By: Jill Squire, BSN, RN, OCN

Introduction

This article aims to illuminate how pelvic floor physical therapy can help with quality of life issues.

Quality of life and self-image can be affected by conditions such as incontinence of urine or stool, erectile dysfunction, vaginal pain or pain with sexual activity, and chronic pelvic pain. Often endured in silence, these issues can significantly impact how a person feels about themself.

There is real hope with pelvic floor physical therapy (PFPT).

The Mighty Muscle Sling Inside Your Pelvis

Your pelvic floor muscles form a crucial sling along the inside of your pelvis. They play a pivotal role in many functions of your body. These muscles work with the nerves and organs of your body to help you urinate and move stool out of your colon, rectum, and anus. The sling of muscles also works with your bodily commands to hold in your urine and stool.

When healthy and strong, you can flex and relax these muscles to go to the bathroom—or not—at times of your choosing. This control exists for passing gas at will, much to the amusement of those who may consider flatulence an art.

This sling also protects the organs in your pelvis and holds them in place.

Your reproductive and sexual response organs are closely entwined with the pelvic floor muscles.

As the Cleveland Clinic explains, your pelvic floor muscles stretch from your pubic bone in the front of your body to your tailbone (coccyx) in the back. They extend to both sides of your pelvis. You can feel your pelvic floor muscles flex if you clench to stop a stream of urine or the passing of stool.

What Can Go Wrong When Your Pelvic Floor Muscles Are Weak or Too Tight?

When you consider everything tucked into your pelvis, a lot can go awry when your pelvic floor muscles cannot flex correctly due to weakness or tightness.

Chronic pelvic pain is uncomfortable and pervasive, and it can increase with any movement of your body involving your core muscles.

Erectile dysfunction, inability to ejaculate, discomfort with orgasms, chronic vaginal pain, and pain with sexual activity can occur with pelvic floor muscle issues. Constipation, incontinence of stool or urine, and pain with bowel movements may also occur.

 Pelvic Floor Physical Therapy may resolve the causative factor.

Causes of Pelvic Floor Muscle Weakness and Tightness

Let’s briefly review what might cause pelvic floor muscles to be too floppy or strung tight like a bowstring.

Duke Health shares the common causes in an easily understood manner.

Weakness can occur with:

• Frequent heavy lifting
• Ongoing cough
• Sports or exercises that involve jumping, sudden stops, or abrupt movements
• Menopause
• Treatment involving the pelvic floor, such as surgery or radiation
• Pregnancy and Childbirth
• Straining on the toilet
• Age
  
  

Tightness/Tension may happen with:

• A history of holding in urine or bowel movements
• Endometriosis
• Interstitial cystitis
• Irritable bowel syndrome
• Pelvic Floor Injury

What is Pelvic Floor Physical Therapy (PFPT)?

PFPT involves exercises, specific movements, interventions, and learning awareness of one’s pelvic floor muscles.

There are several techniques involved in PFPT. Your therapist will individualize a combination of methods best suited to your needs. 

You will learn exercises and sitting positions to do at home between therapy sessions. These home techniques can significantly impact how quickly you improve your pelvic floor muscle health.  

Your physical therapist may suggest practical changes, such as more fiber in your diet or the use of a lubricant with sexual activity.

What to Expect for Your First Session

Your physical therapist trained in PFPT will ask about your symptoms and problems. Be honest. Your openness will enable them to form a treatment plan that best addresses your issues. It can be challenging to talk about these problems. Consider making notes ahead of time and bringing them with you. Your notes can keep you on point and give you something to glance at if you need a moment to feel less self-conscious.

Your therapist will then evaluate you from your diaphragm to the middle of your thighs. They may assess your external and or internal pelvis. While this may be uncomfortable for us as patients, they have seen it all and are there to help you.  

Wrap Up

With your participation in therapy and practice at home, PFTP can dramatically improve the quality of your life. PFPT may not be the first thing to come to your doctor’s mind if you experience any of the issues described here. If your doctor does not bring up PFPT, you can. It is becoming more well-known as an effective treatment.  

Check with your insurer that your physical therapy practice and therapist are in your network.  Verify how many therapy visits are in your benefits per year so that you can plan accordingly.

If you experience incontinence, erectile dysfunction, vaginal pain, pain with sexual activity, or chronic constipation, talk with your doctor about trying PFPT.

References

DukeHealth. “Pelvic Floor Physical Therapy.” Duke Health, edited by Stacey Head ATC, CLT, PT, WCS, 8 Aug. 2023, http://www.dukehealth.org/treatments/physical-therapy/pelvic-floor-physical-therapy.

Professional, Cleveland Clinic medical. “Pelvic Floor Muscles.” Cleveland Clinic, 13 Apr. 2022, my.clevelandclinic.org/health/body/22729-pelvic-floor-muscles.

Stein, Amy, PT, MPT, DPT, BCB-PMD, IF, et al. “The Role of Physical Therapy in Sexual Health in Men and Women: Evaluation and Treatment.” Sexual Medicine Reviews, vol. 7, no. 1, Jan. 2019, pp. 46–56, doi:10.1016/j.sxmr.2018.09.003.

Yaacov, David, MScPT, et al. “The Effect of Pelvic Floor Rehabilitation on Males with Sexual Dysfunction: A Narrative Review.” Sexual Medicine Reviews, vol. 10, no. 1, Jan. 2022, pp. 162–67, doi:10.1016/j.sxmr.2021.02.001.