You do WHAT?
We’re pelvic physical therapists. We treat people with a range of pelvic problems, including bowel and bladder issues, painful intercourse and pelvic pain. Like PTs in other settings, we help our patients resume their daily (or nightly) activities as quickly as possible. What makes us a little different from other physical therapists is our training to assess the pelvic muscles directly via the vagina and/ or rectum, which may explain why reactions to pelvic physical therapy range from shock to fascination. Mention that you’re a physical therapist and those familiar with the profession may request a second opinion for that nagging injury. Tell them that you treat people with pelvic problems and, well, responses are varied. Some are skeptical, which is okay- it gives us the opportunity to share more about this topic we are so passionate about. What we typically find is that most people are genuinely curious about who we treat, what a treatment session looks like, and (our favorite) how we ever decided to go into pelvic health in the first place.
So here’s the inside scoop from us to you on what we do and with whom we do it in a strictly clinical sense:
Who we treat
We treat women of all ages and for a range of problems from pelvic organ prolapse to vulvar pain to hip or back pain. They are young athletes in their teens with incontinence and sedentary women with abdominal pain. Some women have painful intercourse after having babies or after menopause or surgery; others are unable to insert a tampon or have a doctor’s examination due to pain.
We also treat men. Yes, it’s true. Men have pelvic floor muscles too. Which means that they can suffer from many of the same problems that women experience. Men can have incontinence, abdominal pain, rectal pain, constipation, ejaculation problems, and painful intercourse. Prostatitis that does not respond to antibiotics may be a muscular problem that is responsive to physical therapy treatment. Even some physicians are surprised we treat men, because so often pelvic pain and incontinence discussions are geared toward women. So bear in mind that any of the treatments we address here may apply similarly to both women AND men.
What we treat
For a more comprehensive list of pelvic diagnoses, click here. But for a general idea of common pelvic problems:
Incontinence: Bowel or bladder leakage can occur due to muscle weakness, poor muscle coordination, and/ or an overactive nervous system. It’s not just for women after having babies, or a side effect of aging. Our incontinence patients range in age and activity, and not all women with incontinence have been pregnant or have had vaginal deliveries. Men also may experience leakage with or without a history of prostatectomy.
Constipation: No-one likes to talk about pooping. But everyone does it, and it is important that it is not painful and that there is no straining involved. Our patients come to us because their muscles are not coordinating correctly or relaxing enough to allow stool to pass, resulting in small stools, straining, incomplete evacuation, and sometimes abdominal or rectal pain.
Pelvic pain: Pain may be in the vagina, rectum, vulva, testicles or the tip of the penis. It may be more external in the perineum (the area between the labia and rectum on women and scrotum and rectum in men), the sitting bones or the hips, buttocks, abdomen, pubic region, groin, back…well, you get the idea. It may also be associated with the bladder, bowel, ovary, testicles and may feel better or worse after orgasm, intercourse or toileting. Some of our patients have other diagnoses, like endometriosis, interstitial cystitis/ painful bladder syndrome and pudendal neuralgia. Pain may only be during sexual activity, or may be triggered by pressure (touching the area with clothing or by sitting on a hard surface), or during exercise or other activities, or it may be during a combination of activities.
Hip/ back/ tailbone/groin pain: Yes, we see patients with other problems. They may be referred to us with pain in the pelvis that is related to another musculoskeletal problem. We don’t ‘just’ treat the pelvic muscles and structures- we treat the whole system.
What do we do? We assess and sometimes treat the pelvic muscles by touching them with a finger through the vagina or the rectum. But wait! There’s more. Pelvic treatment involves more than manual examination and treatment of the pelvic floor. Pelvic physical therapists do what other orthopedic therapists do: We take a detailed history. We watch how your body moves. We examine your breathing patterns, other joints and muscles in the spine and hips that work with the pelvic floor, and perform sensory and reflex tests. We do a detailed examination of the perineum and pelvic muscles and assess pelvic floor movement, strength and coordination. We consider all of these components to determine a physical therapy diagnosis and treatment plan.
What is ‘hands on’ treatment? Treatment often includes some manual, or hands-on therapy not only to the pelvic muscles but to nearby joints and muscles, including the abdomen, trunk, back and hips. Connective tissue manipulation, scar mobilization, joint mobilizations and myofascial release are different types of manual therapy. To be clear, ‘hands-on’ therapy does NOT melt scar adhesions or lengthen connective tissues. Rather, manual therapy may positively affect the nervous system, promote relaxation and inhibit pain so that patients can increase pain-free movement and resume activities. We might do this early in the session, or at the end, or not at all, depending on a patient’s goals and status at a particular session.
You want to put that where? Foam rollers, tennis balls, braces and orthotics may all be used as part of physical therapy treatment on other parts of the body. We may recommend some of those things too, but in addition we may also recommend different treatment tools or modalities for patient use in the clinic and at home. Items may include cone shaped plastic sensors, balloon catheters, dilators or vibrators that are inserted vaginally or rectally for the purpose of muscle retraining, stretch, and/ or pain relief.
It’s not always a ‘tissue issue’, and treatment is not always ‘hands-on.’ Chronic pain is about more than ‘I stubbed my toe on the door and it hurts.’ Simplified, it’s more about ‘sometimes I stub my toe on the door and it feels like an 18-wheeler ran over it and other times I stub my toe on the same door and I barely notice it.’ So what’s THAT about? Well, it’s in your head. Specifically, your brain. And spinal cord and peripheral nerves. Pain is an output that your brain provides after assessing all of the information at hand: sights, sounds, smells, memories, activities. If all of these things combined trigger the brain to assess a ‘danger,’ pain is the output as a protective mechanism. When you have pain, this by itself creates another set of responses, which further triggers the brain to assess the threat, and so forth. For example, if your pain triggers more muscle tension, worry, fear, changes in how you move, this may contribute to increases in pain, creating a wind-up of symptoms that is difficult to get a handle on.
This is important because when we treat patients for pain, whether there is a history of endometriosis, interstitial cystitis (IC), pudendal neuralgia (PN), prostatitis, vulvar pain or rectal pain, it’s not JUST about treating the body part that hurts. It’s about retraining the brain and nervous system at the same time, which means actively engaging our patients in treatment rather than only doing hands-on treatment.
It takes a village. Physical therapy is one piece of the treatment puzzle for patients. Some patients may respond well to physical therapy alone. Others are not appropriate for physical therapy and need to be referred to another provider. In most cases, other providers may be recommended, including physicians or specialists, sex therapists, nutritionists, massage therapists and other professionals. Topical or oral medication may be a medical component of treatment. Partners are also included in the treatment plan when appropriate for training and carryover to the home program.
Why we do what we do
We love what we do. We believe that pelvic health is an important part of wellness. Our goal is to empower our patients to overcome a problem that is often embarrassing to discuss with friends, family or even their doctors. We educate our patients to ensure that they have the tools necessary to help themselves get stronger, reduce pain, go to the bathroom with ease or meet other personal functional goals. Our practice is designed to treat the individual and not the medical diagnosis. So spread the word- there’s help for people with pelvic problems. Email or call us with questions, schedule a free consultation, or book a private pelvic party with friends to learn more!