Women’s Health Physical Therapy – What to Expect

By: Shona S. Craig, DPT, CLT-Vodder

Have you had any of these problems: leaking urine, poop in your pants, pain with intercourse, pressure sensations “down there,” painful periods, digestive issues, pain during pregnancy, fear of pregnancy and delivery, adverse reactions to birth, menstruation or menopause?  If so, you may benefit from having a pelvic floor physical therapist on your team.

Physical treatment for the pelvic floor has existed for thousands of years.  In recent decades, physical therapists recognized the need and have become experts in pelvic floor rehabilitation. Specializing in this area requires additional training.  Pelvic health physical therapy, as it is becoming known, also looks at how the physical structures are impacted by gender, social roles, emotion, spiritual, and psychological life.

Many people do not realize that there is any professional help for the symptoms mentioned above. Physical Therapy has an answer!  Here is a list of what to expect from a PT visit:

1. Thorough assessment: Women’s Health physical therapists ask A LOT of questions, some of which may seem very personal!  Topics include bladder, bowel, sexual, and menstrual/menopausal symptoms, pregnancy and delivery history, history of injuries and abuse, and pain symptoms.  A physical assessment of your bones and muscles focused on the spine and hips is performed that includes posture, alignment, range of motion, strength and flexibility.
2. Physical evaluation (surprise!): Most women expect a pelvic exam from their gynecologist but not their physical therapist.  Pelvic health physical therapists are trained in evaluating the muscles of the pelvic floor.  The physical therapist can assess strength and flexibility of your pelvic floor muscles, pelvic alignment, areas of pain/discomfort and pelvic organ prolapse.  You can always choose to opt out of the direct assessment of your pelvic floor.  External assessments can be made and exercises can still be determined.
3. Educate! Educate! Educate!:  Understanding your body and how it works is the first step to taking charge of your symptoms.  Having this knowledge helps you to know what you can change and empowers you to take the necessary steps towards your goal. Education can range from anatomy/physiology, how to use the toilet (you thought you knew!), how to have pain free sexual intercourse, how to treat your own symptoms, how to how exercise, and more!!!
4. Guided specific movement training: Physical therapy exercise training for people with pelvic muscle problems is very extensive.  An exercise program may include pelvic floor and hip stretching and relaxation, pelvic floor muscle strengthening, urgency control exercises, exercises working with internal air pressures, pelvic organ decompression, core strengthening, spine mobility, and functional stabilization.   Pelvic floor biofeedback is a tool using electrodes placed externally on the perineal area or intra-vaginally that read muscle activity.  This technology helps you visualize and connect with your pelvic floor muscles.
5. Manual therapy: This term refers to hands on methods of addressing pain, muscle tension, scar tissue, fascial restrictions, and general movement dysfunction.  Techniques can be performed externally and internally. Focus is on the pelvic floor muscles, pelvis, spine and abdominopelvic organs.  This author is partial to fascial release therapies to address adhesions (myofascial release, visceral manipulation, craniosacral therapy, and scar tissue mobilization), manual lymphatic drainage (particularly the original Dr. Vodder method) and trigger point release.

It is normal to have some apprehension about pelvic floor rehabilitation as it is a vulnerable and intimate part of our bodies.  Your privacy is respected during all sessions and the therapists go at your pace, explaining everything along the way.  You are welcome to invite someone to accompany you to your appointments if this will make you more comfortable.  Every woman deserves a physical therapist on their team when addressing the pelvis.