Imagine going to see your doctor for a bladder problem and the doctor says- “Well, I think we need to start with Physical therapy.” Long pause. “Really, doc, it’s my bladder, not my back!”
Many women are confused when their doctor refers them to Physical Therapy for either a bladder control issue or for pelvic pain. Rest assured, pelvic floor physical therapists are specially trained to help women and men regain bladder control and to treat many painful pelvic conditions.
The “core” of the problem often lies in the group of muscles that make up the floor of the pelvis. These muscles are critical for core strength (more about this), bladder, bowel and sexual function. These are, quite obviously, some pretty important functions. Most women who have had children are aware of the infamous Kegel. This is the exercise that we are told to do at our six week post natal check up by our gynecologist as he happily tells you that all is well and you can go back to your “normal” sex life anytime you would like.” Then he adds “Don’t forget those Kegels!” What? Oh, you mean those exercises I read about in What to Expect….and the Kegel is promptly relegated to one of those exercises I should do, but with a new baby, a messy house and an unsure feeling that you will ever get back your normal sex life, who really has time to figure that out?
Truly, a kegel, or a pelvic floor contraction should be crowned the king of all exercises. It is a powerhouse exercise that you don’t even need to don tennis shoes to accomplish. You can prevent a lot of problems including prolapse (your bladder or uterus succumbing to gravity and pushing downwards), urinary leakage, irritative bladder symptoms (frequency and urgency), pelvic pain syndromes and decreased sexual sensations by doing kegels correctly.
But, again, the key is learning to do the exercises correctly and this is where the pelvic floor physical therapist comes in. Pelvic PTs are able to help women (and men) suffering from all kinds of issues related to a “dysfunctional” pelvic floor. This means that the muscles are too weak, too tight or actually uncoordinated. An uncoordinated muscle can create all kinds of bladder problems- including bed wetting, leakage and frequency, even in young women who haven’t had children. A tight or “hypertonic” pelvic floor can create pain with sitting, pain with urinating and pain with sexual intercourse. A weakened pelvic floor can contribute to stress incontinence (the squirt with a sneeze or cough), urinary frequency and prolapse.
So, you decide to trust your doctor and head off to see the local pelvic floor physical therapist. You can expect to fill out a detailed questionnaire asking questions about all the above described conditions. You can expect to have a therapist thoroughly explain all about the anatomy of the pelvic floor and all the many functions. Your therapist will also talk to you about how the therapy will work and make sure you feel comfortable proceeding. You don’t have to worry about being a big PT gym like you were in for your knee rehab. You will be in a private room in a comfortable setting. You will learn how to correctly perform the kegel, but you might learn that you really shouldn’t be doing kegels yet. Many patients actually need to learn how to relax and release the pelvic floor. The PT will assess you and guide you through your program back to good pelvic health. Therapy will actually include a lot more than Kegels, but they may be the starting point. PT has been shown to be an effective form of treatment for bladder, bowel control and pelvic pain. Women and men with pelvic pain are usually especially relieved to get some help.
A quick word about the pelvic floor being a core stabilizer. The abs get all the glory in the gym but really the pelvic floor is a key player in good core stabilization. This is very important for anyone, including athletes. Because of all the training of the abs, the pelvic floor is often over challenged and undertrained in athletes and groin pain and bladder control issues can develop. So, remember the king should be the kegel (done correctly)!
Urology of Virginia offers comprehensive pelvic floor physical therapy with highly trained and specialized therapists. We work closely with our own doctors – who will be happy to send confused patients to PT – or with any referring physician.
– Erin Glace, MSPT, PRPC, BCB-PMD