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Maybe your doctor referred you to pelvic floor therapy or you heard about pelvic floor therapy on a pocast or TikTok. The first step is awareness, but what is pelvic floor therapy? Do you need it? And what the heck should you expect?
Pelvic floor therapy is a specialized area of physical therapy that focuses on issues related to the muscles of the pelvic floor. This includes problems such as bowel, bladder, and/or sexual dysfunction. Additionally, issues related to pregnancy, postpartum, abdominal issues can all fall under the umbrella of this specialty
Your first physical therapy visit for the pelvic floor will be a lot of information gathering. Personally, I spend the majority of the first visit asking a lot of questions. We'll ask questions about urinary habits, bowel habits, any obstetrical or gynecological questions. Depending on the issue at hand, we'll ask questions about what types of things aggravate or alleviate your symptoms.
After the initial part of the evaluation where we ask a lot of questions, we'll begin to do a basic screening of your posture and muscles. First, a general observation of posture and alignment will be done to help determine if there are any postural issues related to your problem. Second, we'll do mobility and strength testing of areas like the hips, low back, and possibly abdomen. These things will help create a bigger overall picture of other factors that could be contributing to your pelvic floor issues.
Following a general overview of your musculoskeletal system, it may be appropriate to do an internal and external assessment of the pelvic floor muscles. However, I often save this for the second or third visit depending on how much information and time was already covered. If a pelvic floor assessment is appropriate, that is something I thoroughly educate patients on first.
An internal assessment is only performed after providing thorough education on the process and obtaining consent from the patient. If someone consents to an internal assessment, I typically start that assessment with an external observation. To start, the therapist will palpate areas like the inner thighs, pubic bone, and the superficial pelvic floor. This is all done laying on a treatment table. There are no tools or speculums used as you think of at the doctor's office.
Furthermore, externally, the therapist will observe if someone is able to contract and relax their pelvic floor as well as seeing what happens when you cough. If the internal assessment is still appropriate, the pelvic floor therapist will typically assess using one gloved and lubricated finger. There are three layers of muscles in the pelvic floor, and the therapist will start at the most superficial layer by palpating and looking for any tightness or tenderness. This will continue from left to right and over each layer of pelvic floor muscles. Following this assessment for muscle tension and/or pain, we'll assess for strength, endurance, and the ability of the muscles to squeeze and release quickly (quick flicks). We're also looking at coordination of the pelvic floor muscles.
Following the assessment of the whole body and potentially the pelvic floor, the therapist will provide you with a few things to work on in order to improve your problem. This could include stretching, strengthening, relaxation, or habit changes. In the first visit we will not usually give you every possible exercise you could do. Instead, we'll start you with a couple of things and see how you do with those. This is also the time when the therapist should provide education on your condition and how he or she thinks they can help you improve.
Developing a plan of care is one of the most important areas of the evaluation. The plan of care is used as a guide for approximately how long therapy might last, how frequently to attend therapy visits, and what types of treatments might be involved. The frequency of therapy visits can vary greatly. At most, patients might be seen twice per week. However, I've also worked with patients who I've seen once per month. It depends on the issue at hand and how much help is needed. The plan of care can change as you work with a physical therapist. I always include the patient when developing the plan of care. If I want to see someone once per week but that is not humanly possible with his or her family life and schedule, then we need to figure out a balance to improve the overall outcome.
At the very least, the professional needs to be a licensed physical or occupational therapist. However, I would highly recommend looking for someone who has experience treating patients with pelvic floor issues as well as extensive training. For physical therapists, there is a board certification that shows you have a certain amount of knowledge and training in this area. You can look for someone to be board certified in women's health physical therapy.
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