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Unlocking the Power of Pelvic Floor Physical Therapy: A Comprehensive Guide

The pelvic floor is a group of muscles and tissues that form a hammock-like structure at the base of the pelvis. While often overlooked, these muscles play a crucial role in various bodily functions, including bladder and bowel control, sexual function, and providing support to organs like the uterus, bladder, and rectum. When the pelvic floor muscles become weak or dysfunctional, it can lead to a range of problems, from urinary incontinence to pelvic pain.
Pelvic floor physical therapy is a specialized form of therapy designed to address these issues and improve pelvic floor function. In this comprehensive guide, we will delve into the world of pelvic floor physical therapy, exploring what it is, who can benefit from it, what to expect during a session, and the potential benefits of this therapy.

Understanding the Pelvic Floor

What is the Pelvic Floor?

Pelvic Diaphragm: This is the main muscle layer of the pelvic floor and consists of several muscles, including the levator ani muscles and the coccygeus muscles. The pelvic diaphragm stretches from the pubic bone in the front to the coccyx (tailbone) in the back. It forms the base of the pelvic cavity.

Levator Ani Muscles: The levator ani muscles are the primary muscles of the pelvic floor and are often divided into three parts:
Puborectalis: This muscle wraps around the rectum and plays a crucial role in maintaining fecal continence.
Pubococcygeus: Located in the front part of the pelvic diaphragm, it helps support the pelvic organs, including the bladder and uterus in women.
Iliococcygeus: Positioned behind the pubococcygeus, it also contributes to pelvic organ support.

Coccygeus Muscles: These muscles are situated behind the levator ani muscles and provide additional support to the pelvic organs.

Perineal Muscles: The perineum is the area between the anus and the genitalia. Several small muscles, known as perineal muscles, are located in this region and contribute to various functions, including controlling bowel movements and maintaining urinary continence.

Connective Tissues: The pelvic floor is reinforced by a network of connective tissues, including ligaments and fascia, which help to maintain the structural integrity of the pelvic organs.

The pelvic floor muscles and connective tissues work together to provide support to the pelvic organs, maintain continence (control over urination and defecation), and play a role in sexual function. These muscles are dynamic, meaning they can contract and relax as needed, allowing for control over the passage of urine and feces, as well as sexual arousal and function.

Maintaining the health and function of the pelvic floor is essential for overall well-being. Pelvic floor physical therapy can help individuals strengthen, relax, and improve the coordination of these muscles, addressing issues such as incontinence, pelvic pain, and sexual dysfunction.

Common Pelvic Floor Problems

  • Discussing conditions like urinary incontinence, pelvic organ prolapse, and pelvic pain.

  • How these problems can affect one's quality of life.

Urinary Incontinence:

Urinary incontinence is a common condition characterized by the unintentional loss of urine. It occurs when the normal control mechanisms of the urinary system are compromised, leading to leakage of urine from the bladder. This condition can vary in severity from occasional, minor leaks to complete loss of bladder control. Urinary incontinence can affect people of all ages, but it is more prevalent in older adults and women.
There are several types of urinary incontinence, each with its own causes and characteristics:
Stress Incontinence: This is the most common type of urinary incontinence and typically occurs when pressure on the bladder increases, causing urine leakage. Common triggers include activities such as coughing, sneezing, laughing, lifting, or exercising. Stress incontinence is often associated with weakened pelvic floor muscles, which support the bladder and urethra.
Urge Incontinence: Also known as "overactive bladder," this type of incontinence involves a sudden and intense urge to urinate, followed by an involuntary loss of urine before reaching the toilet. It can result from overactivity of the bladder muscles or neurological conditions that affect bladder control.
Overflow Incontinence: In this type, the bladder does not empty properly, leading to constant or frequent dribbling of urine. It can occur when the bladder muscles are unable to contract effectively or when there is a blockage in the urinary tract, such as an enlarged prostate in men.
Mixed Incontinence: Some individuals may experience a combination of stress and urge incontinence, which is referred to as mixed incontinence.
Functional Incontinence: This type occurs when physical or cognitive impairments prevent a person from reaching the toilet in time, even though their urinary system is functioning normally. It often affects the elderly or individuals with mobility or cognitive issues.
Transient Incontinence: Temporary urinary incontinence can result from factors such as medication side effects, urinary tract infections (UTIs), excessive alcohol consumption, or high caffeine intake. Once the underlying cause is addressed, this type of incontinence typically resolves.

It's important to note that urinary incontinence is not a disease in itself but rather a symptom of an underlying condition. The causes can be diverse, including weak pelvic floor muscles, neurological disorders, infection and inflammation, and/or hormonal changes.

Treatment for urinary incontinence depends on the type, severity, and underlying cause. It can include lifestyle changes, pelvic floor exercises (Kegels), medications, behavioral therapies, and, in some cases, surgical interventions. Seeking medical evaluation and advice from a healthcare professional is crucial for managing urinary incontinence effectively and improving one's quality of life.

Pelvic Organ Prolapse:

Pelvic organ prolapse is a condition in which one or more pelvic organs, such as the uterus, bladder, or rectum, descend or "prolapse" into the vaginal canal or, in severe cases, outside the body. This occurs when the muscles and connective tissues that support these organs become weak or stretched, often due to factors like pregnancy, childbirth, aging, obesity, or chronic straining.

The severity of pelvic organ prolapse can vary, and it may lead to different symptoms, such as a sensation of pressure or fullness in the pelvic area, urinary incontinence, difficulty emptying the bladder or bowels, and even visible bulges in the vaginal or perineal area.

Pelvic Pain:

Pelvic pain with intercourse, medically known as dyspareunia, is a condition characterized by pain or discomfort that occurs during or after sexual intercourse. This condition can affect both men and women, but it is more commonly reported by women. Pelvic pain with intercourse can be a distressing and challenging issue, and it can have physical, emotional, and relational implications.

There are various potential causes and contributing factors to pelvic pain with intercourse:

Physical Factors:
Vaginal Infections: Infections such as yeast infections or bacterial vaginosis can lead to discomfort or pain during intercourse.
Vaginal Dryness: Insufficient vaginal lubrication can cause friction and discomfort. This can be due to hormonal changes (menopause), medication side effects, or stress.
Vaginismus: Vaginismus is a condition characterized by involuntary muscle spasms of the vaginal muscles, making penetration painful or impossible.
Endometriosis: In cases of endometriosis, tissue similar to the lining of the uterus grows outside the uterus, and this can cause pain during intercourse.
Pelvic Inflammatory Disease (PID): Infections of the female reproductive organs, such as PID, can lead to pelvic pain with intercourse.

Psychological and Emotional Factors:
Stress and Anxiety: Emotional stress, relationship issues, or anxiety related to sex can lead to tension in the pelvic area, contributing to pain.
History of Trauma: Past traumatic experiences, whether physical or emotional, can manifest as pain during sexual activity.

Medical Conditions:
Interstitial Cystitis: A chronic bladder condition can cause pelvic pain and discomfort during intercourse.
Fibroids: Uterine fibroids, noncancerous growths in the uterus, can lead to pain and pressure during sex if they press on sensitive areas.
Pelvic Organ Prolapse: As mentioned earlier, when pelvic organs descend, they can cause discomfort or pain during intercourse.

Menopause: Hormonal changes associated with menopause can lead to vaginal dryness and thinning of the vaginal walls, making intercourse painful.

It's essential to address pelvic pain with intercourse as it can impact one's quality of life and intimate relationships. Diagnosis and treatment depend on the underlying cause and may involve a combination of approaches.

The Basics of Pelvic Floor Physical Therapy

What is Pelvic Floor Physical Therapy?

Pelvic floor physical therapy is a specialized form of physical therapy that focuses on assessing, treating, and rehabilitating the muscles, ligaments, and connective tissues of the pelvic floor.

During the initial evaluation, a pelvic floor physical therapist will assess the strength, flexibility, and coordination of the pelvic floor muscles and related structures. This may involve a physical examination and a discussion of symptoms and medical history. An internal exam may be helpful to assess your condition, but will never be required if you are not comfortable. Based on the assessment findings, the therapist will develop a personalized treatment plan tailored to the individual's needs. This plan may include exercises, manual therapy techniques, and other interventions.

One of the core components of pelvic floor physical therapy is teaching patients how to perform pelvic floor exercises. At Fuerza this can range from Kegel exercises, to bracing drills, to training it all together with irritable movements from a barbell squat to double unders. These exercises help strengthen and improve the control of the pelvic floor muscles. In cases where pelvic floor muscles are overly tense or in spasm, relaxation techniques may be employed to alleviate discomfort. We may also use hands-on techniques to release muscle tension, address trigger points, and improve the flexibility of the pelvic floor muscles and surrounding tissues. You will also be sent a home program with exercises and other strategies to use away from the clinic to capitalize on and compliment your in-office visits to help you get better faster.

Who Can Benefit?

Pelvic floor physical therapy can be beneficial for individuals dealing with a wide range of pelvic floor-related issues, including urinary and fecal incontinence, pelvic pain, pelvic organ prolapse, sexual dysfunction, and more. It is a non-invasive, conservative approach that aims to improve pelvic floor function and overall quality of life.

People who have recently been through a pregnancy will find pelvic therapy particularly helpful after the pregnancy has stretched the pelvic floor and core musculature.


In this comprehensive guide, we've explored the world of pelvic floor physical therapy, shedding light on its significance and how it can positively impact the lives of individuals dealing with pelvic floor dysfunction. Whether you're someone experiencing these issues or a healthcare professional looking to broaden your knowledge, understanding the principles and practices of pelvic floor physical therapy can lead to improved pelvic health and an enhanced quality of life.

If you feel like you could benefit from pelvic floor physical therapy, click this link to book an appointment with our pelvic floor physical therapist.
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