Updated: Jul 3
Updated from Feb 7, 2021
Since starting Breathe Life PT in 2018, the world of pelvic health has evolved. Can I get a “Hallelujah” in the back! There are more physical and occupational therapists interested in becoming pelvic therapists! And for good reason. Everyone has a pelvis, and at least 1 in 5 people will experience some kind of pelvic health change in their lifetime. From pediatric pelvic therapy, to prenatal care, to birth preparation, to navigating menopause related changes, supporting breast and gynecological cancer rehab, to advocating for pelvic health in gender confirming surgeries, we all have a place to practice pelvic therapy! You just need to find the right therapist for you, who specializes in the care right for you!
What is pelvic floor physical therapy?
In general, Pelvic Floor Physical Therapy is specialized physical therapy aimed to treat pelvic dysfunction and promote optimal pelvic health for both women and men and children. Pelvic floor dysfunction refers to a wide range of diagnoses pertaining to the pelvic muscles and the pelvis, including urinary/bowel incontinence, pelvic pain, pelvic organ prolapse, prenatal/postpartum pelvic girdle dysfunction and sexual dysfunction like erectile dysfunction or anorgasmia to name a few. At least 1 out of every 5 Americans will suffer from a pelvic floor dysfunction at some time during their life.
What is the pelvic floor?
The pelvic floor is a group of muscles that attach to the pelvis. Their function is to support your organs, allow for elimination, stabilize your pelvis and hips, promote sexual function and sustain healthy blood flow. Remember pelvic floor muscles are just like any other muscles in the body. They contract, relax and function like a bicep muscle would, but they are even more fascinating than our other skeletal muscles. Because our daily pelvic functions, including daily eliminations and sexual function; it is important to remember that your pelvic floor can be influenced by your emotions, organs, abdominal muscles and skeletal system, nervous system and vice versa. For example, urinary incontinence is not “just a weak bladder muscle” as thought by popular belief. But incontinence can occur because of pelvic muscle weakness, pelvic muscle tension, anxiety, with altered coordination of bladder, brain and pelvic muscles, as well as poor toileting habits.
How does the Pelvic Floor work with the core?
Remember, your pelvic floor is one aspect of the core. Our core is made up of the diaphragm (breathing muscle), transverse abdominals, multifidus (small spine muscles) and pelvic floor. These four muscles make up the core! They must work together and manage your everyday movements and daily eliminations. They cannot, and should not be addressed independently from each other. The diaphragm and pelvic floor synchronize to monitor the pressure in your abdomen. Think of the pressure that occurs in your belly when you sneeze. Oh gosh! This is scary for some…just thinking of it makes you think, “Squeeze the knees.” If the diaphragm and pelvic floor do not coordinate well, leakage and other pelvic related dysfunction can occur.
Why would I need pelvic floor physical therapy?
There are a multitude of reasons one may need pelvic floor physical therapy. Pelvic dysfunction occurs when there is an imbalance of the pelvic and abdominal muscles and the surrounding joints including, lower back, hips, and coccyx, fascia, ligaments, tendons and organ position. The pelvic floor is an integral part of your core stabilization system, which works intimately with your pelvic organs, bones and joints in the region. It is always working throughout the day and is often overlooked as the cause of many issues related to pelvic pain during and after pregnancy, surgery or menopause and urinary and bowel incontinence.
Specialized pelvic floor physical therapists help men and women across the lifespan continuum, including young athletes, childbearing aged women, peri-menopausal women and men to navigate acute injury to the pelvis or chronic changes. Some common conditions we treat: Pelvic Pain Conditions, Urinary Symptoms Gut & Bowel Health Orthopedic Pelvic Pain Sexual Dysfunction Pregnancy and Post-Partum Care for the Core, Pelvic Organ Prolapse
Do men have pelvic floors too?
Of course! Even though men do not carry children or go through menopause, men have a pelvic floor which functions similarly to a woman’s pelvic floor. Men with pelvic floor dysfunctions will report a slower urine stream, difficulty or pain with erection, tailbone/lower back pain, constipation, or bowel or bladder incontinence. It is not uncommon for a man to have an increase in these symptoms after having any kind of prostate surgery or hernia repairs. We do not currently treat men, but click here to find a pelvic therapist near you.
What can I expect during Pelvic Floor PT Evaluation?
Your first evaluation at Breathe Life Physical Therapy & Wellness, includes a one-on-one visit discussing your concerns and symptoms related to your pelvis and daily activities. You will have the opportunity to share your past medical history, including pregnancies, abdominal or back surgeries, and gynecological/urinary history. We want to know your story as it gives us insight to who you are and how we can help you navigate your pelvic health.
Your exam may include general movement like bending forward and backward, observing your body mechanics and strength testing. A comprehensive review of the pelvic floor musculature, pelvic organ function and normal bladder/bowel habits will also be discussed.
An external and internal assessment of your pelvic muscles (through the vaginal or rectal canal) may be valuable, however you have the option to choose or refuse any part of the process with which you don't feel comfortable.
An external pelvic floor assessment includes a visual assessment of the skin, symmetry and color of tissues, and observation of muscles performing a contraction. Just like observing your posture, the vulva also has a posture that can provide insight in your overall health.
An internal pelvic floor muscle assessment includes checking all layers of pelvic floor for strength, mobility, pain, symmetry and control. Therapist will also palpate muscles in all three layers of the pelvic floor to assess the coordination for functional activities like coughing, lifting and relaxation. Your breathing mechanics will also be assessed as the diaphragm, our breathing muscle in our ribcage, works intimately with the pelvic floor.
What happens at additional treatments?
Your therapist designs individualized programs depending on the findings from the evaluation. The pelvic therapist may prescribe breathing and core stability exercises to improve the coordination of all muscles in the pelvis, back and core. They may also recommend relaxation and behavior modifications to improve pain or learn control for your daily toileting habits. Initially, you may require assisted neuromuscular training such as manual feedback via the internal pelvic muscles to improve muscle tone, activation and coordination.
Do I need a prescription?
Thankfully, in NJ, there is Direct Access; so appointments can be made without a prescription. A prescription is not required for the initial evaluation; however, after 30 days or 10 visits (whichever is first), a primary care provider must issue a prescription to continue care. A primary care provider, gynecologist or urogynecologist may issue this type of prescription.
We create a team approach. There are many specialists outside of your gynecologist who can help!
Many pelvic conditions have multiple causes and involve multiple systems of the body. Our goal at Breathe Life PT is to create a team to surround you on your pelvic health journey. Dealing with a pelvic health issue is not easy. It can be emotionally, physically and mentally taxing. We have a huge network of primary care providers, gynecologist or urogynecologist, doulas, midwives, colorectal specialists, mental health counsels and functional medicine practitioners who may help to coordinate your care and holistic treatment. Therefore, it is necessary to have a medical provider onboard with treatment to help coordinate care or to rule out more serious conditions.
My gynecologist told me to do “Kegels”. I do them every day, but I am not sure if they help to improve my leakage? What is going on?
Kegels or a pelvic floor contraction are important to strengthen and maintain good function of the pelvic floor including improving incontinence. However, research shows 40% of women perform Kegels incorrectly and can promote more leakage! Many women who have leakage with coughing, laughing, sneezing have an altered pattern of contracting their pelvic floor muscles. Believe it or not, too much pelvic muscle activation can promote incontinence. Pelvic floor PT can teach you to re-train your pelvic muscles to properly coordinate a contraction to eliminate or minimize most types of urinary incontinence.
What Services Do You Offer?
At Breathe Life PT, you can begin restoring your pelvic health to live out an active, comfortable and confident life! We proudly offer:
One-on-one physical therapy provided by a Doctor of Physical Therapy in a spa like environment where you will feel comfortable and safe
Combined treatment approach of functional training and manual therapy, not a recipe of pointless, time consuming exercises.
One of the first USA therapists to be trained in pelvic organ prolapse and pessary management
Utilize high-tech Low Intensity Shockwave Therapy to provide alternatives to pain medication and injections
Pilates duet classes with like minded women who desire physical and mental strength
Health Coaching with a Licensed Nurse who values holistic women's health
Virtual Support and online community with exclusive resources focus on all things pelvic health. It's like having a provider or knowledgeable girlfriend available 24/7 to answer your questions and know you are not abnormal down there!
Dr. Amanda Heritage, PT, DPT is the owner of Breathe Life Physical Therapy & Wellness, LLC located in Collingswood, NJ. She enjoys encouraging women about pelvic therapy as a treatment option for those suffering with pelvic pain, incontinence or constipation.