is especially true for women who are pregnant or who recently gave birth.
During pregnancy (prepartum), your body undergoes a great number of changes. Your weight may increase, and parts of your body will start to take on a greater amount of strain. Your abdominal wall and pelvic muscles will adjust themselves to make room for your baby. This can lead to pain while performing certain movements or holding certain positions such as sitting for long periods of time. Conditions such as pubis symphysis dysfunction and urinary incontinence can be attributed to these kinds of changes in the body during pregnancy. Having pelvic floor therapy done during pregnancy can better prepare women’s bodies during childbirth.
After giving birth (postpartum), pelvic floor treatment is also very beneficial. A significant number of women suffer from pelvic organ prolapse and/or diastasis of the abdominis rectus – the separation of the abdominal muscles. Another issue that many women face after childbirth is the tearing of the perineum from an episiotomy. Getting treatment after giving birth can ensure a faster recovery and correct any musculoskeletal dysfunctions.
Pelvic Floor Dysfunction in Men
For men, pelvic floor dysfunction is largely ignored or overlooked – even by many practicing medical doctors and physical therapists. Men suffering from chronic groin pain, erectile dysfunction, urinary incontinence, or pain after ejaculation may not know that pelvic floor dysfunction is the point of origin.
Male pelvic pain is, more often than not, mistakenly diagnosed as prostatitis – the inflammation of the prostate gland. This can lead to unnecessary prescriptions like antibiotics, which will have no effect, and in more serious cases, undergoing surgery when surgery is not needed.
Men are strongly encouraged to see our pelvic floor specialist, Irene Hernandez, DPT, for an evaluation to rule out prostatitis.
Meet Our Pelvic Floor Therapist
Irene Hernandez, DPT
Physical Therapist & Certified Pelvic Floor Therapist
- Treats Pelvic Floor dysfunction for both men and women.
- Pilates-based Physical Therapy.
- Hypopressive Method – used to help post-natal women prevent and/or recover from pelvic floor dysfunction (incontinence, prolapse).
- Iyengar yoga instructor.
Common Conditions Treated
Weak pelvic floor muscles may be the reason you suffer from Low Back Pain. When we think of our body’s core muscles, we normally imagine pronounced six-pack abs. Our core is much more than this, though. The best way to imagine our body’s core is by visualizing it as a cylinder – our abs only make up one side (front) of our core. The other muscles involved are our transversus abdominis which wraps around our organs (like a natural corset), our diaphragm which sits right below our rib cage and assists our lungs to take in air and breathe, our back muscles which include the erector spinae and longissimus thoracis, our oblique muscles (sides), and last but not least, our pelvic floor muscles which make up the “bottom of the cylinder.”
Our core muscles play a crucial part in holding our organs in the right place and work together to help us move and carry out our daily activities. Our pelvic floor muscles are no different. When they become weak, other muscles – in this case your lower back, have to pick up the slack and become overworked. Unfortunately, many medical doctors neglect the role of the pelvic floor as it is not entirely understood.
Luckily, there has been a large push in the world of physical therapy and women’s health to raise awareness of the importance of the pelvic floor and the therapies available to correct any dysfunctions. If you currently suffer from unexplainable back pain and feel like you’ve run out of solutions or options, we strongly encourage you to see our pelvic floor therapist, Irene Hernandez, DPT for an evaluation.
Pubis Symphysis Dysfunction (SPD)
Pubis Symphysis Dysfunction (also known as Pelvic Girdle Pain) normally affects pregnant women and is described as a sharp pain originating from the pubic area or as a radiating pain that is felt in the surrounding muscles and joints around the hips, lower back, and upper inner thighs. During pregnancy, your pelvis can experience pain and muscle weakness from the changes in your body.
The pubis symphysis, which is the cartilage that holds the two halves of the pelvis together (colored green in the illustration above) separates during childbirth allowing more space for the child to exit. This also creates instability of the pelvis making it difficult or painful to walk, sit, or bear weight on one leg.
With physical therapy, and more specifically, pelvic floor therapy, we can help strengthen weak muscles to help support your body as it changes and prevents more serious issues to arise during and after birth. Stabilization exercises and raising awareness of your body’s posture and positioning can help reduce complications throughout your pregnancy.
Swelling of Genital Area
During pregnancy, you may experience swelling in your genital area. Discoloration and increased sensitivity may occur due to the increased blood flow. For some women, a swollen vagina may interfere with urination and many women complain of painful urination.
Vaginal and Vulvar Vein Varicosities are also common during pregnancy. These varicose veins may appear externally or internally and can be painful to the touch. They are due to the increased pressure pushed upon the uterus and pelvis from the child, especially as you get closer to delivery.
Pelvic floor therapy consisting of lymphatic drainage massage in the perineal area, can address these symptoms and help relieve sensitivity and pain. Women who have given birth multiple times in the past may be more susceptible and are encouraged to seek treatment.
A woman’s body experiences a lot of trauma during childbirth. Luckily, there are a number of issues that pelvic floor therapy can address postpartum.
Treatment of Episiotomy
Episiotomy is a surgical procedure that cuts the perineum (the muscle between the vagina and anus) to allow more room for a large baby, twins, or premature baby to be delivered. After the skin, muscle and fascia heal from this surgery, scar tissue will form. In some cases, this scar tissue can cause discomfort, itchiness, muscle tightness, and can make sex painful.
It is important to set the healing process on the right track with the proper rehabilitation of this scar tissue and the pelvic floor to “retrain” it, improve mobility, and reduce pain. This is especially true for the healing muscle, which can be very tight and may develop trigger points. In this case, manual therapy, as well as mobilizing exercises, can help a great deal.
Diastasis Rectus Abdominis (Separated Abdominal Muscles)
During pregnancy, your body releases hormones to allow your abdominal muscles to stretch to make more room for your developing baby. In some cases, your abdominal muscles may split down the middle and become separated. Re-training and strengthening of the abdominal wall are very important postpartum as it plays a big role in the voluntary control of urine and feces. Leakage can occur when the rectus abdominis is weak.
Seeing a pelvic floor therapist during and after pregnancy can help strengthen your abs and prevent diastasis recti.
Rehabilitation and Strengthening of Pelvic Floor Muscles
There are plenty of online resources claiming to have the perfect regimen for strengthening your pelvic floor muscles after pregnancy. Unfortunately, there is no professional guidance as to whether you are performing these exercises correctly. For many women, this can lead to more problems.
By getting treatment from a certified pelvic floor therapist, you’ll be eliminating any of the guesswork of whether you are doing certain exercises correctly or not.
Symptoms include pain in the lower abdomen, lower back, pelvis, rectum, or vagina especially during intercourse, and menstruation.
Women with endometriosis describe their menstruation cramps being far more intense than normal, usually describing it as a constant sharp, stinging pain. Other symptoms can include urinary urgency and frequency, constipation and fatigue.
Endometriosis is a condition that only affects women. It is when tissues normally found in the uterus grow outside of it, commonly around the ovaries, fallopian tubes, and in more rare cases, other parts of the body.
It is associated with inflammation, scar tissue and adhesion formation in the abdominal and pelvic areas. These growths cause a lot of pain and may require surgery to remove.
Our pelvic floor therapist can help to relieve pain felt in the abdomen, back, and pelvic areas due to endometriosis.
Tightness in the pelvic floor muscles can occur from the involuntary contractions that endometriosis pain causes. Trigger points can form in these muscles, which must be treated with manual therapy in order to relieve pain, and improve bladder and bowel function.
Myofascial release and visceral mobilization techniques help reduce the tissue restrictions caused by adhesions and improve the movement and function of the pelvic organs. Breathing, bodily awareness, yoga and relaxation techniques help reduce and cope with the experience of pain.
Treating Pelvic Floor Dysfunction
How is pelvic floor dysfunction treated?
So how does a physical therapist treat pelvic floor dysfunction? What would a typical session look like? Below are some modalities that we use to treat our patients.
Your pelvic floor therapy session will probably include the use of soft tissue mobilizations such as myofascial and trigger point release and deep tissue massage.
Trigger points are the “knots” in our muscles that can create areas of pain and sensitivity. With manual therapy, the pelvic floor therapist will be able to work out or “release” these trigger points and help tight muscles mobilize, relax, and function properly.
Spinal and Joint Mobilizations
Spinal and Joint Mobilizations are used to increase mobility and decrease pain. This is done through passive movements with the physical therapist.
Lymphatic Drainage Massage
Lymphatic Drainage Massage is useful for releasing toxins from your body’s tissues that may be contributing to pain. This helps improve the body’s immunity, reduce swelling (edema) and inflammation, increase blood flow to help deliver nutrient rich blood to problem areas, eliminate sensitive varicose veins, relieve abdominal bloating, and relieve pain.
Your body’s internal organs, specifically those related to the pelvic floor may also need manual therapy. This is called Visceral Mobilization. Both your pelvic and abdominal organs can be treated with visceral mobilization. Anyone suffering from bowel and urinary incontinence, pain during intercourse (both men and women), endometriosis, and digestive disorders can benefit from this form of manual therapy.
Biofeedback is used to help patients increase their awareness of their pelvic floor muscles and retrain them.
Electrical Stimulation is used for weak pelvic floor muscle training. When a muscle becomes weak, it becomes very difficult to control and use. Electric stimulation mimics the kinds of electric signals the brain would send to the muscle’s nerves for it to contract and/or relax. This “activates” the muscle, allowing you to feel the sensation of using that part of your body. From there, you will be trained to use your pelvic floor muscles to play its part along with the rest of your body’s core. Knowing how to activate your pelvic floor muscles is the first step to strengthening them.
Bladder and bowel reeducation.
You can expect to put in some time doing exercises during your pelvic floor session. Graded pelvic floor muscle training designed to improve core and postural strength as well as the hip and pelvic muscles will be used. Stretching and a proper home exercise program will be reviewed with you as well. We want all our patients to learn more about their bodies and to have greater control over their health.
Our pelvic floor therapist incorporates yoga and Pilates exercises as part of therapy. Yoga and Pilates are both low impact forms of exercise that anyone at any age can benefit from to improve balance, strengthen their body’s core, and increase mobility.
Our Pelvic Floor Therapy Locations
Park Sports Physical Therapy142 Prospect Park West
Brooklyn, NY 11215(718) 398-8800