Pelvic Floor Therapists Near Me

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FAQs:

What is Pelvic Floor Physical Therapy?

Pelvic floor physical therapy is a specialized kind of physical therapy to relieve the symptoms of pelvic floor dysfunction and helps the muscles work the way they should. This includes several exercises that help your pelvic muscles relax and get stronger. When you begin pelvic floor therapy, a physical therapist (PT) will learn more about your symptoms. Your PT will check your core muscles to see how strong they are, along with how much core endurance you have. Your PT will also have you try certain activities and positions to check the coordination of your pelvic floor muscles.

What Does Pelvic Floor Therapy Do?

Pelvic floor physical therapy is used to treat all types of disorders classified as pelvic floor dysfunction. Both decreased and increased muscle tone can lead to pelvic floor dysfunction.

Muscle tone refers to the amount of resting tension in a muscle when it is not contracted.

Low Tone Disorders

When a muscle has a low tone, the muscle is more relaxed and looser than normal, making it difficult to actively contract.

When the pelvic floor muscles are weak due to low tone and you have difficulty actively contracting them, your core cannot be adequately supported and your control over your bladder and bowel movements may be affected.

Low-tone pelvic floor disorders that can be helped by pelvic floor therapy include:

1. Pelvic organ prolapse: Abnormal descent of the pelvic organs, including the uterus, vagina, bladder, or rectum, from their normal positioning

2. Stress incontinence: Involuntary leaking of urine during activities that increase intra-abdominal pressure, including coughing, sneezing, laughing, squatting, and heavy lifting

3. Overactive bladder: A condition characterized by urinary urgency, frequency, and urge incontinence when your bladder involuntarily contracts

4. Anal incontinence: Involuntary leaking of gas, fluid, or stool from the rectum

High Tone Disorders

When a muscle has a high tone, the muscle is tighter and more restricted than normal. This can often cause pain when you try to relax or stretch the muscle.

When the pelvic floor muscles are excessively tight due to high tone, you may experience pelvic pain, muscle spasms, as well as pain, and difficulty with insertion during intercourse or a gynecological exam.

High-tone pelvic floor disorders for which pelvic floor therapy may be recommended include:

1. Pelvic floor myofascial pain: Chronic pain that results from tightened pelvic floor muscles

2. Vaginismus: Uncontrolled, involuntary spasm of the muscles surrounding the vagina that occurs with penetration 

3. Dyspareunia: Pain from vaginal penetration during sexual intercourse is called dyspareunia

4. Vulvodynia: Pain and discomfort in the vulva, often referred from tight and dysfunctional pelvic floor muscles

What are Bladder Control Issues?

Bladder control issues (urinary incontinence) cause you to lose control of your bladder. The issues cause you to urinate (pee) or leak uncontrollably.

Your kidneys remove waste from your blood and make pee so your body can get rid of the waste. Pee travels through tubes of muscle called ureters (yer-it-ters) to your bladder.

Your bladder is a round, hollow organ in your pelvic area that holds your pee. It’s below your kidneys and behind your pelvis bone. It’s about the size of a grapefruit, and it expands as it fills with pee and shrinks when you go to the bathroom.

When you have to pee, muscles in the walls of your bladder contract (tighten), and a sphincter muscle that keeps pee inside your bladder relaxes. This allows pee to flow out of your bladder through a tube called a urethra (yer-ree-thruh) and eventually exit your body.

Bladder control problems happen when your bladder muscles contract more than usual or don’t contract at the same time. If your bladder muscles contract with excessive strength, they can over-overpower your sphincter muscles. This results in pee exiting from the bladder, into your urethra, and out of your body uncontrollably.

What Does Pelvic Floor Physical Therapy Entail?

Pelvic floor therapy differs from other types of physical therapy that people might be more familiar with, such as shoulder or knee therapy. The first step is a consultation with a physical therapist. After the consultation, the physical therapist will work with you to create an individualized plan to address your pelvic health needs. Sessions could include exercises, stretches, manual therapy, biofeedback therapy, or electrical stimulation to strengthen or relax your pelvic floor muscles. The number of sessions needed will vary, and each session is customized to address your needs and symptoms.

How to Know if You Need Pelvic Floor Therapy?

Pelvic floor therapy is appropriate for those with low-tone or high-tone forms of pelvic floor dysfunction and related pelvic floor muscle pain.

Pain in the pelvic region may not always be related to pelvic floor muscle dysfunction, however. The following symptoms may be signs of a more serious condition:

- Burning sensation during urination

- Heavy bleeding during menstruation

- Severe menstrual cramping

- Irregular periods

- Blood in urine or stool

- Abnormal vaginal discharge

- Fever

- Chills

- Nausea and vomiting

Make sure to contact your primary care physician or gynecologist if you have been experiencing any of these symptoms. You may have an infection or another condition related to your gastrointestinal, urinary, or reproductive organs that requires further medical treatment.

Does Pelvic Floor Physical Therapy Work?

While pelvic physical therapy sounds unusual and invasive, it is quite effective. Patients see a success rate and enjoy an improved quality of life after treatment—though efficacy depends on the severity of the condition treated. Treatment of myofascial pelvic pain with therapy takes 6-8 sessions of one hour each for a few weeks but may require several months in severe cases. Patients may also need to return for periodic therapy to keep their problems in check.

Are you or your loved one suffering from pelvic pain and associated symptoms? Well, you should know that pelvic pain is not normal at any time, and getting early treatment is crucial. The longer you experience chronic pain, the more likely that your nerve receptors will get sensitized to it. As a result, your body will develop a heightened reaction to pain, making it more severe and very difficult to treat. So, if you are experiencing unexplained chronic pelvic pain, consult a specialist in pelvic floor disorders as soon as possible to get a timely diagnosis and treatment.

Is Pelvic Floor Therapy Painful?

It’s important to note that while some discomfort may be experienced during assessments, the overarching design of pelvic floor therapy is rooted in a gradual and personalized approach tailored to your comfort level. Therapists are attentive to individual sensitivities and work collaboratively with clients to ensure the therapy journey is as comfortable and accommodating as possible.

How Long Does Pelvic Floor Therapy Take?

Sessions typically last 60 minutes. If you and your provider decide that longer sessions would be beneficial, session time may be increased. The number of visits you need will vary based on your specific pelvic floor problems, how long you’ve had these problems, your overall health, consistency with your home program, and what you want to get back to doing! The average person will start to notice an improvement in just 3-4 visits. You will see the most progress if you attend physical therapy once a week for the first few weeks. From there, sessions may continue at a once-a-week frequency or decrease to every other week for hands-on care and progressions to your home exercise program based on your progress and needs. ​

What to Wear to Pelvic Floor Therapy?

A pelvic floor workout is designed to reduce or eliminate bladder problems, painful sex, and vaginal prolapse in women. It may also be beneficial for those who have recently undergone childbirth or surgery. Your therapist may apply lubricant and press on various points of the pelvic floor muscles to assess their tone, strength, endurance, and control.

1. Loose Clothes

When attending pelvic floor physical therapy sessions, it’s essential to wear clothing that allows you to move freely and comfortably. Loose-fitting clothes such as yoga pants and a t-shirt offer coverage while still allowing your therapist access to the areas they need to work on. Avoid tight or restrictive clothing as these can obstruct proper blood flow and nerve conduction to the lower limbs and pelvic area. Tight jeans, in particular, tend to contribute to these problems since they increase pressure on the pelvic floor. Studies have demonstrated that wearing tight pants can cause abnormal movement and posture in the lumbar spine and pelvis, leading to musculoskeletal disorders with pain or discomfort.

2. Warm Socks

Your lower torso is home to the pelvic floor, a hammock-like soft tissue structure designed to support organs like your rectum, bladder, and bowels. But if this structure becomes overstretched or tense, it can lead to various issues. Myofascial pain in the pelvic floor has been reported to be responsible for up to 23% of chronic pelvic pain cases and is the primary factor in 78% of bladder conditions called interstitial cystitis (Harvard Health, 2018). Pelvic floor physical therapists typically utilize gentle internal manual therapy, visualizations, and guided breathing during treatments to release tension in muscles and fascia, promote relaxation, and restore blood, lymph, and nerve innervation to your pelvic bowl. It is highly recommended to wear warm socks during pelvic floor physiotherapy sessions to protect your feet from getting chilled during manipulations on cold floors in the clinic.

3. Comfortable Shoes

Pelvic floor physical therapy is a fantastic way to strengthen your pelvic floor muscles and prevent bladder problems. It’s especially helpful for women with vaginismus, endometriosis, or urinary incontinence after pregnancy or surgery. Kegels, squeezing your pelvic floor and other exercises that engage muscles are all incredibly therapeutic for the pelvic floor and other parts of the body – leading to improved sexual function as well as orgasms. However, you should take great care in selecting your shoes for treatment sessions. Wearing appropriate footwear can make all the difference in your progress and enable therapists to provide more precise exercise prescriptions. High heels that squeeze your toes together, such as high heels, can create tightness in the pelvic floor. On the other hand, ballet flats give your feet room and allow you to center your pelvic floor; this has positive effects on all other horizontal structures in your body such as ankles, knees, hips, and spine.

4. Underwear

Your physical therapist may ask you to undress from the waist down for a comprehensive pelvic muscle exam conducted privately. They use non-latex gloves and lubricant on your pelvic floor muscles, as well as performing an internal exam using the vagina or rectum as needed. Your therapist will also review your medical history and address any specific worries. This helps them gain a better insight into what’s wrong with your body, so they can suggest an individualized treatment plan to suit each individual.

A physical therapist with special training in the pelvic floor will conduct a detailed evaluation of your posture, alignment, and movements. They may also test for balance, strength, flexibility, and coordination; additionally, they test sensory and sensation awareness as well.

Does Insurance Cover Pelvic Floor Therapy?

Because optimum pelvic floor health can prevent or alleviate many common medical issues and avoid the need for expensive surgery in many cases, most insurance carriers do cover pelvic floor therapy. However, it is important to keep in mind that every plan is different. Therefore, patients should contact their insurance carrier to find out if it is covered or call a pelvic physical therapist they are considering to inquire about which types of insurance are accepted and what the out-of-pocket costs for treatment will be. Even if services are covered, some of the costs may come out of your deductible.

Even if your policy does cover pelvic floor physical therapy, you should be aware that like doctors and other specialists, not all physical therapists will be included in your plan. In addition, some pelvic floor physical therapists work in cash-only clinics that do not accept insurance, although some may provide an invoice for those who wish to seek reimbursement from their insurance carrier. It is best to clarify all of this upfront so there are no surprises when it comes time to pay for treatment.

How Much Does Pelvic Floor Physical Therapy Cost?

The cost of pelvic floor physical therapy can vary depending on several factors, including the location, the expertise of the therapist, and the duration of the treatment. In general, the cost of pelvic floor physical therapy ranges from $100 to $250 per session. It is important to note that these figures are approximate and can vary significantly.

The initial evaluation session with a pelvic floor physical therapist may be slightly more expensive than subsequent sessions. During the evaluation, the therapist will assess the individual’s specific condition, medical history, and goals for therapy. This session usually lasts longer than the subsequent sessions, allowing the therapist to gather comprehensive information and develop a personalized treatment plan.

The frequency and duration of the treatment sessions also play a role in determining the overall cost. Some individuals may require weekly sessions initially, while others may only need bi-weekly or monthly visits. The average duration of treatment varies depending on the severity of the condition and the individual’s response to therapy. It is not uncommon for individuals to undergo pelvic floor physical therapy for several weeks or even months.

What is the Pelvic Floor?

Everyone has a pelvic floor. It’s made up of the muscles that support the urinary and reproductive tracts. This group of muscles also controls your bladder and bowels.

In women, the pelvic floor keeps your bladder in place in the front and the vagina and rectum in the back. Your uterus is held in place at the top of the pelvic floor by muscles, tendons, and connective tissue. In men, the pelvic floor helps keep the bowels, bladder, urethra, and rectum in place.

The pelvic floor muscles attach to your tailbone and pubic bone. If the muscles in the pelvic floor are weak or don’t work as they should, this is called pelvic floor dysfunction.

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is a common condition where you can’t correctly relax and coordinate the muscles in your pelvic floor to urinate (pee) or have a bowel movement (poop). Think of your pelvis as being home to organs like your bladder, uterus, prostate, and rectum. Your pelvic floor muscles are the home’s foundation. They’re the support structure keeping everything in place.

Normally, you’re able to go to the bathroom without issue because your body tightens and relaxes your pelvic floor muscles. This is just like any other muscular action, like tightening your biceps when you lift a heavy box or clenching your fist.

But if you have pelvic floor dysfunction, your body keeps tightening these muscles instead of relaxing them. This tension means you may have:

1. Trouble evacuating (releasing) a bowel movement.

2. An incomplete bowel movement.

3. Pee or poop leakage.

If you’re assigned female at birth (AFAB), pelvic floor dysfunction may also cause pain during intercourse. If you’re assigned male at birth (AMAB), you may have problems getting or keeping an erection (erectile dysfunction).

Symptoms of Pelvic Floor Dysfunction

The following signs and symptoms can let you know you might have a pelvic floor issue:

- Frequent bathroom visits.

- Having to frequently start and stop when you’re trying to pee.

- Straining or pushing to pass a bowel movement.

- Having to change positions on the toilet or use your hand to eliminate stool.

- Constipation (Experts estimate that up to half of the people with long-term constipation also have pelvic floor dysfunction).

- Leaking stool (fecal incontinence).

- Leaking urine (urinary incontinence).

- Painful urination.

- Unexplained lower back pain.

- Ongoing pain in your pelvic region, genitals, or rectum — with or without a bowel movement.

Causes of Pelvic Floor Dysfunction

Experts don’t know the exact cause of pelvic floor dysfunction. But, a few known factors may play a role. These include:

- Traumatic injuries to your pelvic area (like a car accident or a fall from a high place).

- Overusing your pelvic muscles (straining to go).

- Prior pelvic surgery (like a hysterectomy or prostatectomy).

- Pregnancy and childbirth (especially difficult deliveries).

- Aging (muscles naturally weaken somewhat over time).

- Stress and anxiety.

- Connective tissue disorders.

Four Primary Functions of the Pelvic Floor

The pelvic floor is a group of 26 muscles that make up the bottom of the pelvic region. These muscles function together like a hammock across the pelvis and attach from the pubic bone in the front to the tailbone in the back.

The pelvic floor has four primary functions:

1. Support pelvic organs, including the bladder, uterus, prostate, and rectum.

2. Stabilize the pelvis and spine.

3. Assist with sexual function.

4. Support bowel and bladder control.

Pelvic floor muscles are similar to other muscles in the body. They can be weak, stretched out, strong, or tight. Pelvic floor weakness or tension leads to pelvic muscle dysfunction. Weakness in the muscles can be a common cause of incontinence, and tension can lead to pelvic pain.

Physical therapists are experts in the functions of muscles, joints, and nerves. Some therapists have additional training and are educated on pelvic floor muscle health. Your primary care provider may refer you to a pelvic floor physical therapist to address pelvic floor function.

Conditions that can be Mistaken for Pelvic Floor Dysfunction

Pelvic floor dysfunction can exist alongside (and be mistaken for) many other conditions, including:

1. Interstitial cystitis: This condition causes pain in your pelvis or bladder. The pain can lead to loss of muscle relaxation in your pelvic floor muscles. So, having one of these conditions increases your risk of having the other.

2. Irritable bowel syndrome (IBS): IBS is a group of symptoms that affect your digestive tract. While researchers haven’t identified a link between IBS and pelvic floor dysfunction, they share certain symptoms. These symptoms include constipation and trouble emptying your bowels.

3. Pelvic organ prolapse (POP): POP happens when the muscles holding your pelvic organs (uterus, bladder, and rectum) in place loosen and become too stretched out. The weaker muscles can cause your organs to stick out of your vagina.

4. Erectile dysfunction (ED): ED is when you can’t get or maintain an erection during sex. Sometimes, pelvic muscle tension or pain is the cause, but ED is a complex condition, so this may not be the case.

5. Prostatitis: Pelvic floor dysfunction symptoms closely resemble prostatitis. This is an infection or inflammation of your prostate. Prostatitis can have many causes, including bacteria, sexually transmitted infections (STIs), or trauma to your nervous system.

6. Constipation: Constipation can mimic pelvic floor dysfunction or vice versa. Constipation and straining can also lead to pelvic floor dysfunction.

7. Anorectal conditions: Conditions that affect your anus (butthole) and rectum, like fissures or fistulas, can share features of pelvic floor dysfunction.

Tests to Diagnose Pelvic Floor Dysfunction

Your provider may do a physical exam to test how well you can control your pelvic floor muscles. Using their hands, your provider will check for spasms, knots, or weakness in these muscles. Your provider will also perform a rectal exam and (if you’re AFAB) a pelvic exam.

You may also need other tests, including:

1. Anorectal Manometry. This test measures how well your anal sphincters are working. It measures the pressure in your muscle contractions that help you poop. Providers often perform an electromyography (EMG) at the same time to test the coordination of your pelvic floor muscles.

2. Defecating Proctogram. Your provider may order this test to see how well you can start a bowel movement and empty your bowels. It can show how different organs are working when you poop. Providers also use it to check for prolapse and other anatomic abnormalities of your pelvic floor organs.

3. Urodynamics. Your provider may order urodynamic testing if you have problems peeing. This test can show how well you can empty your bladder. A weak pee flow and having to start and stop peeing can be signs of pelvic floor dysfunction.

How to Treat Pelvic Floor Dysfunction

Healthcare providers can treat pelvic floor dysfunction without surgery. Treatments include:

1. Pelvic Floor Physical Therapy: A physical therapist can help you identify which pelvic floor muscles are too tense. They can teach you exercises to stretch these muscles and improve their coordination.

2. Biofeedback: This is the most common treatment for pelvic floor dysfunction. It usually occurs alongside physical therapy. During your appointment, your physical therapist may use sensors and video to monitor your pelvic floor muscles as you relax or clench them. They’ll give you guidance to improve your muscle coordination.

3. Medications: You may need daily medications to keep your bowel movements soft and regular. Some of these medications are available over the counter (OTC) and include stool softeners such as MiraLAX, Colace, senna, or generic stool softeners.

4. Relaxation techniques: Your provider or physical therapist might recommend relaxation techniques such as meditation, warm baths, yoga, exercises, or acupuncture to relieve tension in your pelvic floor muscles.

5. Trigger point injections: If physical therapy and biofeedback don’t help, your provider may recommend you see a pain injection specialist. These doctors can pinpoint the specific muscles that are overly tense. They’ll use a small needle to inject numbing medications to relax them.

What to Expect from Pelvic Floor Physical Therapy

On the day of your pelvic floor therapy evaluation, you will be brought into a private treatment room. Your physical therapist will go over your medical history, symptoms, and complaints.

They will also perform a physical exam, which will consist of an external and internal component:

During the external exam, your physical therapist will assess your lumbar spine, sacroiliac joints, and muscles that surround or attach to the pelvis—including the rectus abdominis, iliopsoas, and piriformis—to check for pain, tightness, or tenderness.

During the internal exam, your physical therapist will assess your pelvic floor muscles for tone, elasticity, pain, and tenderness. They may insert one or two gloved fingers into your vagina and/or rectum to palpate the pelvic floor muscles from the inside. A lubricant is often used to help ease the discomfort.

Your physical therapist will also examine your ability to perform voluntary contraction and relaxation of your pelvic floor muscles, as well as movement of your pelvic floor with your breathing patterns. 

Expect an initial exam to last about an hour. After your physical therapist has completed the examinations and made a clinical assessment of the possible causes of your symptoms, you will be scheduled for follow-up sessions. Each session will take place in a private treatment room and last about 45 minutes.

Pelvic Floor Therapy Exercises

Your therapist will guide you through exercises designed to strengthen or relax specific muscles. Exercises targeting the pelvic floor muscles in a therapeutic context have the potential to alleviate symptoms associated with pelvic floor dysfunction, including issues like urine leakage.

1. Kegel Exercises: Contract and lift the pelvic floor muscles as if you are trying to stop the flow of urine. Hold for a few seconds, and then release. Repeat this contraction-relaxation cycle.

2. Pelvic Clocks: Imagine your pelvic area as the face of a clock. Gently tilt your pelvis forward, backward, and side to side, moving through each hour on the clock. This helps engage different muscles.

3. Bridge Exercise: Lie on your back with your knees bent and feet flat on the floor. Lift your hips towards the ceiling, engaging the glutes and pelvic floor muscles. Hold for a few seconds and then lower back down.

4. Squats: Stand with feet shoulder-width apart and slowly lower your body into a squat position. Focus on engaging the pelvic floor muscles as you rise back up.

5. Inner Thigh Squeeze: Place a soft ball or pillow between your knees and gently squeeze, engaging the inner thigh and pelvic floor muscles. Hold for a few seconds and release.

6. Diaphragmatic Breathing: Practice deep, diaphragmatic breathing to promote relaxation and coordination of the pelvic floor muscles. Inhale deeply through your nose, allowing your diaphragm to expand, and then exhale slowly.

How to Find a Pelvic Floor Therapist Near Me

Here are some tips to help in your search:

1. Ask your health professional, family, friends or Google.

2. Check out the clinic's website. This is the face of the practice and often the clinic's first interaction with you. The clinic website should put in the effort to answer common questions a prospective patient may have, explain what to expect at your first visit, educate you on what they do and how they can help, highlight the therapists' experience and credentials, and convey that their practice is an inviting and safe space.

3. Reach out to the clinic. Call your clinic. The office manager listened to my questions and concerns. She also suggested I email one of the therapists for more detailed information. I emailed, and the therapist wrote back within days and answered all my questions.

4. Find out if your insurance provider will cover pelvic PT sessions. At best, most insurers consider pelvic PTs "out-of-network providers." Why this isn't standard postpartum care and isn't covered fully by insurance companies is criminal.

5. Talk to and try more than one therapist. Personal comfort and fit are important, also you gain different perspectives from each therapist. There are many paths to healing. Find one that feels right for you.

6. Find out if you'll get one-on-one attention. This is very intimate care. You shouldn't be left alone with exercises or a device, while the therapist is off working on another patient or doing paperwork. Make a list of questions you want answered to help inform your decision. No question is too small. A good pelvic PT should patiently answer your questions.

Sources:

WebMD

Mayo Clinic Health System

My Cleveland Clinic

Very Well Health

Tribeca Physical Therapy

Fyzical

Gyn Raleigh

Pelvic Floor Pro

Mama on the Mend

Wild Hawk Physical Therapy

Pelvic Health and Wellness