“I would recommend that people call the facility and maybe schedule the first appointment and see how you feel about it. I also think patient support groups tend to have closed Facebook groups and they can recommend people in certain geographical areas. I know people call [our practice] a lot and we try and get them paired up with somebody we trust in their area,” Prendergast says.
Ultrasound uses high-frequency sound waves applied through a wand or probe on your skin to produce an internal image or to help treat pain. Real-time ultrasound can let you see your pelvic floor muscles functioning and help you learn to relax them. Therapeutic ultrasound uses sound waves to produce deep warmth that may help reduce spasm and increase blood flow or, on a nonthermal setting, may promote healing and reduce inflammation.
Try squatting. Biomechanical specialist Katy Bowman points out that the gluteal muscles are the ones that are most important for pelvic floor function. Doing regular squats elongates your pelvic floor muscles and makes them more functional. Squats also help re-position your pelvis by balancing out the anterior pull of your sacrum. When you have a flat butt and no curve in the small of your back, that’s a sign that your pelvic floor is starting to weaken. Humans used to squat to eliminate urine and feces. Some cultures still use squat toilets. And, many cultures use the squat as a sitting position instead of using chairs. To do a deep squat (called malasana, or garland pose, in yoga), you may want to start with a towel or yoga mat rolled up under your heels, then lower yourself slowly until your tailbone is as close to the floor as possible with your heels still flat on the floor or your towel. You can practice deep squatting at home, at the gym, or at the yoga studio. You can also practice deep squats while playing with small children (notice how they do this!), gardening, and while using the toilet with the help of a Squatty Potty or something to lift your feet. In addition to strengthening your pelvic floor, you may notice fewer problems with your gut function, and may even avoid hemorrhoids. Note: many Westerners cannot do the deep squats that other cultures are brought up doing. We tend to lose this ability after childhood. Don’t worry about it. Just squat as low as you can while keeping your knees in alignment with your toes. I personally can’t do anywhere near the kind of squat that my 3-year-old granddaughter can do.
As physical therapists, are our hands are amazing gifts and phenomenal diagnostic tools that we can use to assess restrictions, tender points, swelling, muscle guarding, atrophy, nerve irritation and skeletal malalignment. We also use our hands to treat out these problems, provide feedback to the muscles, and facilitate the activation of certain muscle groups. There have been a great number of manual techniques that have evolved over the course of physical therapy’s history. Let’s go over a few.
Visceral mobilization restores movement to the viscera or organs. As elucidated earlier in our blog, the viscera can affect a host of things even including how well the abdominal muscles reunite following pregnancy or any abdominal surgery. Visceral mobilization aids in relieving constipation/IBS symptoms, bladder symptoms, digestive issues like reflux, as well as sexual pain. Visceral mobilization can facilitate blood supply to aid in their function, allow organs to do their job by ensuring they have the mobility to move in the way they are required to perform their function, and to allow them to reside in the correct place in their body cavity. Evidence is beginning to emerge to demonstrate how visceral mobilization can even aid in fertility problems.
Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.
Biofeedback is now the most common treatment for pelvic floor dysfunction. It is usually done with the help of a physical therapist and it improves the condition for 75% of patients, according to the Cleveland Clinic. It is non-invasive, and after working with a physical therapist, you may be able to use a home unit to continue with this therapy.
Strengthening weak pelvic floor muscles often helps a person gain better bowel and bladder control. A physical therapist can help you be sure you are doing a Kegel correctly and prescribe a home program to meet your individual needs. Diet modifications can also reduce urinary and fecal incontinence. Bladder re-training can decrease urinary frequency and help you regain control of your bladder.
Joint mobilization is a common and favorite tool of most orthopedic physical therapists. We love it so much because it can have so many different benefits depending on the type of technique used. Maitland describes types of joint mobilization on a scale between 1 and 5. Grade 1 and 2 mobilizations are applied to a joint to help to lessen pain and spasm. These types of mobilizations are typically used when a patient is in a lot of pain and to help break the pain cycle. On a non-painful joint, grade 3, 4, and 5 (grade 5 requires post graduate training) mobilizations can be used to help restore full range of motion. By restoring full range of motion within a restricted joint, it is possible to lessen the burden on that and surrounding joints, thereby alleviating pain and improving function.
Mechanistically, the causes of pelvic floor dysfunction are two-fold: widening of the pelvic floor hiatus and descent of pelvic floor below the pubococcygeal line, with specific organ prolapse graded relative to the hiatus. Associations include obesity, menopause, pregnancy and childbirth. Some women may be more likely to developing pelvic floor dysfunction because of an inherited deficiency in their collagen type. Some women may have congenitally weak connective tissue and fascia and are therefore at risk of stress urinary incontinence and pelvic organ prolapse.
For internal massage, your PT may insert a finger into the vagina or rectum and massage the muscles and connective tissue directly. A frequently used technique is “Thiele stripping,” in which your therapist finds a trigger point by feeling a twitch in the muscle underneath, exercising it using a circular motion, and then putting pressure on it to help relax it, repeating the process until the muscle starts to release. Internal massage can also help release nerves. Sometimes, anesthetics can be injected into these trigger points. PTs may do this in a few states, but in most states, a doctor or nurse must administer injections.
One of the great benefits to skin rolling is it increases the circulation in the area to which it was applied. Often times, areas that are tight or restricted are receiving reduced blood flow and oxygen. By bringing blood flow to the area, toxins can be cleared and the healing contents of the blood are brought to the injured area. Skin rolling can also restore the mobility of surrounding joints and nerves, which can help to restore normal function. By allowing the skin to move more freely, pelvic congestion, heaviness and aching can be effectively treated.
Biofeedback uses electrodes placed on your body (on the perineum and/or the area around the anus) or probes inserted in the vagina or rectum to sense the degree of tenseness in your pelvic floor muscles. Results displayed on a computer or other device provide cues to help you learn to relax those muscles. Usually, patients feel relief after six to eight weeks of therapy. You may be able to buy or rent a unit to use at home.
Wear loose-fitting clothing. Wearing tight clothing has the same effect as sucking in your gut. Plus, if you regularly wear tight jeans or Spanx, you may be interfering with peristalsis in your gut, which could cause constipation, gas, and bloating. Finally, tight clothing can cause reduced circulation to your lower body and make it difficult to breathe properly.
My pelvic floor dysfunction has the opposite effect in terms of peeing. My bladder will not fully empty when I pee although I’ll wait and wait until a little more will come out, then I’ll go lie down because I have some burning sensation and discomfort. At that time, lying down, I will experience of flood of urine. my urologist wants to test me by filling my bladder up but that is counterintuitive to me so I’m not sure if I should have that test?
The therapist may do manual therapy or massage both externally and internally to stabilize your pelvis before using other kinds of treatment. Manual therapy takes time and patience, and may require one to three sessions per week, depending on the technique used and your response to treatment. You may feel worse initially. However, many patients see improvement after six to eight weeks.
Stephanie Prendergast, a pelvic floor physical therapist who is a co-founder and LA’s clinical director of the Pelvic Health & Rehabilitation Center, says that while information on pelvic floor issues isn’t always easily accessible, doctors can spend some time online looking at medical journals and learning about different disorders so they can better treat their patients.