Urinary leakage, pelvic pain or dysfunction can be embarrassing. In fact, only one in twelve people with incontinence seek help with the condition. It takes an average of seven years for a woman to speak with her doctor about her incontinence symptoms. With expert help available, there's no need to be ashamed. Many conditions that lead to incontinence can be treated by a physical therapist.
Kim Fletcher, physical therapist and specialist in women’s health physical therapy with Summit Therapy, clarifies what a specialty physical therapist does. “A pelvic physical therapist has advanced training in the assessment and treatment of pelvic dysfunction and understands the relationship that the pelvic floor muscles have with respect to the urinary, bowel and reproductive systems,” states Fletcher.
Many people can benefit from pelvic physical therapy—men, women, children, and transgender patients. Urinary incontinence is the most common condition treated by pelvic physical therapy. Men who have had prostate surgery and face leakage often find help through physical therapy. Women who have given birth, report leakage with age or have undergone bladder prolapse surgery also seek remedy through physical therapy. Bowel dysfunction is another condition that can be remedied. Constipation and fecal incontinence are not a normal part of aging. Those recommended for rectal surgery are advised to work on muscle strength and coordination prior to surgery. Physical therapy also addresses other discomfort in the pelvis. Low back, hip, pelvic, coccyx and tailbone pain can be referred to a pelvic specialist when symptoms haven’t been resolved in standard outpatient physical therapy.
Fletcher recommends seeking help anytime pelvic-related problems interfere with daily activities. “The sooner somebody gets in, the quicker we can help resolve any of these issues,” she advises. A referral is required for pelvic physical therapy. This gives your primary care physician the opportunity to rule out more serious conditions related to your specific complaints.
Physical therapy diagnosis begins with a thorough medical history. Therapists discuss the pelvic anatomy and how pelvic floor muscles play a role in the patient’s complaints. The next step is an orthopedic-based assessment. Providers check coordination, strength and stability through a few physical moves. Spinal movement, pelvic alignment and hip muscle strength are evaluated. The final step of the exam is an internal pelvic floor assessment. Depending on the symptoms present, the exam is performed vaginally or rectally. One finger is inserted to assess each muscle layer of the pelvic floor. Soft tissue restriction from prior injuries is considered. The examiner looks for endurance, motor control and coordination of the pelvic floor, along with any pain.
Treatment is always dependent on symptoms and diagnosis. The goal is to strengthen weakened areas for improved function. Specific exercises are assigned to target those weakened areas. Muscles may need help stretching or relaxing. Breathing exercises are often prescribed for a weakened pelvic floor. It can be tough to “see” the muscles working, so in these cases, biofeedback is used to show patients what is happening through sensors and a screen.
“That’s what a pelvic floor physical therapist is here for, to help you work through these issues and get you functioning as optimally as possible,” assures Fletcher. “Just know that you can go on and enjoy life with your family and friends without worrying about urinary incontinence or being debilitated by pelvic pain.”