Pelvic Health Therapy -What is it, and do you need it?

A lot of the time, pelvic health therapy is associated with Kegels. Many of us have heard of them…. the message often is, “If you have pelvic floor issues, do your Kegels!” (FYI: Kegels aren’t actually for everyone and there’s A LOT more you can do for your pelvic floor). On the other hand, fewer of us have heard of pelvic health/pelvic floor therapy. So, what is it? And how do you know if you need it? Let’s dive in!

The basics of physical and occupational therapy, and the niche of pelvic health rehab

Physical and occupational therapists are the pros at improving the function of our bodies. This may address your breathing habits, muscle strength and endurance, flexibility, balance, cardiovascular function, etc. So how does that work with the pelvic floor?

Your pelvic floor is just like the muscles of the rest of your body – they can get injured and rehabbed just the same. And it’s not just your pelvic floor that can be addressed with pelvic floor therapy, it’s also your surrounding body parts (think abdomen, hip, low back, groin, even down to your ankles!). Both physical and occupational therapists can be trained to treat pelvic health disorders. Most often, these practitioners receive additional training following graduation from grad school, as most programs don’t delve very deeply into niche practices.

How do you know if you need this specialized form of therapy?

Any form of the following symptoms may mean you should seek out therapy (this goes for anyone with a pelvis, not just for vagina owners, which is a common misconception):

• Urinary symptoms: leakage of urine, feeling like you can’t fully empty the bladder, frequent urination including feeling the need to urinate minutes after you already have (urinating more than 2x at night or 8x during the day, pain or burning with urination, strong urge to urinate, and difficulty starting or stopping urine stream.
• Bowel symptoms: loss of bowel control, difficulty fully emptying the bowels, straining or pain with bowel movements, or having a bowel movement less often than every three days.
• Pelvic pain in genitals, perineum (area between the vaginal and rectal opening), pubic or bladder area, or pain with urination.
• Tailbone injury, even as far back as your childhood (you may have fallen on your tailbone, buttocks, or low back).
• Feelings of falling out or pressure at the vaginal or rectal opening.
• Pain or discomfort during or after sexual activity, orgasm/climax, or penetrative intercourse (this is true for both vagina or penis owners), or sexual activity increases other symptoms.
• Low back, hip, groin, or tailbone pain, or history of sciatica that has not gotten better.
• Prolonged sitting increases any of your symptoms.

What might cause someone to need pelvic health rehab?

Pelvic floor issues just come naturally with childbirth and aging, right? This is another common misconception! Although pelvic floor dysfunctions are common after pregnancy, birth, and with aging, it doesn’t mean it’s something that you have to live with.

Sometimes, injuries to the pelvic floor do occur with childbirth. Did you know that internal injuries post-childbirth are about the size of a dinner plate? A LOT is going on there, and it’s a pretty traumatic experience for the body.

With vaginal deliveries, folks may experience tearing, whether that be natural or tool-induced (using a vacuum or forceps), or through an episiotomy (intentional surgical cut made to the vaginal tissues). This can cause the muscles not to function properly, and through time may lead to incontinence, pelvic organ prolapse, and pain with intercourse.

Those who have had C-sections may also experience dysfunctions, too. These may not be as directly related to a pelvic floor injury and can be due to abdominal weakness that can lead to other issues (low back or hip pain, incontinence, or pain with intercourse, just to name a few).

Haven’t had a baby? Contrary to popular belief, pelvic floor dysfunction can absolutely still affect people who have never been pregnant. You can still have muscle imbalances or dysfunctions that are causing issues. This can be due to hormonal changes that occur with menopause or with gender-affirming surgeries or transitions, heavy lifting, running or high-impact sports such as gymnastics, history of sexual abuse or trauma, cycling, surgeries of the abdomen, pelvic floor, and low back, and sometimes, these issue can occur even if no injury is present.

What to expect during your first visit

During a pelvic floor evaluation, your therapist will evaluate a number of different things. Your therapist will first talk with you to learn about your medical history and symptoms. A hands-on examination may or may not be completed on the first visit, and may include external and internal pelvic floor examination to assess muscle tone, strength, endurance, coordination, presence of pain, or presence of a prolapse.

Other assessments may be geared toward breathing patterns, muscle length, and strength of the abdominals, hip, and low back musculature. Each evaluation will vary based on practitioner and patient, and your therapist will explain the details during your first visit.

For many patients, an internal exam can provide the best assessment on pelvic floor strength and functioning to help us determine how many appointments you’ll need and how often you should be seen. However, an internal exam is not a requirement of treatment, and we can still evaluate your symptoms and progress externally for patients who do not consent to an internal exam.

How to start pelvic floor therapy

There are numerous ways you can begin pelvic floor therapy. The most common way is to get a referral from your medical provider. This can be your general practitioner, OB/ GYN, urologist, GI, neurologist, physiatrist, or pain specialist, just to name a few!

Michigan is a direct access state, meaning you can begin therapy without a physician referral for up to 21 days or 10 visits, whichever comes first. After that, a referral would be required to continue therapy. There is also the option of cash pay where you can pay out of pocket instead of going through insurance. Renue Physical Therapy offers pelvic floor physical and occupational therapy at various locations, including: Bridgeport, Caro, Frankenmuth, Midland and Saginaw.