Taking the mystery out of pelvic health therapy - know what to expect

A laugh, cough or sneeze and you suddenly leak. Pain in the pelvic region that you try to hide throughout your day. Pregnancy, postpartum or menopausal changes happening to your body that make you feel like a stranger in your own body. Private, sexual intimacy issues with a partner that you’d like resolved but you don’t know where to turn.

All can be addressed with pelvic health physical therapy, but what exactly is that, and what can I expect when I make an appointment with rehabilitation experts who specialize in pelvic dysfunction?

Let’s take the mystery out of what happens at those appointments and how taking that first step can make all the difference when it comes to your pelvic health.

Am I the only one?

Pelvic dysfunction isn’t rare; in fact, it is pervasive and personal. Statistics show that one out of every three females and at least one of every six males has some type of pelvic health-related issue. Both genders generally underreport their issues to a medical provider, in large part because of the embarrassing nature of the symptoms. Studies suggest that men and women can experience pelvic floor dysfunction, often related to loss of coordination, control or strength of the muscles.

In women, common symptoms are urinary incontinence (leakage), pelvic organ prolapse (feeling of heaviness or bulging) and fecal incontinence with up to 25% of women experiencing more than one of these symptoms simultaneously.

In men, common symptoms include erectile dysfunction, premature or painful ejaculation, urinary frequency/urgency and constipation. Overly tight pelvic floors can present as chronic pelvic pain syndrome and prostatitis-like symptoms.

What is pelvic health or pelvic floor dysfunction?

When your pelvic health is strong, the muscles, nerves and organs within the pelvis (controlling bladder, bowel and reproduction) are functioning properly. When there is some type of pelvic dysfunction, the pelvic floor muscles become weak, damaged or too tight, leading to issues with bladder and bowel control and pain. Symptoms can include urinary or fecal incontinence, constipation, pain and issues with intimacy.

Aging can be a primary factor in pelvic health changes as can pregnancy, childbirth, obesity or side effects from surgical procedures.

In most cases, pelvic floor dysfunction can be reduced or relieved with pelvic health therapy, a specialized focus within physical therapy and related disciplines.

Initial discussion

It’s not abnormal to have some anxiety about seeing someone about pelvic floor-related issues. If your physician or primary care provider refers you for pelvic health physical therapy, it’s important to take the next step. Your therapist understands apprehension exists and sometimes the hardest part is making the first appointment.

The first appointment is about getting to know you, your medical history, the issues you are experiencing and understanding what you want to achieve through therapy. This initial discussion is vital in establishing a relationship with you, in a safe and comfortable space, where we openly communicate and build a level of trust for future care visits.

Achieving optimal pelvic health takes time. Your personalized plan of care will likely include several in-center appointments with a pelvic health therapist who will also give you exercises you can do on your own at home in between appointments to keep making progress.

Education

We all have a pelvic floor. Having one and understanding the anatomy of it and how it functions with the whole body are two very different things. Your pelvic health therapist takes the time to explain the role of muscles, nerves and connective tissue of the pelvic floor and how it relates to the symptoms you are having. Being able to visualize the way something works helps you correct what is not working.

Pelvic health issues are common, and you’re not alone in experiencing them. But common doesn’t mean normal. You don’t have to settle for these symptoms when you have the power to make changes that can help you get back to living without limits.

Pelvic health physical assessment

We often hear the physical assessment is the most concerning for new patients who’ve never experienced the benefits of pelvic health therapy. In the most basic sense, pelvic health is part of orthopedics. While it is one portion of the body, pelvic health is part of the elaborate orthopedic condition of the whole body working together for your general health and well-being.
When we assess you for pelvic health issues, we step back and don’t just look at the symptoms, but also at the whole person to decide where the stressors are coming from. We assess posture, breathing, functional or repetitive tasks you do at work or in life and any current exercise regimen.

Externally we’re looking at:

• Posture
• Breathing mechanics
• Hip and core strength
• Movement patterns

Following an external exam, if indicated, your therapist may suggest an internal exam. Internal pelvic exams are not needed by everyone and are always optional, even if recommended. The patient drives the care experience and the internal exam is never done without consent.

An internal exam will provide information about pelvic floor muscle tone, strength, coordination and tenderness.

Treatment during session

Your care plan and treatment is designed just for you. Your therapist will outline the plan created for you, go over the frequency of visits and expected outcomes. The rate of your progression and your goals determine the frequency and number of in-center visits.

• Breathing and relaxation exercises – reduces pelvic floor tension
• Gentle movement and stretching – targets hips, lower back and pelvic region
• Biofeedback or electrical stimulation – helps retrain muscle function
• Manual therapy – releases tight pelvic floor muscles and mobilizes tissues

Sessions are private, respectful and patient-centered. You should wear comfortable clothing that allows for movement. Again, internal exams and treatment are optional and you can ask questions at any time.

You are not a passive rider on the train of treatment. Your therapist will clearly communicate what they are doing, the why behind it and train you in identifying how the methods used are working to address your pelvic conditions. This careful education helps you be in control of what is happening in your body and correcting where needed.

Pelvic floor exercises at home

Most care plans include home exercises and strategies for symptom management. Your therapist will teach you personalized pelvic floor exercises for relaxation, mobility or strengthening. They will also educate you on proper posture, bladder and bowel habits and pain management strategies.

Pelvic floor exercises at home are generally easy to add into your daily routine and aren’t time-consuming. You can do them when you wake up, when you lay down to rest or some you can even do during your daily activities without anyone knowing.

Commitment to the process

Your care plan is a process. Rarely is rehabilitation an instant solution — it involves understanding and consistency — and your success relies heavily on your commitment to the process.

We return your investment in the process with our own commitment. We monitor your progress at each session, including gathering your important feedback about what you’re feeling and if you’re seeing improvement. If the answer is falling in the no-change category, we’re going to try new treatments and methods.

We’ll also explore what is new based on research and evidence-based guidance. Our greatest skill is the ability to use our pelvic health expertise in a flexible way that meets your needs. If that means revamping your care plan, that’s what we do, using all the tools at our disposal including behavioral and functional strategies, meditation, nutrition and more.

The whole body plays a role in your success.

Follow-up plan

Once you graduate or complete the program, there is good news: You did it.

You committed and made the progress you wanted, but the door is now fully open for any future issues you may experience. We may make recommendations for regular check-ins or we may tell you to call if you see a return of old symptoms or the appearance of new problems.

You now have an open-access ticket to carry your pelvic health into the future. With a simple call we can schedule you for what you need, when you need it.

Finding hope

Many people live with the symptoms of pelvic floor dysfunction for years before seeking help, silently facing physical, emotional and social challenges. This struggle can take a toll on how you move through life, but it doesn’t have to be that way.

Investing in pelvic health therapy can save you years of feeling embarrassed or being uncomfortable. Our advanced clinical expertise combined with the ability for you to have access to our services in a timely manner can be life changing.

The first step is yours.

Take back your health by calling and making an appointment for an initial evaluation today. Don’t let pelvic health conditions run your life.

Clinical contribution to this blog provided by Physical Therapist Colleen Hickey, national director of our CoreVia Pelvic Health program.