Kegels, Kegels, Kegels….

Before I get into the different PT treatment options for the pelvic floor, I wanted to mention the different types of prolapse that can occur. If your pelvic floor becomes weak, there is a possibility that your bladder, uterus, or rectum can “fall” outside. Yes, you read that correctly! The pelvic floor is essentially a hammock. If that hammock becomes loose, what was being supported starts to sag. Bladder and uterine prolapse can be quite common following multiple vaginal child births or a traumatic child birth. Typically, you’ll feel like something is falling out of you when you stand or strain. There are different stages of prolapse as well. I will discuss treatment options later on for prolapse.

Ok, now let’s talk about the different physical therapy treatment options available and what a visit might look like. Kegel’s are the exercises that everyone has heard about. Just do kegels all day every day and you won’t have any issues. FALSE! Kegels are a good exercise; however, they need to be done properly and for some it can actually be causing more discomfort.

Pelvic Floor Physical Therapy

Many who suffer from pelvic floor symptoms do not know there are treatment options available. There are Pelvic Floor Physical Therapists who specialize in treatment of pelvic floor dysfunctions. However, it is rarely promoted. I recently gave birth and no one talked to me about seeing a physical therapist or even mentioned what symptoms to look for related to this. I believe every woman who becomes pregnant needs to be educated on pelvic floor health. You can perform preventative treatments while pregnant and then continue into post partum treatments. It is a disservice to this population. Ok, I will get off my soap box, but, as you can tell, I am passionate about this topic.

Initial Evaluation

During the initial evaluation, the therapist will take you into a private room with a closed door. The sessions are very private and safe. The therapist will take an extensive history of your bowel and bladder habits. Your current symptoms will be discussed as well as anything that could be related; hip pain, low back pain, abdominal pain, etc. Typically, they will perform an internal exam of the vagina and/or rectum depending on the symptoms. This portion of the evaluation may be done in the upcoming visits. It all depends on how comfortable the patient feels and/or how emotional or taxing the history portion takes. There will be an education component to the evaluations, the therapist is there to answer all your questions. A bladder diary may be sent home with the patient, to keep track of their voiding for 3 days. It is a good way for the therapist to see exactly what is going on and will enlighten the patient.

Follow up Visits

The course of treatment will depend on the type of dysfunction diagnosed. If the pelvic floor needs to be strengthened (incontinence, prolapse), then the patient will be taught how to properly perform a kegel. Therapist can use a biofeedback machine, that helps the patient visualize their muscle contractions. It is a small probe that is inserted vaginally or rectally and is connected to a computer. On the screen it will show when you are contracting your pelvic floor (Kegel) correctly and when you are activating the improper muscles. It is amazing how many people do them wrong. Doing too many kegels can actually cause the muscles to spasm. Kegels are not the only strengthening exercise that can be done. Abdominal, low back, and hip strengthening are all beneficial and help support the pelvic floor. For painful intercourse, spastic emptying of the bladder, and constipation, stretching of the pelvic floor musculature is usually an important treatment option. The pelvic floor, just like any other muscle group, can become tight and develop knots or trigger points. The therapist will manually release the trigger points and educate the patient on how to stretch and release them on their own. At times, spouses/partners are brought in and taught how to perform the stretches together at home. The partners are educated on how to separate therapy from foreplay. There needs to be a clear line between the two, especially with individuals who suffered sexual trauma.

Home Exercise Programs

Once the patient gets the hang of doing the exercises efficiently and properly in the clinic, they will be asked to perform them at home. The home exercises can be altered as the patient progresses. Typically, pelvic floor patients come in 1-2 times a week because there is a good amount that can be done at home. Each patient is different and each therapist makes their own plan of care. This is the tip of the ice berg for pelvic floor physical therapy. It is worth it to call and get scheduled for an initial evaluation if you are suffering from any of the dysfunctions mentioned this week. Say goodbye to your pads, change of clothes in your purse, fear of coughing or sneezing, and anxiety in the bedroom.

Other Treatment Options

In some cases the prolapse cannot be fully treated by physical therapy. This is when the uterus, bladder, or rectum have to be tacked back up into place. They have come a long way with these surgeries and have found ways to make them safer and durable. Every pelvic floor session with your therapist is private and confidential. Remember, there is no reason to live with these symptoms or be ashamed of them. Please contact your local pelvic floor therapist. At least sit down and have a conversation with them.

Disclaimer: I am in no way diagnosing anyone, if you have persistent pain you need to call your local physical therapist and schedule an appointment.