Procedures

If your doctor has suggested pelvic floor physical therapy, you probably have a lot of questions. Although this is a common and effective way of treating a host of problems, it isn’t something most people are familiar with if they haven’t needed it before. Here’s a look at what is involved in this treatment.

What Is the Pelvic Floor?

The pelvic floor is made up of the muscles that support the uterus, bowel,and bladder. When these muscles are too tight or too weak, they may cause chronic discomfort and pain for women during pelvic exams, sex, and tampon use.

Weak pelvic muscles can result in urine leaks and pelvic organ prolapse, which occurs when organs such as the uterus or cervix fall into the vagina. Some of the top causes of pelvic floor weakening are pregnancy, childbirth, and chronic constipation.

How Pelvic Floor Therapy Works

Pelvic floor therapy entails performing targeted exercises to help strengthen the pelvic floor muscles and keep them flexible. A pelvic floor therapist works with you to determine the root cause of your pelvic issues and develops a plan for easing symptoms and improving your overall pelvic health.

At your first session, the therapist will take your history, including your past medical and surgical history, any medications you are taking, and your gynecological and obstetric history. They will also carry out an orthopedic examination focusing on the lumbar spine, posture, hips, and gait. You may be asked to stand, walk, sit, or carry out certain movements so that the therapist can detect joint or posture issues that could be affecting the muscles in the pelvic floor.

Here are some of the conditions that may be improved with pelvic floor physical therapy.

• Painful sex
• Constipation
• Endometriosis
• Painful urination
• Urinary incontinence
• Pain in the pelvis, thighs, lower back, rectum, genitals, or abdomen
• Postpartum issues

A pelvic floor physical therapy treatment plan typically includes stretching or strengthening exercises, relaxation exercises, coordination exercises, and modalities such as heat, electrical stimulation, or ice. Biofeedback may be used for strengthening or relaxing pelvic floor muscles. In addition, your pelvic floor therapist will provide education on how to manage your condition and prevent it from worsening.

Some of the exercises that pelvic floor therapy may entail include:

Kegel Exercises

One common activity prescribed in pelvic floor therapy is Kegel exercises. These movements involve contracting and relaxing the muscles in the pelvic floor repeatedly. The movement is similar to the one you might make when you are trying to hold in or stop the flow of urine.

The general process involves tightening the muscles and holding them for up to five seconds before resting for a few seconds and repeating up to a total of 10 Kegels. A pelvic floor physical therapist can demonstrate how to perform this exercise correctly as it is important not to squeeze too hard. Women should work up to doing five sets of 10 Kegels every day to get the most benefits and increase pelvic muscle strength. These exercises can be performed very discreetly at any time.

Bridge Exercise

The bridge exercise is a movement aimed at boosting pelvic floor strength that is performed lying down flat on the ground with your feet on the floor and your knees bent. You then lift your buttocks several inches off of the floor, squeezing both your buttocks and your pelvic muscles tightly and holding the position for five to 10 seconds before releasing and resting your body on the ground. Your pelvic floor physical therapist will tell you how many bridge exercises you should perform daily.

Yoga

Practicing yoga is also beneficial to pelvic function. Many pelvic floor physical therapists recommend that women perform a daily regimen of yoga to keep their body strong and their muscles flexible, not only in the pelvic floor but throughout the body. Many yoga poses build core strength, including in the muscles that support the reproductive organs and bladder. Yoga also raises your blood circulation, which can reduce pain throughout the body and improve sexual function.

Squats

Squats are a very simple exercise that help to build strength in the pelvic muscles, buttocks, and hamstrings. They are performed standing upright with feet slightly wider than shoulder width. From this position, you simply bend at the knees and push your hips back like you are getting ready to sit in a chair, then stand up, and repeat the process again. For boosting pelvic and overall muscle strength, 15 squats per day are recommended.

Get in Touch With Raleigh Gynecology & Wellness

Pelvic floor physical therapy is generally very effective, and patients often report an improved quality of life after treatment. However, individual results vary depending on the condition being treated and its severity. To discuss your pelvic condition and treatment options, get in touch with the professional women’s healthcare team at Raleigh Gynecology & Wellness today.

Endometriosis is a common gynecological condition that leaves many women experiencing chronic pelvic pain, even in its mildest form. Although hormone treatments and surgery may not be necessary for most women with this condition, the pain can be difficult to manage. One approach that helps many women find relief from endometriosis is pelvic floor physical therapy. Here are some tips on this effective treatment.

Understand What Is Involved

Physical therapy is a treatment aimed at supporting the musculoskeletal system by improving movement and mobility so that bodily functions can be restored. Physical therapists are licensed healthcare professionals who are trained in this field.

Pelvic floor physical therapy focuses on improving the pelvic floor muscles and the abdominals. Pelvic floor physical therapists help women experiencing bladder or bowel incontinence, urinary urgency or frequency, pelvic or abdominal pain, constipation, pain during sexual activity, pregnancy and postpartum pain, abdominal muscle separation, and prolapse.

It involves performing exercises focused on strengthening the pelvic floor muscles. These muscles span the bottom of the pelvis and support the vagina, uterus, bowel, and bladder. In addition to supporting each of these organs, the muscles provide stability to the pelvis overall.

A well-rounded pelvic floor physical therapy regimen for endometriosis involves stretches, manual techniques, lifestyle tips, and strengthening exercises designed to optimize the function of the pelvic floor muscles. Here are some recommendations for getting the most out of this effective treatment.

Learn How Pelvic Floor Physical Therapy Helps Endometriosis Pain

Adhesions are a common occurrence for women with endometriosis. These are tissues that form while the body is healing and can bind two structures together. They may occur because of endometriosis itself, injury, or surgery. However, untreated endometriosis may cause adhesions even in women who do not get surgery for it. Regardless of their cause, these adhesions often cause pain.

For women who have endometriosis, the pain related to adhesions and lesions can spur the surrounding muscles to contract in an attempt to protect the area from pain. Over time, this can lead to muscle tightness and pain in the pelvic floor, abdomen, and back. Physical therapy addresses the musculoskeletal system and soft tissue dysfunction that contributes to this type of pain.

Determine Whether You Need Pelvic Floor Physical Therapy For Your Endometriosis

Although pelvic floor physical therapy is not necessary for every woman with endometriosis, anyone who is experiencing abdominal, pelvic, or back pain – especially if it interferes with their daily activities, sexual activity, work, or exercise should consult with a pelvic floor physical therapist to determine whether the abdominal or pelvic floor muscles are contributing to their symptoms.

Know What To Expect At Your Appointment

During the first session of pelvic floor physical therapy for endometriosis, the therapist will ask about your symptoms and medical history. They may review what you have already tried for your symptoms and what seems to help, your recreational and work activities, and your treatment goals. The exercises recommended in pelvic floor physical therapy will be tailored to each individual’s conditions, abilities, and objectives.

There’s also an educational component to pelvic floor physical therapy. The therapist will discuss the anatomy of the abdomen and pelvic floor and explain how those areas relate to endometriosis and your symptoms. They may also provide some breathing techniques and other tips that can be completed at home.

In subsequent sessions, the therapist will check the strength and flexibility of your abdomen, hips, pelvis, and back, in addition to carrying out a pelvic floor muscle assessment. This may entail a simple internal exam in which the therapist will insert a gloved finger into the vagina to assess the strength of the pelvic floor and determine which muscles are contributing to your symptoms. However, those who are not comfortable with this type of exam can discuss other options for the therapist to assess the pelvic area.

The frequency and length of therapy sessions needed will depend on the individual and their symptoms. However, studies have shown that endometriosis patients often experience an improvement in their pain after just six sessions.

Don’t Avoid Physical Therapy Because You Are Worried About Pain

Some women worry that pelvic floor physical therapy will cause them additional pain. Although it is true that it can be uncomfortable to start moving the body in certain ways it has not moved before, the therapist will always stay within your comfort level and respect your feedback. If one approach is causing pain, communicate that to your therapist immediately and they will adapt the treatment plan accordingly.

Reach Out to the Women’s Healthcare Professionals

If you have endometriosis symptoms or have been diagnosed with endometriosis and would like to learn more about treatment options, make an appointment with the women’s healthcare professionals at Raleigh Gynecology & Wellness today.

If your doctor has suggested pelvic floor therapy, you may be wondering what this treatment involves and how it can improve your quality of life. Here is a look at what is involved in pelvic floor therapy and the benefits it offers.

What Is the Pelvic Floor?

The pelvic floor houses the muscles that support your urinary and reproductive tracts and control your bladder and bowels.

Your pelvic floor keeps your bladder in place in the front as well as your vagina and rectum in the back. Muscles also hold your uterus in place at the top of the pelvic floor. The muscles in the pelvic floor are attached to the tailbone and pubic bone.

What Is Pelvic Floor Dysfunction?

Any time the muscles in the pelvic floor are weak or are not performing as expected, it is known as pelvic floor dysfunction. This simply means that your pelvic muscles are unable to work together in the normal manner.

Some of the signs of pelvic floor dysfunction include frequent urination, pain during sex, difficulty controlling bowels or urine, and constipation.

Although the cause of pelvic floor dysfunction is not always known, some common triggers include aging, being overweight, pregnancy, overuse of pelvic muscles, serious injuries in the pelvic area, and pelvic surgery.

How Can Pelvic Floor Therapy Help?

Pelvic floor therapy is a type of physical therapy that is designed to relieve the symptoms of pelvic floor dysfunction and restore proper functioning to the pelvic floor muscles.

Pelvic floor therapy may include techniques and exercises such as:

Kegels

Kegels are a type of exercise that can strengthen the pelvic floor muscles through contraction and relaxation. In addition to controlling incontinence, performing these movements regularly can help relieve pain during sex. A physical therapist can teach you how to perform these exercises at home for quicker healing.

Biofeedback

Biofeedback uses devices to assess the contraction of the pelvic floor muscles. For example, measurements with electrodes may be used to determine how therapy is progressing.

Electrical Stimulation

Electrical stimulation can be used to reduce muscle spasms and pelvic pain. It can be performed in a physical therapist’s office, or patients may be instructed how to do it at home using specialized equipment.

Trigger Point Therapy

This therapy involves applying pressure to certain spots on the body known as trigger points to bring about healing.

When you begin pelvic floor therapy, a physical therapist will discuss your symptoms with you and perform some checks to determine your core muscle strength and your degree of core endurance. They may also ask you to try certain positions and activities so they can determine the coordination of the muscles in your pelvic floor.

They will then devise a plan for your pelvic floor physical therapy that will help you reach your goals. There may be internal therapy as well as external therapy depending on your specific problem and your comfort level.

The Benefits Of Pelvic Floor Physical Therapy

Pelvic floor physical therapy can treat a broad range of problems.

These include:

Urinary Problems

• Urinary urgency
• Urinary frequency
• Urinary incontinence
• Difficulty stopping and starting urination
• Painful urination
• Difficulty emptying the bladder completely

Bowel Problems

• Straining during bowel movements
• Painful bowel movements
• Fecal incontinence

Pain

• Genital area pain
• Rectal pain
• Pelvic pain
• Pain during intercourse

Many women benefit from pelvic floor therapy after giving birth. The process of pregnancy itself can cause functional problems of the pelvic floor. For example, the increasing weight and pressure that are placed on pelvic floor muscles during pregnancy can cause them to become weak and stretched, which can lead to pelvic floor dysfunction. Changes in posture can also cause lower back pain and pelvic pain that persists long after giving birth.

Childbirth can also cause problems in the pelvic floor, particularly in vaginal deliveries as newborns pass through a pelvic floor opening and may cause the surrounding muscle to tear and scar.

Following pelvic floor therapy, many women may be able to enjoy dramatic improvements in their quality of life, whether it means returning to a favorite sport, being able to start a family, or just getting through each day without experiencing incontinence.

Women typically start to notice improvement after a few visits, although the amount of time it takes will depend on the woman and her condition. In cases where improvements are not observed in a reasonable time frame, the physical therapist can adjust their approach.

Make An Appointment With The Women’s Healthcare Team At Raleigh Gynecology & Wellness

If you are experiencing problems such as incontinence, pain during intercourse, and pelvic pain, pelvic floor therapy could help you restore your quality of life. Reach out to the women’s healthcare team at Raleigh Gynecology & Wellness for an assessment of your pelvic issue and to discuss whether this type of physical therapy is the right solution for you.

Whether you have given birth via vaginal delivery or a C-section, your pelvic floor muscles may become stretched or damaged during the processes of pregnancy and childbirth.

Although this is normal and not always a cause for concern, it can cause functional problems of the pelvic floor that manifest as urinary or fecal incontinence, urinary urgency or frequency, pain during sexual activity, pelvic organ prolapse, pelvic pain, lower back pain, diastasis recti, or scar pain.

Many of these issues can be fully treated with outpatient pelvic floor physical therapy. However, new moms need to wait for at least six weeks after delivery before they begin this type of therapy to give their body time to heal from childbirth.

Why Is It Better To Wait?

This time period coincides with the typical gynecological checkup that women are advised to undergo six to eight weeks postpartum. Although official guidelines from the American College of Obstetrics and Gynecologists have recently changed to acknowledge that women need individualized support and may need obstetric care within the first three weeks after giving birth, it is still best to wait the full six weeks before beginning pelvic floor therapy.

However, women with specific and immediate concerns, such as significant pelvic pain or urinary incontinence, may wish to have a preliminary appointment to discuss their condition and establish a plan of action earlier. Although most physical therapists will not conduct an internal exam too soon after delivery, much can be done externally to alleviate the problem. Physical therapists can also guide women on ways they can facilitate their recovery and the proper ways to lift their body, along with recommended positions for breastfeeding.

Once six weeks have passed, women may find that pelvic floor therapy can dramatically improve their quality of life. Some women are hesitant to leave their house following birth because they are concerned about leakage or discomfort, and some may struggle to push their baby in a stroller or lift the baby up. Therapy can help them resume normal functioning.

Pelvic floor physical therapy after childbirth may include some of the following components, depending on the patient’s specific goals and complaints:

• Coordination exercises
• Biofeedback to strengthen and relax muscles
• Patient education
• Behavioral modification
• Scar massage
• Strengthening exercises targeting the pelvic floor and abdominal muscles
• Electrical stimulation
• Relaxation exercises and stretching for painful or shortened muscles
• Heat or ice

In addition, patients will be given “homework” in the form of exercises and stretches that need to be performed regularly at home to give their progress a boost.

Why Is Pelvic Floor Therapy Recommended After Childbirth?

The pelvic floor serves many functions, including controlling the bladder and bowels, providing postural support, and supporting pelvic organs such as the bowels, uterus, and bladder. It also contributes to sexual function. Therefore, many aspects of a woman’s life can be impacted if her pelvic floor is not in optimal condition.

Throughout pregnancy, increasing pressure is placed on the pelvic floor muscles, causing them to become stretched or weak. In some cases, they may react by over contracting, causing them to become tense. This means that the process of pregnancy on its own is enough to cause pelvic floor dysfunction, regardless of how the baby is delivered.

In addition, during a vaginal delivery, newborns pass through an opening in the pelvic floor which can cause the muscle to tear and develop scar tissue. The pelvic floor can stretch as much as three times its normal resting length during a vaginal delivery, which can also cause problems.

In addition, many mothers-to-be experience changes in posture as their pregnancy progresses and their stomach grows. This can increase the arch of their back because of the weight of their stomach pulling it forward, leading to strain on spinal joints and the muscles and ligaments supporting the spine and can manifest as lower back pain. Although this pain may recede in the weeks after delivery, some women will continue to experience chronic back pain after pregnancy.

Abdominal muscles, not surprisingly, are also often affected by pregnancy as they stretch to accommodate a growing baby. This can lead to core muscle weakness that can exacerbate back pain. It may also cause a problem known as diastasis recti. Many people believe that this is chiefly an aesthetic concern, but it can also cause back or pelvic pain.

A pelvic floor physical therapist will have specialized training in assessing and treating postpartum women who are experiencing all types of pelvic floor dysfunction. Even those who are not experiencing specific problems, such as urinary incontinence or pain, may still benefit from pelvic floor therapy as it can help them restore their muscles to avoid future issues.

Reach out to the Women’s Healthcare Team

Women’s bodies are designed to support pregnancy and childbirth, but sometimes additional help is needed to restore normal function following delivery. Get in touch with the women’s healthcare team at Raleigh Gynecology & Wellness to find out whether the changes you are experiencing postpartum could be improved with pelvic floor therapy.

If you are experiencing pelvic organ prolapse, your doctor may have suggested that you address it with a pessary, and a pessary fitting. Pelvic organ prolapse occurs when one or more of the organs in the pelvis slips down from its normal position and bulges out into the vagina. It may involve your uterus, bladder, bowel, or even the top of the vagina itself. Although it is not dangerous, it can be uncomfortable or painful.

If lifestyle changes, such as losing weight and avoiding heavy lifting, and pelvic floor exercises have not resolved your pelvic organ prolapse, your doctor may recommend that you try a pessary. These are prosthetic devices that can be inserted into your vagina to provide support to its internal structure.

In addition to pelvic organ prolapse, they are also used to help address urinary incontinence. They might also be used in some cases as a vessel to slowly administer certain medications. For many women, a pessary can help them avoid the need for pelvic surgery.

However, it is important to get the right fit for your pessary to be effective. Here is a look at how you can prepare for your pessary fitting and what to expect.

The Pessary Fitting Process

Before getting a pessary, your doctor will perform a vaginal exam to diagnose the severity of your prolapse and take careful measurements to ensure that you get the right fit for your condition. You may be asked to strain so your doctor can determine the full extent of the prolapse.

Your doctor will advise you on whether you need to empty your bladder prior to the fitting. In some cases, it may be desirable to have a slightly full bladder, particularly if the pessary is being fitted with the aim of alleviating urinary incontinence.

Pessary Types

There are two main categories of pessaries: space-filling and support pessaries. These are available in different sizes and shapes to accommodate body differences among women. They are typically made using medical-grade silicone, which allows them to resist absorption while remaining durable.

The ring pessary is the most common type of support pessary because of its ability to fit a wide range of women and its suitability for all stages of pelvic organ prolapse.

When it comes to space-filling pessaries, the Gellhorn is the most popular variety. Featuring a broad base with a stem in various lengths, it can fit most women comfortably.

Insertion

Your gynecologist will insert the pessary during the initial fitting, and he or she may need to try different sizes and styles to find the best one for you.

If a pessary is properly sized, you should not be able to feel it. If you are uncomfortable once it has been inserted, it is probably too large for you, and your doctor will likely try a smaller size. Your doctor will use lubricant on the leading edge of the pessary to make insertion more comfortable.

Pessary fitting may require a bit of trial and error among the different pessary types and sizes until the best solution is found.

You may be asked to visit your doctor again a few weeks later to assess the device’s fit. At this appointment, your gynecologist will remove your pessary to examine your vagina for any signs of irritation. If everything looks okay, they will then clean it and replace it. You will also be asked to return for follow-up appointments.

Caring For Your Pessary

Once your pessary has been fitted, your doctor will advise you on the best way to remove and clean the specific model chosen. Ring pessaries can be removed by you and may need to be cleaned weekly or nightly. The procedure generally entails cleaning with a mild soap and water before rinsing it thoroughly. It must be dried completely before being reinserted into the vagina. Water-based lubricant can help make the insertion process more comfortable.

Some types of pessaries can only be removed and cleaned by a doctor, such as a Gellhorn pessary. If you use this type of pessary, you will be asked to see your doctor every one to three months so that it can be removed, cleaned, and replaced.

Side Effects

Although pessaries are a safe and comfortable option for many women, it is important to be aware of the potential for mild side effects such as discharge, urinary tract infections, and vaginal irritation. The removable nature of pessaries means that side effects can usually be alleviated easily.

Although many women opt to remove their pessary before sexual activity, it is possible to have sexual intercourse with a ring pessary in place.

Get In Touch With The Women’s Healthcare Team

If you would like to learn more about pelvic organ prolapse treatments and pessary fittings, get in touch with the women’s healthcare professionals at Raleigh Gynecology & Wellness. Serving the Triangle Area for more than 30 years, our team provides a broad range of women’s healthcare services with a focus on patient comfort.