What is pelvic floor physical therapy?
So your doctor recommended pelvic floor physical therapy (PFPT) 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 some patients 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, diet, and sexual history. She 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?
What your PFPT does during each session will vary. Often, only a pelvic exam can provide a correct diagnosis (not all bladder leakage is from weak pelvic floor muscles.) Pelvic floor treatments typically include internal manipulation of the pelvic floor through the vagina. Your therapist will stretch and massage the tissues that aren’t working correctly. The therapy can be awkward, so your therapist will do her best to make you comfortable.
Specifically, in physical therapy for 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 breathing exercises, 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. Learning how to contract pelvic floor muscles correctly is a lifelong benefit. 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. There are many other pelvic floor disorders, such as pelvic pain, that seek their expertise and time. Check this directory of providers.
- Can you get time off work? 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.
- Does your insurance cover it? Pelvic floor physical therapy sessions can cost as much as $250 per session, so the entire treatment can be well over $1000. Insurance may cover this expense; often there is a limit of 6 sessions. The treatments and health improvements are money well spent, but it’s just not possible financially for many women.
- Are you comfortable? Let’s face it, pelvic floor physical therapy is invasive. 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.
Studies, unfortunately, show that less than half the women prescribed PFPT will go, and only 15% of women prescribed PFPT will complete the recommended series of treatments.
What can I do at home?
For other conditions, your physical therapist may recommend using vaginal weights. Also known as kegel weights, kegel balls, or kegel bells, 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 pelvic muscles.
At-Home Pelvic Floor Physical Therapy Devices
For home-based pelvic floor physical therapy, your physical therapist may recommend a Kegel exercise device to complement office therapy either in conjunction with PT, or after pelvic floor physical therapy sessions are done. There are times, when women start, but cannot continue to go. Instead of forgoing therapy, she can transition to home-use and practice what she has learned.
The FDA recently created a new product category for external pelvic floor devices that treat incontinence. No vaginal insertion is required! The first one available in the US 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 can be worn under clothing while she walks around and does other activities. ELITONE is convenient for women who are busy or who don’t have access to pelvic floor physical therapy.