What is Pelvic Floor Physical Therapy?
So your doctor just recommended pelvic floor physical therapy to treat your urinary incontinence. You’ve been to physical therapy to treat other injuries, but you didn’t know that pelvic floor physical therapy even existed. You have questions… you may be a bit nervous…. Hopefully, this article will help.
Women see pelvic floor physical therapists for a variety of reasons. Some are looking to reduce those embarrassing and worrisome leaks that happen when they cough, sneeze, laugh, or exercise. Others are dealing with pelvic pain or various types of sexual dysfunction. Others 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. Hopefully, 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 the 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. 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. She will stretch and massage the tissues that aren’t working correctly. This can be a bit awkward, and in some cases painful, so she will do her best to distract you and make you comfortable.
In treating stress incontinence, your therapist may focus on pelvic floor muscle training. She may ask you to perform Kegel exercises. She may assess the strength of your pelvic floor muscle contractions with her finger or with vaginally-inserted, computerized probe. As many as one-quarter 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 device to help you activate the correct muscles. These devices deliver a signal that causes the pelvic floor muscles to contract, essentially doing 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 wonderful 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 whole 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. If there is, the wait can be many months.
- 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 in the middle of the day each week isn’t always possible. And for new moms looking to recover their pelvic floor, physical therapy offices don’t exactly offer childcare.
- 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 for many women it’s just not a financial option.
- I’m Not Sure I Can Do That – Let’s face it, you may be uncomfortable with the invasiveness of pelvic floor physical therapy. You’re just not ready for an internal massage or to use a vaginally inserted probe. We get that, but there are some non-invasive options, so keep reading.
What can I do at Home?
Between sessions, your physical therapist may recommend home-based activities. This may include keeping a diary of your symptoms, for example, the number of accidents you have each day or the number of 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 work to stretch your pelvic tissues. For other conditions, your physical therapist may recommend using vaginal weights. The weight (sometimes called a cone) is partially inserted, and you contract your pelvic floor muscles to hold it in place. As you get stronger you progress through heavier weights. If you have stress incontinence your therapist may recommend daily Kegel exercises or a home-use electrical stimulation product that helps exercise the correct muscles.
Home Use 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. The vaginally inserted devices are available in a variety of styles, shapes, sizes, and materials. It’s important to get a recommendation for which device is 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 US is the ELITONE device. ELITONE is worn against your pelvic region like a pad. It comfortably contacts your pelvic floor muscles, essentially doing Kegel exercises for you. It’s a great treatment option for women looking to treat stress urinary incontinence but doesn’t want a vaginally inserted product. ELITONE is available without a prescription. So it’s also a good option for women who are busy, can’t afford other solutions, or without access to physical therapy.
There are a number of excellent online resources for you to explore as you learn more about pelvic floor physical therapy and pelvic floor therapy devices. Here are a few of our favorites: