What is pelvic floor physical therapy?
So your doctor recommended pelvic floor physical therapy to treat your urinary incontinence. You’ve been to physical therapy to treat other injuries, but you’ve never heard of pelvic floor physical therapy. Along with your many questions, you may be a bit nervous. Keep reading to find out what your first office visit will look like and how treatment can help.
Women see pelvic floor physical therapists for a variety of reasons. Some are looking to reduce embarrassing leaks that happen when they cough, laugh, or exercise. Others are dealing with pelvic pain or various types of sexual dysfunction. And then there are patients who have recently had a baby and are looking to recover from the trauma of vaginal delivery. Each situation requires different treatment. A certified pelvic floor physical therapist is trained to provide specialized care that will improve your pelvic floor health.
During your first office visit, your physical therapist (thankfully, most of them are women) will take your medical history. She’ll want to learn about your symptoms, any medications you’re taking, your diet, and your sexual history. She probably will inquire about your emotional comfort with this type of treatment. If she conducts a pelvic exam, she will evaluate your posture, flexibility, and pelvic floor muscle strength. Based on her findings, your “physio” will recommend a treatment plan, typically 30–60 minute weekly sessions over 6–8 weeks. Many women see tremendous improvement after these initial sessions, while others may continue weekly treatments or move to less frequent (e.g., monthly) maintenance sessions.
What exactly will she do to me?
What your physical therapist does during each session will vary. Pelvic floor treatments typically include internal manipulation of the pelvic floor through the vagina or rectum. Your therapist, usually a woman, will stretch and massage the tissues that aren’t working correctly. The therapy can be awkward, and in some cases painful, so your therapist will do her best to distract you and make you comfortable.
In treating stress incontinence, your therapist may focus on pelvic floor exercises by asking you to perform Kegels. To assess the strength of your pelvic floor muscle contractions, she uses her finger or a vaginally inserted, computerized probe to measure your contractions. As many as 25% of women don’t do Kegel exercises correctly. If you’re in that group, your physio will coach you to improve your technique. She may also use an electrical stimulation (e-stim) device to help activate the correct muscles. These devices deliver a signal that causes the pelvic floor muscles to contract, essentially doing your Kegel exercises for you.
In addition to the hands-on aspect of physical therapy, your therapist may provide education on lifestyle changes that are key to improving your pelvic floor health. For treating incontinence, these may include modifications to your diet and fluid intake.
Is pelvic floor physical therapy for me?
Pelvic floor physical therapy can provide useful benefits. Women who had given up hope are often amazed at the life-changing results. However, for some women, obtaining treatment can be difficult for a host of reasons.
- Too few physical therapists. There are not nearly enough pelvic floor physical therapists to treat the 1 in 3 women who could benefit from the expertise they provide. This means that for many women, there isn’t a nearby clinic to visit, and if there is, the wait can be months. Check this directory of providers.
- Who has time? Everyone wants to get better, but sometimes it’s hard to make time to take care of yourself. Carving out an hour each week isn’t always possible. And for new moms looking to recover their pelvic floor, childcare may be an issue.
- It’s expensive. Pelvic floor physical therapy sessions can cost as much as $250 per session, so the entire treatment can be well over $1000. Some insurers don’t cover this expense. The treatments and health improvements are money well spent, but it’s just not possible financially for many women.
- I’m not sure I can do that. Let’s face it, pelvic floor physical therapy is invasive and uncomfortable. You may not want a physical therapist doing internal massage or using a vaginal probe. We get that, but there are some noninvasive options, so keep reading.
What can I do at home?
Between sessions, your physical therapist might recommend home-based activities, such as keeping a diary of your symptoms, the number of accidents each day, or how many pads you use. For certain pelvic floor conditions, you may be asked to use vaginal dilators. These typically come as a set with increasing diameters that gradually stretch your pelvic tissues.
For other conditions, your physical therapist may recommend using vaginal weights. Also known as a cone, a vaginal weight is partially inserted into your vagina so you can contract your pelvic floor muscles and hold it in place. As you get stronger, you progress through heavier weights. If you have stress incontinence, your therapist may prescribe daily Kegel exercises or a home-use electrical stimulation product that helps exercise the correct muscles.
At-Home Pelvic Floor Physical Therapy Devices
For these home-based treatments, your physical therapist may require you to purchase the device as a complement to office therapy. Vaginally inserted devices are available in a variety of styles, shapes, sizes, and materials, but it’s important to get a recommendation for the device that’s best for you.
The FDA recently created a new product category for external pelvic floor devices that treat incontinence. No vaginal insertion required! The first one available in the U.S. is the ELITONE device. ELITONE is worn like a pad. It gently contracts your pelvic floor muscles, essentially doing Kegel exercises for you. This option allows women to treat stress urinary incontinence at home without inserting a vaginal probe, plus ELITONE is available without a prescription. And because it’s worn under clothing, ELITONE is convenient for women who are busy or who don’t have access to pelvic floor physical therapy.