Types of Pelvic Floor Therapy
- Melissa Hines
- 11 hours ago
- 4 min read
by Alicia Jeffrey-Thomas, PT, PRPC
If you’re experiencing pelvic floor issues like incontinence, pelvic pain, constipation, etc., you’ve hopefully been told to go to pelvic floor therapy by your healthcare provider. But there’s a lot of conflicting information out there about what pelvic floor therapy actually consists of. Pelvic floor therapy is performed by licensed physical and occupational therapists with additional specialized training in treating pelvic floor conditions. This service is offered in private practices and outpatient hospital settings, and sometimes even virtually (although we want to make sure we know the differences between the types of care offered in each of these settings).
In-Person vs Virtual Pelvic Floor Therapy
Virtual care is a hot topic in the world of medicine right now, but especially when it comes to pelvic floor therapy. In-Person pelvic floor rehab is the gold standard of treatment. It’s what all of our research outcomes are based on, and for good reason: most people don’t have a good connection to their pelvic floor muscles. Heck, some people don’t even realize they have pelvic floor muscles. One study said that around 50% of people could not coordinate their pelvic floor muscles correctly when given verbal instructions alone, so it makes sense that having someone who can fully assess what’s going on with your body will get the best information to guide your treatment.
That being said, there are some places where virtual care can be beneficial. There are many places in the country and the world at large where access to in-person care is limited, and in this case virtual care can fill some of those gaps. We can provide education and even some exercise interventions depending on the patient. It can also be a convenient substitute when a normally in-person client is stuck at home due to work or childcare needs.
At Wellest, we do our initial postpartum follow up virtually with established patients. This allows us to reconnect with them sooner (2 weeks postpartum, compared to 6 weeks at most other clinics) so we can hear what happened during the birth, and help to troubleshoot any initial concerns regarding healing, toileting, etc.
Virtual therapy limits the types of assessments that can be done. You can’t do a pelvic floor exam over a Zoom call, for example. Sometimes you can be coached on how to assess things yourself, but that depends on a lot of factors including the patient’s understanding, their mobility, etc. and even then, it’s a little like playing a game of telephone.
When you come in-person for pelvic floor therapy, however, we are better able to look head to toe to try to find the drivers behind your symptoms. What we recommend for treatment specifically is going to be based off of what we think is most appropriate to address your needs and what you are comfortable with. This usually includes some degree of both internal and external treatment.
Internal Treatment
This is the part that people are sometimes nervous about when it comes to seeking pelvic floor care, so let’s talk about why it might be important. Assessing the pelvic floor muscles is a key part of understanding what a patient needs. We don’t want to guess based on symptoms, because even symptoms like urinary leakage, which people typically associate with a “weak” pelvic floor can actually be due to tightness. The treatment we give varies widely depending on where your muscles fall on the spectrum.
An internal pelvic floor muscle assessment (and subsequent treatment) involves inserting a single gloved finger, either vaginally or rectally depending on your anatomy and your reasons for seeking care. We are looking at muscle coordination (can the pelvic floor contract, relax, and bulge appropriately, etc.), the tone of the muscles, whether palpation reproduces pain or other symptoms, and just the overall perineal anatomy.
An internal exam does not need to be done on the first visit. We recognize that seeking care for pelvic floor dysfunction can make people feel very vulnerable. We will never force anyone to have any treatment or examination they do not consent to.
External Treatment
This part of pelvic floor therapy can look a lot like your typical orthopedic physical therapy visit. We do hands on manual therapy, including techniques such as myofascial release, and even other modalities like dry needling, to the glutes, abdomen, back, thighs etc. to help loosen tight areas and relieve pain. Depending on the patient’s comfort level, there are also external pelvic floor muscles around the perineum (generally the space between the pubic bone and tailbone) that can benefit from hands on treatment as well.
External treatment can also include various exercises. Depending on what’s going on with your body, your therapist might prescribe stretches, breathing exercises, and/or strengthening exercises. These work in conjunction with the hands-on treatment to re-educate your body on what it should be doing.
At Wellest, we believe that everybody deserves comprehensive care for their needs. Give us a call today to get started on your pelvic health journey.