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What the heck happens at pelvic floor physical therapy?
Updated: Jul 9, 2021
You do what!? -A common response when casually talking about what I do in a social situation. By now it may be safe to say that most people have heard the term pelvic floor but many have no idea what happens when you have a session with a physical therapist that specializes in helping people with pelvic floor issues.
My whole goal in writing this blog has been to increase awareness and decrease fear around pelvic health. I would hate for a person to not know that there was help out there or worse yet, be too intimidated to access that help. If you have read the last couple of blogs (and if you haven't, check them out HERE and HERE) you now know what the pelvic floor is and some common conditions that impact this area. Today I am going to introduce you to what happens when you work with a pelvic health physical therapist. Scratch that. I will give you some examples of what you will encounter when working with me. All physical therapists practice a bit differently but there are commonalities among the good ones. Here is an abbreviated case study to help shed some light on what I do.
The client is a 55-year-old female that recently has an empty nest. In her newly found free time she has taken up tennis lessons at the local club and even has a twice weekly doubles game going with a group of girlfriends. She has always remembered leaking urine with sneezing but now she is surprised to find that she leaks when serving or really reaching to keep a volley going. She also recognizes that it is getting harder to hold it when coming home after a day at work. She recalls that her mother wore pads in her later years and wants to do all she can to take care of herself now to prevent ending up in a situation like her mother.
She gives me a call and decides to schedule an appointment after I answer a couple of her questions. Here is an overview of how we worked together to solve her problem.
March 1st. She attends her first session and I begin by asking about her goals and why they are important to her. I ask her many questions about her symptoms as well things that may seem less relevant but are actually quite important. I want to know about her bowel habits, her diet, her medical history, medication use and any orthopedic complaints. By understanding her thorough history, I can generate a hypothesis that needs testing.
With this particular woman I suspect that she has some pelvic floor muscle weakness, some tennis strategies that could use modification, and some less than optimal habits like going pee just in case or restricting fluids in an effort to stop leaks.
After assessing her movements like bending, squatting, and jumping, I next suggest that it would be helpful for me to evaluate her pelvic floor muscle function. I give her a couple of options:
1. She can keep her clothing on and I will place a hand near her sit bone to feel for a pelvic floor muscle contraction. This approach gives me very basic information, but enough to get her started on a program In about 30% of cases that I see, this all of the pelvic floor assessment that is ever required.
2. I can perform a pelvic floor muscle examination where I place a gloved and lubricated finger into the vagina to assess the pelvic floor muscle strength, coordination, and endurance. Based on what I feel, I can give her a specific training program that addresses her deficits.
She opts for option 2 because she has never really known if she was doing a “kegel” correctly and she just wants to be confident with that after the appointment. On examination, I find that she does a really nice job with contracting the back of her pelvic floor but has little ability to coordinate a contraction in the front part of the pelvic floor. I give her some cues that help her access that part of the pelvic floor and she feels hopeful that she will be able to stop the leaks in tennis with this new skill. On the first visit I give her a specific training program that will take 8 minutes 2x per day to complete.
2nd visit, March 10th - 55 minute appt.
She catches me up to speed on how her exercises have been going. At her request I confirm that she is doing her pelvic floor muscle exercises correctly through an internal vaginal assessment. She is doing great so I give her a progression to work on to improve her endurance and coordination. Next, I watch her simulate a tennis serve in the clinic and make some small recommendations based on what I see. I also teach her how to complete a bladder journal and ask that she logs this information for 3 days.
3rd visit, March 25th - 55 min appt.
She returns with her completed bladder journal and it reveals that she may benefit from drinking a little more water. I also teach her some urge delay techniques that help with those “gotta go, gotta go” times. Her leaks in tennis have reduced by about 50%. I recommend that she works on her exercise program and new techniques for 3-4 weeks. We also discuss having the next appointment at a tennis court so I can watch her full serve and get some real time feedback on if my modifications are helpful to her.
4th visit, April 20th - 40 min appt.
At the tennis court. I find a couple key things that she is doing in her serve involving her breath and her landing mechanics that we shift a bit. It feels a bit awkward to her but she immediately notices that she is leaking less urine. We decide to meet up again in 3 weeks.
5th visit, May 10th - 60 minute appointment
Her urgency symptoms are 80% improved and she is no longer leaking with tennis. We review her exercise program which she now completes 20 minutes per day, 5 days per week. I add some total body strengthening to it and give her ideas for progressions. I ask her to call me to give me an update in about a month and if all is well, we will consider the problem solved.
At a follow up call in late June she tells me all is well and she doesn’t think she needs any more from me at the moment. She no longer leaks urine or has the “gotta go” feeling but most importantly she is no longer fearful about ending up in a nursing home because of urine leaks.
Please use this case as and an example of what a course of care may look line but not as medical advice. Two people may have very similar symptoms but different programs based on their evaluation findings and lifestyle. If you are ready to get to the bottom of your pelvic floor issue then go to the source. Give me a call and after a thorough evaluation we will set up a plan just for you!
Are you excited about your potential but not sure you want to work with me? That is fine. There are other great PT’s in town that can help you. Check them out here.