Enrich Motion - Pelvic Floor PT - What it Is and Who Needs It

Pelvic Health Physical Therapy (PT) is an increasingly recognized specialty focused on addressing dysfunctions related to the pelvic floor. The pelvic floor is a compound structure encompassing all visceral, neurovascular, and myofascial components contained within the bony pelvis, extending from the pubic bone to the coccyx and between the lateral ischial walls.

What Exactly Does the Pelvic Floor Do?

The muscles of the pelvic floor (PFM) perform several critical roles in the body, including:

Continence control (sphincteric function).
Supportive function for all pelvic floor structures.
Stability and posture maintenance.
Coordination with respiration.
Sexual function.

The deepest PFM group, the levator ani (LA) muscles, are vital for pelvic floor support. According to Helt et al., the LA muscles are composed primarily of slow-twitch fibers (~70%), meaning they are in a constant state of activity or resting "tone" to provide active support against the weight of the abdominal contents and pelvic viscera against intra-abdominal pressures.

Who Needs Pelvic Floor PT?

Physical therapy addresses Pelvic Floor Muscle Dysfunction (PFMD) and is often recommended as a first-line, conservative approach before considering surgery.

Individuals referred for PFM rehabilitation often present with a variety of symptoms, including:

Urinary Symptoms

Pelvic PT is often sought for lower urinary tract symptoms, including various types of incontinence:

Urinary incontinence (Stress UI, Urge UI, Mixed UI).
Urinary urgency and frequency.
Straining, slow or intermittent urine stream, or the feeling of incomplete emptying.

Conservative intervention, sometimes termed "behavioral treatment," is widely recognized in the literature as the "first line of defense" for urinary incontinence.

Prolapse Symptoms

Pelvic Organ Prolapse (POP) occurs when the pelvic organs descend and is one of many pelvic floor disorders affecting women. Symptoms of prolapse are defined as a departure from normal sensation, structure, or function related to the position of the pelvic organs. Patients often report a sensation of pressure or heaviness in the vagina or a feeling of a bulge in or coming out of the vagina. These symptoms may worsen with prolonged standing or walking, or toward the end of the day.

Physical therapy (Pelvic Floor Muscle Training or PFMT) is recommended as a first line treatment for POP stages 1 and 2 and may lead to anatomical and symptom improvement.

Bowel Symptoms

PFMT can help address various bowel symptoms associated with PFMD, such as:

Fecal or anal incontinence.
Obstructed defecation or functional constipation.
Rectal/anal prolapse.
Feelings of incomplete emptying.

Chronic constipation is important to address, as straining associated with constipation can increase intra-abdominal pressure, which in turn contributes to pelvic floor dysfunction, including POP and UI.

Pelvic Pain

Physical therapy evaluation can help determine the source of pain, which may originate from musculoskeletal or myofascial issues.

Common diagnoses seen in PT include:

Myofascial pain.
Vulvodynia (chronic, burning, aching pain in the vulva).
Dyspareunia (genital pain resulting from sexual penetration).
Pelvic girdle pain and coccydynia (tailbone pain).

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