When you start working with a physical therapist to address pelvic floor functioning, there are some things you can expect. At your first appointment, your therapist will do an assessment before deciding which types of therapy will be most effective. That assessment will include an orthopedic evaluation. You may be asked to stand, walk, and sit so the therapist can see whether you may have posture or joint issues that could be affecting the pelvic floor muscles.
Most physical therapy to treat pelvic floor dysfunction and pain is hands-on, which includes both internal and external therapy. Because internal physical therapy may be difficult for some people, therapists are sensitive to the needs of every individual and will not begin with internal physical therapy until you are ready.
Internal techniques may include using a specialized instrument or a finger inside the vagina or rectum to do trigger point therapy.
Depending on your condition, your therapist may also suggest Kegel exercises to strengthen your muscles. She will help train you on the proper way to do Kegels.
The evaluation of the pelvic floor itself usually requires an internal exam. To do this, we will use manual palpation either vaginally or rectally, whichever is appropriate. Manual palpation means that we will use one finger to do the assessment. This is different from a female gynecological exam, which uses instruments, such as a speculum. The purpose of the exam is to assess for muscle strength, excessive tightness, trigger points (small muscle “knots”), painful areas, and muscle coordination. Usually, the internal exam is not painful. If you are coming here because of a pain condition, it’s important during the exam to identify the specific muscles that are causing pain. This will help to create a proper plan of care.
The initial evaluation will first determine whether therapy is appropriate, and if it is, it will determine the appropriate plan of care. Treatment may include:
Strengthening or stretching exercises of the trunk, legs, or pelvic muscles
Relaxation exercises for shortened pelvic muscles
Education in self-management and prevention
Biofeedback for either strengthening or relaxation of the pelvic muscles
Modalities like heat, ice, or electrical stimulation.
Treatment will vary depending on the specific problems identified.
Pelvic floor therapy is recommended as a first-line treatment for many disorders of the pelvic region.