Are you new to Pelvic Floor Physical Therapy? You may be wondering what happens during a pelvic floor PT session. Our Pelvic Health 101 Guide is a comprehensive overview of the pelvic floor process and what to expect.
Most people don’t know that physical therapy can help with pelvic pain, dysfunction relating to pregnancy/postpartum, menopause, and post-cancer treatment issues. Part of the reason for this is because these problems are so common that they are often mistaken for being normal.
Another part of the problem is that pelvic floor dysfunction, which may involve pelvic pain and bladder or sexual dysfunction, is not necessarily caused by a structural disease that is easily picked up in medical exams. Because of this, medical providers often tell patients there is nothing wrong, leading to increased frustration and stress, which, in turn, can amplify the problem.
This is why so many folks learn to live with low back pain that has been there for decades since pregnancy/postpartum, bladder leakage/incontinence that has gotten worse over the years, or long-lasting pain that feels like an infection although test results are negative.
Pelvic floor therapy can help solve many health conditions, including gynecological, urinary, sexual, and gastrointestinal issues caused by pregnancy/postpartum, menopause, and post-cancer treatment issues. Here at Pillar Kinetic, our clinic provides pelvic floor physical therapy in Las Vegas to women and men of all fitness levels.
Whether you are looking to perform your best in the gym, have pain-free intimacy, complete a full work day, or travel without pain, we don’t think pelvic floor dysfunction should limit you. Learn more about pelvic floor physical therapy in our guide.
Article Contents
Pelvic floor physical therapy is a non-surgical treatment that helps improve or restore the function of the pelvic floor muscles. It is a combination of strengthening exercises, stretches, manual therapy, and ongoing education to reduce symptoms, and strengthen, relax the muscles in the pelvic floor.
What Does a Pelvic Floor Physical Therapist Do?
A Physical Therapist (PT) is a provider who uses musculoskeletal and neuromuscular assessment to help determine the root causes of pain and dysfunction, then implements a treatment plan to address these causes and resolve the problem.
A Pelvic Floor Physical Therapist is a PT who specializes in applying this approach to gynecological, urinary, sexual, and gastrointestinal issues.
When we injure our shoulder, we typically recognize that there are muscles, bones and nerves that need to be taken care of in order to get back to activities of daily living without pain. Everyone has a pelvis. In certain cases, our pelvic floor muscle function can change due to childbirth, aging, surgery, stress, and other causes. Because our pelvis and abdomen house and support several organs, it is easy to forget that muscles, joints, and nerves need to function properly here as well.
For example, if someone is having a problem such as urinary incontinence or leakage, the bladder itself is sometimes assumed to be the cause of the problem. However, one main mechanism that prevents leakage from the bladder during coughing, sneezing, and jumping is related to the ability of our muscles to manage pressure and impact.
A Pelvic PT is the provider who can specifically examine these muscles and their ability to work correctly during your daily routine, whether exercising, lifting your kids, or participating in social events.
Pelvic Floor Symptoms
Many people interested in pelvic floor therapy may have questions about evaluations and how they work. Here’s what to know about pelvic floor evaluations.
What Does an Evaluation Look Like?
Evaluation with a Pelvic Floor Physical Therapist involves an in-depth discussion of past medical history, lifestyle, and treatment goals.
Next, an external musculoskeletal assessment is typically similar to what could be expected with a more traditional orthopedic diagnosis. Looking at the spine, pelvis, hips, and abdominal muscles can provide great information as we build a plan to address pelvic health dysfunction and pain. The most unique part of a pelvic floor evaluation is the pelvic floor muscle exam.
This involves disrobing from the pants down so your physical therapist can assess the muscles of your pelvic floor (typically both externally and internally). This allows your therapist to determine how your pelvic floor muscles are contributing to your problem by observing how these muscles relax, contract, respond to changes in pressure, etc. Without having this information, it is challenging to determine which exercises will correct the problem.
What to Know About Pelvic Floor Exams
Pelvic Floor exam most often involves the patient lying on their back with hips open wide and a sheet covering them. The therapist performs an external exam first in order to observe the support of the tissues, their quality, presence of pain, and organ descent.
For the internal component of the exam, the therapist inserts typically one finger vaginally (for women) in order to assess the deeper layers of the pelvic floor. This is important in assessing pain, reproduction of symptoms, endurance, strength, and the ability of the muscles to relax. Depending on the complaint you are seeing your therapist for, your preference, and the characteristics of the symptoms, the pelvic floor exam can also take place in a different position, such as side lying or up on hands and knees.
Sometimes, the exam is done rectally, as for men or in order to palpate closer to the structures like the tailbone, posterior hip musculature, etc. Your therapist will likely ask you to relax, bear down, cough, and contract or squeeze the pelvic floor muscles during your pelvic floor exam. It is always up to the patient whether or not they prefer to participate in internal muscle exams. Your Pelvic PT can also gain information from a thorough screening and external exam, but internal examination provides helpful clinical insight.
So Where Does a Pelvic Floor Muscle Exam Take Place?
Pelvic rehabilitation is not taught as part of any medical profession’s curriculum or as a requirement for licensure. Training in this area is an option to complete as postgraduate coursework in those who wish to specialize. It is important to have a comprehensive pelvic floor muscle assessment (or at least screening by a specialist) prior to committing to a treatment program.
The vast majority of professionals who offer pelvic floor exams are physical and occupational therapists. However, several other healthcare professions have the option to complete coursework as well. It is important to note that medical exams such as pap smears, urodynamics testing and imaging such as vaginal ultrasound do NOT test for pelvic floor dysfunction (although they can be important for plenty of other reasons and provide information that is helpful for your therapist to know).
There is a strong misconception among medical providers that pelvic floor conditions can all be treated the same way or with one isolated exercise, such as Kegels. This is untrue and can cause worsening symptoms in many people. Symptoms alone do not provide the information needed to build a comprehensive treatment approach.
Non-surgical pelvic floor treatment consists of manual therapy, exercises and stretches, and additional techniques aimed at strengthening and supporting pelvic floor muscles, and reducing your symptoms.
What Can Pelvic Floor Therapy Help With?
The benefits of Pelvic floor physical therapy can help with a wide range of health conditions.
What Does Pelvic Floor Treatment Look Like?
Pelvic Floor Physical Therapy often involves some treatment similar to general or orthopedic physical therapy exercises, including flexibility, progressive strength training, soft tissue mobilization, and functional movement training. The main difference is that the chosen techniques typically depend on the relationship between the target tissue and the pelvic floor or other structures.
For example, a hip muscle called the obturator internus has connections to the pelvic floor and a communication network via reflexes to and from the bladder. This muscle can be involved in the function of the pelvic floor and symptoms, which can be determined upon exam. A therapist may choose exercises that target this muscle to address symptoms such as urinary urgency or the sensation of a distressing, urgent need to use the bathroom.
Dry Needling & Pelvic Floor PT
Treatment may also involve techniques such as dry needling for the pelvic floor, myofascial release (internal and external), visceral mobilization, E-stim, and joint mobilization. Modifications often need to be made to enable patients to continue their daily activities. This could include work-related tasks, household roles, or keeping up with their fitness program.
Many pelvic floor conditions can be made worse by repeating movements that exacerbate symptoms such as vaginal pressure/pelvic organ prolapse, abdominal muscle separation/diastasis rectus, and urinary leakage/stress urinary incontinence. For this reason, pelvic rehab often focuses on movement strategies to prevent worsening conditions while addressing the underlying root causes. This may involve modifications from rolling out of bed to barbell lifting.
Pelvic floor physical therapy provides several benefits for men, ranging from sexual to urologic health. Here’s what pelvic floor therapy typically consists of for men.
Can Men Benefit from Pelvic Physical Therapy?
Yes! We all have pelvises and can all have Pelvic Floor Dysfunction. When we think of urinary incontinence or leakage, we often think of women. Still, the truth is men also may have changes to their pelvic floor such as following a procedure such as a prostatectomy.
Along with the muscles of the pelvic floor that support the bladder and constrict around the urethra, the prostate gland helps reinforce support and even blends with part of the pelvic floor. When this organ needs to be removed fully or partially, the result can be urinary incontinence in men. With changes to support internally from above, it is important to coordinate muscles of the deep abdominals and pelvic floor to work together during functional tasks and movement.
Symptoms in Men
Men can experience pelvic pain, which may present as prostatitis or interstitial cystitis/Bladder Pain Syndrome which typically involves symptoms of urinary urgency, urinary frequency, urethral burning, weak urinary stream, and/or discomfort with bladder filling and even testicular pain. Men also can experience pelvic pain that may be located at specific places, such as with penile tip pain.
Symptoms of the above conditions can often be reproduced and relieved with a good physical examination of muscles and nerve pathways. However, treatment is often limited to antibiotics and medical testing. These tests are unlikely to pick up irritation along a nerve pathway or get an in-depth assessment of abdominal and pelvic muscle function.
Pelvic Floor and ED
A common condition men experience is erectile dysfunction (ED). ED can have several causes, which are not always musculoskeletal, and warrant a visit to a medical provider to rule out other causes; when the answer is not found by a medical exam, that can be frustrating as this can limit effective treatment options.
Muscles of the pelvic floor play a role in allowing increased blood flow into the penis, maintaining it there during arousal, and then allowing increased blood flow out of the penis. This is how erection is maintained. The pelvic floor interacts with nerve pathways and musculature within the lower back and pelvis, which can be a reason for tissue restriction that reduces the muscle’s ability to facilitate an effective erection.
This is where a pelvic floor physical therapist can evaluate the patient by performing a physical examination of the lower back, hips, and abdominals to the pelvic floor to gain insight into the cause of the problem and how to address it.
Some people may be familiar with coming to Pelvic Physical Therapy postpartum, but are unsure when to start. The truth is, the most optimal time to start is actually during pregnancy.
During pregnancy, ligaments and muscles of our deep core lengthen to create space for the growing baby. This can cause them to weaken, become delayed in function, and offer less automatic support. This is part of the reason pregnancy is a risk factor for urinary incontinence/leakage, pelvic organ prolapse, and diastasis rectus abdominus.
Core weakness is also part of the reason other muscles of our low back, hips, and pelvis may become tight to continue providing support. This tension can cause or contribute to many other pregnancy-related symptoms, such as sciatica, pelvic girdle pain, and groin pain.
The good news? Muscles are re-trainable, and you do not have to endure significant pain throughout pregnancy. In fact, these issues are easier and quicker to resolve the sooner you get treatment for them, vs. waiting until postpartum.
Pelvic PT and Exercise for Pregnancy
Another important reason for Pelvic Physical Therapy during Pregnancy is that exercise is one of the best things you can do to address or prevent pain and symptoms and set yourself up for an ideal transition into postpartum.
The American College Of Obstetrics and Gynecology states women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy. Benefits of exercise during pregnancy include decreased risk of pain, constipation, gestational diabetes, and excess weight gain. Most women are recommended to “exercise, but not too hard” or “just listen to your body” to ensure safety during exercise.
These things are true, but are general and mean something different to every person. Women also sometimes stop exercising during pregnancy due to low back pain, pelvic girdle pain, symptoms of pressure issues like stress urinary incontinence, or concern for pelvic organ prolapse. Unfortunately, general advice on exertion does not help women navigate these issues to support exercise through pregnancy.
Exercise without understanding how to monitor for signs and symptoms, modify as needed, and target specific muscles of the core can increase the risk of conditions such as stress urinary incontinence and pelvic organ prolapse. This is why we created our Birth Rx program. Birth Rx is designed to address pregnancy or pelvic floor-related symptoms early on and build preventive strategies for pressure issues such as urinary incontinence and pelvic organ prolapse.
Pushing through symptoms during pregnancy can make postpartum more challenging and potentially result in long-term impairments. However, targeted training of deep core muscles with movement and intentional changes in intra-abdominal pressure can be used to strengthen our pressure control system. Whether you are new to exercise or a high-level athlete, pregnancy is an important time to improve endurance, load, and pressure management.
The last sessions of Birth Rx are typically focused on preparation for labor. This is where we discuss your birth plan in detail and cover positioning considerations depending on individual musculoskeletal concerns.
Pelvic PT and Exercise for Pregnancy
Another important reason for Pelvic Physical Therapy during Pregnancy is that exercise is one of the best things you can do to address or prevent pain and symptoms and set yourself up for an ideal transition into postpartum.
The American College Of Obstetrics and Gynecology states women with uncomplicated pregnancies should be encouraged to engage in aerobic and strength-conditioning exercises before, during, and after pregnancy. Benefits of exercise during pregnancy include decreased risk of pain, constipation, gestational diabetes, and excess weight gain. Most women are recommended to “exercise, but not too hard” or “just listen to your body” to ensure safety during exercise.
These things are true, but are general and mean something different to every person. Women also sometimes stop exercising during pregnancy due to low back pain, pelvic girdle pain, symptoms of pressure issues like stress urinary incontinence, or concern for pelvic organ prolapse. Unfortunately, general advice on exertion does not help women navigate these issues to support exercise through pregnancy.
Exercise without understanding how to monitor for signs and symptoms, modify as needed, and target specific muscles of the core can increase the risk of conditions such as stress urinary incontinence and pelvic organ prolapse. This is why we created our Birth Rx program. Birth Rx is designed to address pregnancy or pelvic floor-related symptoms early on and build preventive strategies for pressure issues such as urinary incontinence and pelvic organ prolapse.
Pushing through symptoms during pregnancy can make postpartum more challenging and potentially result in long-term impairments. However, targeted training of deep core muscles with movement and intentional changes in intra-abdominal pressure can be used to strengthen our pressure control system. Whether you are new to exercise or a high-level athlete, pregnancy is an important time to improve endurance, load, and pressure management.
The last sessions of Birth Rx are typically focused on preparation for labor. This is where we discuss your birth plan in detail and cover positioning considerations depending on individual musculoskeletal concerns.
Pelvic Floor and Postpartum
In Postpartum, it is important to know the status of your pelvic floor and address any causes or risk factors for issues such as urinary incontinence, pelvic organ prolapse and diastasis rectus abdominus going forward. This is a vulnerable time period, but we can use pelvic rehab and preventive strategies to address or prevent pelvic floor symptoms.
Typically, you will see your OB for a postpartum check-up, which is around six weeks postpartum, to assess healing and screen for any medical challenges. If there are no medical concerns at this time, typically, you will be cleared for intercourse and return to physical activity.
This has everything to do with medical safety for exercise, and nothing to do with whether or not you have worsening pelvic floor symptoms, a high risk for pelvic floor dysfunction, or whether your body is ready to take on increasing load and impact. This piece is traditionally overlooked within our healthcare system until problems become severe. This is why a Pelvic Floor Physical Therapist should evaluate every postpartum woman.
Pressure issues and return to exercise are two important considerations postpartum, but some women also experience pain during this time. This can result from birth injuries such as perineal lacerations/perineal tears, tissue changes, and pelvic floor muscle dysfunction.
Symptoms may include painful sitting, constipation, and painful intercourse, also known as dyspareunia. Your Pelvic Floor Physical Therapist can evaluate to find the source of your pain and make a plan to resolve it. Treatment may include myofascial release, scar tissue mobilization, pelvic rehab exercises, and body mechanics training.
Infertility
Physical therapy can help with infertility through a variety of manual therapy techniques. Pelvic Health PT aims to get the client out of inflammation by treating tissue restrictions. Pelvic Floor PTs are trained in visceral mobilization, which can help to optimize the chances of successful conception, particularly with blocked fallopian tubes.
This pelvic alignment and fertility treatment is most effective when infertility causes are linked to a history of Pelvic Inflammatory Disease (PID), abdominopelvic surgeries, or ovulatory problems.
Bladder discomfort can have several different causes. Most typically, bladder symptoms at first glance are assumed to be caused by urinary tract infections (UTIs). Sometimes, it is a true UTI, but symptoms are often assumed to be infections and treated with antibiotics, all without a comprehensive physical exam or a positive urine culture.
This often leads to repeat prescriptions of antibiotics with temporary relief followed by recurrence of symptoms due to the neuromuscular causes that are going unaddressed. The gold standard for diagnosing a UTI is a urine culture, and the American Urogynecologic Society recommends having a urine culture whenever possible prior to starting treatment.
Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)
A common condition we see in pelvic floor physical therapy is Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS), which is defined as an unpleasant sensation (pain, pressure, discomfort) perceived to be coming from the urinary bladder, associated with lower urinary tract symptoms of more than 6 weeks duration, in the absence of infection or other identifiable cause.
IC/PBS involves pelvic pain, which may include painful sitting, painful sex, and exacerbations with certain exercises. This condition often has no pertinent medical findings, which can confuse and discourage people from looking for answers. The piece often overlooked is an in-depth physical assessment that comprehensively addresses all components.
Physical therapists can help people with IC/PBS by evaluating the abdominal wall, pelvic floor, hips, low back and nerve pathways. Treatment often involves bladder retraining, mobility of the pelvic floor, myofascial mobilization, low back and hip mobility. Treatment for each person with IC/PBS depends on their own specific impairments, and should never look the same for every patient. This is why we believe treatment sessions should always be one on one.
Fun fact about IC/PBS: The American Urological Association lists manual physical therapy by a trained specialist as the only Level A evidence treatment for the condition. What does this mean? Physical Therapy needs to be part of treatment for anyone with this condition.
Common Bladder Symptoms
Some other very common bladder symptoms that are often caused by a combination of pelvic floor or abdominal wall dysfunction, hormonal changes, and behavioral habits are urinary frequency, urinary urgency, burning urination, and nocturia.
Urinary frequency is defined as regularly needing to urinate more than once every 2 hours during the day. Urgency is when it feels like the bladder does not have a gradual sense of filling, but instead a sudden, uncomfortable message to hurry to the bathroom. Urinary urgency can become paired with anxiety or stress with using the bathroom and planning for bathroom trips.
These are often signs of pelvic floor dysfunction. If the pelvic floor is unable to do its job (relax as we urinate), it can feel like emptying the bladder is difficult. Nocturia is defined as regularly waking up to urinate more than once during the night. As we age, urinary urgency and nocturia can result in falls on the way to the bathroom.
Addressing bladder symptoms can help to prevent injuries and loss of independence over time. Physical therapy is a great first-line option to address neuromuscular components of urinary symptoms once an infection is ruled out (with a culture!). Addressing bladder habits, body mechanics, and soft tissue mobility can help avoid needing long-term bladder medications.
Pelvic Floor PT and Menopause
When most people think of menopause/perimenopause, we think of a transient period that may involve hot flashes and changes in weight gain. The truth is that menopause affects just about every system of our body, including reproductive/sexual, urinary, musculoskeletal, metabolic, and cardiovascular. Also, these changes do not stop or reverse after the transition ends.
These changes set us up for aging throughout the rest of our lifespan. Menopause is defined as one year after the final menstrual period. The average age of menopause is 51, with 45-54 being considered within the typical range. Perimenopause is the period leading up to that last menstrual period, in which women can experience symptoms related to the transition.
Perimenopause can last up to 10 years, and this experience is significantly different from one person to the other. If you do the math on this, perimenopause can begin as early as 35 years old without being considered abnormal or early. Because of this, we feel it is important for any woman 35+ to understand changes, symptoms, and ways she can set herself up for healthy aging moving forward.
Symptom of Menopause
Symptoms that women often become aware of during perimenopause and early menopause are often related to Genitourinary Syndrome of Menopause (GSM). These symptoms can include vaginal dryness, irritation, urinary frequency, urinary urgency, and painful insertion/painful intercourse.
These symptoms are mainly related to low hormones in the vulva (the tissues surrounding the vaginal opening and urethra). These hormonal changes affect the health, strength, and support of local tissues. Pelvic floor muscle impairments often compound these tissue changes, including weakness, tension, or lack of coordination.
For this reason, treatment by a Gynecologist and a Physical Therapist knowledgeable in treating menopause-related issues is ideal. Treatment by a Physical Therapist in this area may involve internal and external myofascial release, a dilator program, mobility exercise, and body mechanics training. Just like with all pelvic floor conditions, it is truly inappropriate to treat any woman for these symptoms without a comprehensive pelvic floor muscle examination.
Genitourinary Syndrome (GSM)
With or without Genitourinary Syndrome (GSM) specific symptoms, changes in tissue health over time due to hormone changes can unmask or exacerbate other pelvic floor impairments and conditions. Some common examples are stress urinary incontinence/leakage and/or pelvic organ prolapse.
While these things may have been present in years leading up to perimenopause, they may have been mild enough not to greatly affect quality of life. Sometimes, people can live most of their lives with mild-moderate pelvic floor dysfunction, but thinning and weakening of connective tissue during the menopause transition then results in the start or exacerbation of symptoms due to those impairments. The good news, these are treatable!
Osteoporosis
So what about the other more famous menopausal symptoms like osteoporosis or bone breakdown and increased weight gain? With low levels of premenopausal estrogen, there is a tendency toward increased bone breakdown and fat deposition around the abdomen. In the past, we have been told to accept these changes due to aging and the long-term health risks that come with them. That is not our philosophy at Pillar Kinetic.
Throughout our lifespan, there is a balance between our body’s tendency to build and break down bones. Several factors, including nutrition, sleep, exercise, and hormones, influence this balance.
For women during and following the menopausal transition, there is an increased tendency for the body to break down vs. build bone. This can lead to osteoporosis, or the weakening of bones, as we age. This is one important reason why falls and injuries can be detrimental in senior adults.
Osteoporosis greatly increases the risk of fractures, which often result in hospital admissions, loss of independence, and sometimes loss of ability to walk. The acceptance of this trajectory has led to the misconception that women should avoid lifting heavy from middle age going forward, in case of an injury. Yet, the way to physically stimulate bone growth is by doing weight-bearing physical activity, lifting weights, and utilizing impact as a part of your workout routine.
By putting progressive demand through our large muscle groups that move our body by pulling off the bone, we use load to stimulate stress, which helps increase bone density (the strength of our bones!). Understandably, women have varied experiences with exercise, activity, and movement over their lives. Lifting heavy to one woman may not look the same as lifting heavy to another, especially on day one of learning lifting mechanics. It would be a gross generalization to expect all women to carry out these recommendations without guidance.
This is where a Physical Therapist experienced in treating menopause-aged women can help design a program tailored specifically to where someone is and their needs. Suppose the ability to lift, move, and take impact is limited due to other conditions such as joint pain, urinary leakage, or prolapse. In that case, your therapist will address those barriers with you one-on-one so that they do not prevent you from reaching your long-term goals.
Menopause Transition
During and following the menopause transition, women have an increased tendency to store fat around the abdomen. This is otherwise known as visceral fat storage. This type of fat distribution is correlated with an increased risk of stroke, heart attack, and metabolic disease such as type II diabetes. Cardiovascular conditioning is important for the health of our heart and blood vessels.
Strength training helps our body use energy from food effectively and maintain healthy blood sugar levels. This is one-way exercise, nutrition, and lifestyle modifications reduce risks of chronic health conditions that greatly impact the quality of life. Women going through the menopause transition can work with providers to build a comprehensive fitness program that will be preventive and effective for their specific needs.
It is important to remember that Pelvic Pain is not normal. Painful intercourse is not something we should live with and accept. Nor is pain with sitting, pain with a tampon or speculum insertion, pain with bowel or bladder function, or painful periods.
Pelvic Pain can have more than one cause or sometimes multiple factors at play. Because the pelvis houses several organs, muscles, and nerve pathways, the source of pelvic pain can sometimes require in-depth assessment, and one essential part of this assessment should be a pelvic floor muscle examination.
Endometriosis
About 10% of women have a condition called endometriosis, in which tissue similar to that lining the uterus resides in areas outside of the uterus. The tissue responds to monthly hormone fluctuations, typically resulting in symptoms that come and go in a cyclical pattern.
Some common symptoms are painful periods or dysmenorrhea, abdominal pain/cramping, back pain, sciatica, constipation or pain with gut motility and bowel movements, urinary frequency/urgency, painful intercourse, or dyspareunia. Some people have symptoms outside the pelvis, also influenced by hormones, including menstrual headaches or nausea. Each person with this condition presents individually, and the severity of the condition greatly varies from person to person.
One of the most frustrating things about endometriosis is that, on average, it takes 7 years to get an accurate diagnosis. This is partly due to medical providers’ and the general public’s lack of understanding of the condition. Endometriosis is underfunded, and education in medical school programs is lacking. Also, women are rarely ever taught what a normal period should feel like, and due to the genetic influence of endometriosis, many women with painful periods also have a mother who assumes painful periods are normal.
The only true way to rule out endometriosis is by laparoscopic surgical assessment by an experienced Gynecologist. Ideally, medical treatment of endometriosis should be overseen by a Gynecologist who treats pelvic pain and endometriosis as the majority of their caseload. Medical interventions often used are hormonal treatments such as birth control and laparoscopic excision surgery by an excision specialist. Endometriosis excision is the gold-standard surgical technique.
Organs and muscles in the pelvis are located closely together, with a highway of nerve pathways that connect each structure and communicate via reflexes. Endometriosis lesions create soft tissue/muscular restrictions. They can attach to or between organs. They can irritate nerve pathways, which in turn affects nearby and distant tissues. These lesions create a fluctuating state of inflammation in the pelvis, and the result of this is often chronic pain and a sensitized nervous system.
Rather than having one specific structural cause, pain is now a result of a combination of tight muscles, lack of mobility for organs to complete their functions efficiently, and referred pain signals to and from different structures. This overwhelms the brain’s pain system and can result in muscle guarding, creating increased tension as a mechanism of protection, which can lead to more overwhelming pain signals.
This complex highway of pain communication from muscles to muscle, muscles to organs, nerves to muscle, nerves to organs gives the brain the task of deciphering the pain and responding to it. For this reason, medical treatments to reduce inflammation, remove endometriosis lesions, and address hormonal contributors are not enough to holistically address all endometriosis pain.
The brain changes in its responses to pain when it has been present and evolving over time. For this reason, people with endometriosis need to rehabilitate the muscles of their lower back, abdominals, and pelvic floor, assess and treat sensitized nerve pathways, and downtrain their nervous system. Bladder retraining can be essential as well if the person has had years of bladder symptoms driving their bathroom habits, which in turn reinforces urgency and pelvic floor tension. Body mechanics training for bowel movements and intercourse is often important.
For these reasons, pelvic floor physical therapy is a must for anyone with endometriosis as part of pre/post-op and for management of symptoms as needed. Addressing the brain, the movement system, and self-management techniques will help with healing and the necessary medical interventions. Both are needed, and one without the other is typically incomplete.
Would you have your quads, glutes, or hamstring muscles cut through on an operating table and then expect to return to running without post-op assessment and progressive training? Probably not. The same should hold true for surgeries that involve incisions through the muscles and connective tissue of our abdomen. This includes gynecologic surgeries, cesarean sections, appendectomies (removal of the appendix), and cholecystectomies (removal of the gallbladder).
Our abdominal muscles work with the pelvic floor to respond to changes in intra-abdominal pressures, load, and impact. These muscles must increase and decrease tension in response to both internal and external loads. For instance, when you sneeze, your abdominal muscles and pelvic floor must have the flexibility and the quick response to resist pressure above and prevent loss of urine. Scar tissue following surgery also tends to create soft tissue restrictions.
Scar tissue near the bladder can result in urinary urgency or discomfort with bladder filling. Scar tissue in multiple areas of the abdomen can create restrictions that reduce motility to tissues of our gastrointestinal system, such as the intestines. This often results in constipation. For this reason, myofascial release, flexibility and coordination of the core are important postoperatively from any abdominal surgery.
Hysterectomy
Following hysterectomy, women are at increased risk for pelvic organ prolapse due to the fact that there is one less organ in the pelvic cavity propping up the neighboring organs for support. Additionally, there will be new scar tissue in the abdominopelvic region, which creates tension and can alter the response of the core muscles to pressure changes.
For these reasons, it is important to have both pre-op and post-op rehabilitation as part of your treatment plan when having a hysterectomy or other pelvic surgeries. As time passes, it is important to continue moving and loading our muscles and joints. Make sure you have a plan for safe, progressive exercise that does not result in pain or pressure symptoms.
When choosing the Pelvic Floor Physical Therapist for you, knowing which questions to ask is important. Any provider in pelvic rehabilitation should have postgraduate training in the specialty, and it is okay to ask. In school, no type of therapist, doctor, or trainer is taught to specialize in pelvic floor rehabilitation. Your provider does not necessarily need to be a physical therapist, but they still need to have taken post graduate coursework.
Early in your treatment program, you must have been offered an internal and/or perineal exam unless medically contraindicated. It is difficult to know details about your individual pelvic health needs without one, and any trained specialist will at least discuss it with you while planning for your course of care.
Be wary of any pelvic floor rehab that happens completely on the table. It may be a starting point, and you may be prescribed some exercises to lie on your back, but life does not happen on the table for most of us. If your symptoms are with running, jumping, or lifting, you should practice or work toward those things in the clinic.
Your don’t have to let pelvic pain, leakage, and other health conditions interfere with your life! At Pillar Kinetic, we provide pelvic floor therapy to address several health issues, working with our clients 1-on-1 to help strengthen your pelvic muscles, reduce pelvic pain and solve your symptoms.
New to pelvic floor physical therapy? Get answers to the most frequently asked questions.
We help people with pelvic pain, incontinence, prolapse, painful intercourse, birth prep, and postpartum recovery.
We are cash-based, but many patients successfully use HSA/FSA accounts or seek partial reimbursement from their insurance.
Your therapist will review your health history, discuss your goals, possibly take you through a movement screen, and perform a physical exam which may include an internal assessment. Treatment is always private and tailored to your comfort. For more info check out the video on this page detailing what happens during an evaluation.
Everyone has a pelvis. In certain cases, our pelvic floor muscle function can change due to childbirth, aging, surgery, stress, and other causes. When pelvic floor dysfunction or injury occurs, you may experience symptoms and issues like sexual dysfunction, urinary leakage or urgency, menstrual pain, pelvic organ prolapse, and general pelvic pain or discomfort. These issues can interfere with your quality of life. We treat both males and females experiencing certain health conditions from pelvic floor dysfunction in Las Vegas, Nevada.
Everyone has a pelvis. We treat both males and females experiencing certain health conditions from pelvic floor dysfunction in Las Vegas, Nevada.
A Physical Therapist (PT) is a provider who uses a physical exam to determine root causes of pain and dysfunction, then implements a treatment plan to address these impairments and resolve the problem. A Pelvic Floor Physical Therapist is a PT who specializes in applying this approach to gynecological, urinary, sexual, and gastrointestinal issues.
Pelvic Health PTs go through postgraduate training to assess, treat and manage pelvic floor dysfunction. A pelvic floor physical therapist typically completes an internal examination to identify tension, strength, endurance, and coordination of the pelvic floor muscles. Pelvic Floor PTs often use both internal and external manual techniques as part of assessment and treatment. Additionally, Pelvic health physical therapy also typically involves an individualized exercise program, body mechanics training and symptom management techniques similar to physical therapy for any other part of the body.
Pelvic floor physical therapy might also include exercise, muscle strengthening or coordination training. While kegel exercises may be part of your plan, pelvic floor therapy goes far beyond just strengthening a muscle group.
This can vary between individual cases. At Pillar Kinetic, our professional Las Vegas pelvic floor physical therapists will address all of your questions and concerns with you to see if an internal examination is the best for your individual case.
An internal pelvic floor muscle assessment typically involves insertion of one gloved, lubricated finger into the vagina or rectum in order to examine function of the pelvic floor muscles. It is always the patient’s choice if and when they would like to participate in an internal exam, which is why we recommend discussing the clinical reasoning for it in your specific case.
Sessions are one hour long. We can schedule a recurring time that works best for your schedule. Most clients will spend 3-6 months with us, though this can vary on a case-by-case basis.
No, a referral is not required to see a pelvic floor physical therapist. Just give us a call to schedule your initial consultation.
No! Pregnancy and Early Postpartum are vulnerable times for our bodies, meaning this is when pressure issues like urinary leakage, pelvic organ prolapse, and abdominal muscle separation can occur or worsen. The better we learn to coordinate movements for good pressure control during pregnancy, the better we are set up for postpartum (the rest of your life!). Also, exercise during pregnancy is recommended by the American College of Obstetrics and Gynecology (ACOG), and we can help if you need guidance with this.
No. Surgery is an option for certain conditions and in appropriate cases. However, without addressing the surrounding muscle and nerve function, you may not get the full benefits of the surgery or may require repeat procedures in the future. We are happy to help navigate care planning on a case-by-case basis, but for procedures such as prolapse and/or urinary incontinence repairs or endometriosis excision, we strongly recommend working pre- and post-op with your pelvic floor physical therapist.
No. Your body goes through significant changes with cancer treatments, including radiation, chemotherapy, or surgical procedures. Research shows exercise helps to improve tolerance to cancer therapies and reduce cancer-related fatigue. We are happy to help with guidance on this. Also, if your treatment may affect your pelvic floor (such as in an abdominal surgery, gynecologic surgery, or prostatectomy), it is recommended to begin addressing muscle function as early in your treatment as possible.
No. Continue all medical follow ups as recommended by your doctors, but you do not need a referral or clearance and should not wait to begin physical therapy.
Yes! You always have the option to bring someone with you to your appointments.
Yes! There is always work to do aside from internal soft tissue work. Also, internal pelvic floor assessment/treatment is not contraindicated during menstruation.