Pelvic floor physical therapy has come a long way in the past couple decades. The origins of this profession are somewhat muddy. However, we have records of pelvic floor muscle exercises described during the days of Hippocrates in ancient Greece. Modern roots seem to trace back to Margaret Morris in the 1930s, a PT who advocated rehabilitative pelvic floor exercises to prevent leaking. However, Arnold Kegel (pronounced KEG-el), a German doctor of the 1940s is the eponym of the pelvic floor exercises we know (and possibly love/hate) today.
So what is pelvic floor physical therapy?
Pelvic floor physical therapy is the restoration of proper pelvic floor muscle function to resolve symptoms that are directly or indirectly related to their dysfunction. It is NOT just “Kegels.” It may involve isolated treatment of the pelvic floor, but the entire movement system should be functionally incorporated into a comprehensive pelvic floor physical therapy plan of care. This means that a patient should be performing the actions of his or her daily life, integrating the pelvic floor with the rest of the body before completing PT.
How do I know if I need it?
The pelvic floor muscles can be considered the guardians of the pelvis:
They prevent or allow the passage of urine and stool… also babies, penises, tampons, menstrual cups, suppositories, pessaries, etc.
They assist with sexual function, arousal and orgasm
They support the pelvic organs like the bladder, bowel, and reproductive organs
They manage pressure within the system or “cabin” so everyone on board stays happy and nothing gets ejected unexpectedly (stated another way, they work so you don’t pee when you sneeze)
They circulate blood and lymphatic fluid to prevent pooling and congestion
They stabilize the pelvis, hips and low back from below
Considering all the roles of these muscles, it is no surprise that when they start to act up it can feel a bit like the sky is falling. Any of the following symptoms may indicate pelvic floor dysfunction and warrants a consultation with a qualified pelvic floor physical therapist:
Leaking pee or poop. Period. No caveats. This should not happen. It is not normal. And you do not have to put up with it. Pelvic floor PT is really good at treating this!
Urgency or feeling like you will not make it to the bathroom on time
Frequency or feeling like to pee too often
Pain with sexual activity or penetration
Difficulty achieving or sustaining arousal or erection
Dulled or painful orgasm
Difficulty or pain emptying bowel or bladder
Feeling of heaviness, dullness, or something falling out of the vagina or anus
Pain in or around the low abdomen, pelvis, genitals, or rectum
Pain in the low back, hips, groin that is not responding to traditional PT
If you have pelvic floor dysfunction, you might experience anywhere from one to all of these symptoms. Do not panic. Find a pelvic floor physical therapist. The good news is that pelvic floor PT should be a one-stop-shop to improve all these alarming and frustrating symptoms at once and put the sky back where it belongs.
There are some common medical conditions that often overlap with pelvic floor dysfunction:
Low back pain
Sacroiliac dysfunction
Interstitial cystitis or Painful Bladder Syndrome
Overactive Bladder Syndrome
Polycystic Ovarian Syndrome
History of abdominal/inguinal hernias
History of chronic constipation
History of multiple pregnancies
History of vaginal delivery with instrument assist (vacuum, forceps)
History of 3rd and 4th degree perineal tearing
Menopause
Endometriosis
Varicocele
History of urogenital cancers
History of prostate cancer
History of hysterectomy
Chronic bronchitis, asthma or allergies
History of bulemia
Temporomandibular joint dysfunction
Fibromyalgia
Ehlers Danlos Syndrome
Pudendal Neuralgia
Tailbone injury
Migraines
This is not a comprehensive list, nor does it imply any causation. For example, we do not know that endometriosis causes pelvic floor dysfunction or vice versa; however, the two conditions are correlated.
If some of the items on these lists resonated with your current situation, seek out professional help. Physical therapy services are direct access in all 50 states, meaning you do not need a referral from a physical to see an expert. It may be one of the more unique physical therapy experiences of your life, but it may also be the best. Because when pee and poop isn’t where it should be, it’s hard to have a good day.
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