Pelvic floor health physical therapists help women who have problems with sexual intercourse, urination, fertility, pregnancy preparedness, pelvic and/or tailbone pain, postpartum recovery. Depending on exam findings, treatment includes manual techniques, specific exercise prescription (a Kegel is not simply a Kegel!), and the use of electrical stimulation and/or biofeedback tools. Read below for more information or call us with your questions. We're not shy and we've seen it all.
All of our therapists can treat women who are pregnant and having musculoskeletal pain and or movement problems, but Angela Messerli, DPT, and Tricia Yost, DPT, specialize in internal pelvic floor conditions.
This page focuses on the female pelvic floor. Please be aware that we are sensitive to the needs of those persons who don't identify as a woman/man, male/female. Life in Balance is an inclusive practice and we can treat all pelvic floors.
Stress urinary incontinence (SUI) is the leakage of urine due to weakness in the pelvic floor musculature. Such leakage occurs in times of "stress," such as running, jumping, laughing, coughing, sneezing, or other activities that increase intra-abdominal pressure.
Treatment for SUI is more than merely doing Kegels, and generally includes specific exercise prescription for strengthening and function and structural correction for proper pelvic alignment. Physical therapy treatment may also include a review of dietary contributors and/or the use of electrical stimulation or biofeedback. Most patients experience significant improvement in six to eight visits.
Pelvic pain can be due to conditions such as pelvic floor muscle imbalance, endometriosis, post-surgical abdominal adhesions, pudendal neuralgia, interstitial cystitis, postpartum adhesions and scarring, or nerve entrapments. Vaginismus, involuntary muscle spasms around the vaginal opening and dyspareunia, painful intercourse, are forms of pelvic pain that are also helped with physical therapy. The most effective treatment is manual therapy targeting soft-tissue restrictions and hypertonicity and sacroiliac alignment. Additional physical therapy treatment may include exercises to relax the pelvic floor musculature, the use of biofeedback and/or electrical stimulation. Treatment duration for this diagnosis varies due to myriad causes.
Adhesions and Infertility
Adhesions are areas of thickening in connective tissue that form as a result of tissue damage caused by disease (such as pelvic inflammatory disease or endometriosis), trauma (fall on the tailbone or sexual abuse), and/or pelvic or abdominal surgery. Adhesions in the pelvis or abdomen can affect fertility by creating mechanical problems. The result may include limited mobility of the reproductive organs within the pelvic cavity, decreased blood flow to the ovaries, and/or pain. Manual therapy techniques to release the adhesions can restore mobility of the organs and improve blood flow to the tissues, thereby helping to regain some or all of the function affected.
Urge incontinence (UI) is the sudden and often frequent need to urinate due to involuntary bladder spasms or contractions, regardless of the amount of urine in the bladder. Women may feel a strong urge to use the bathroom, but have difficulty getting there in time. They may also notice that once in the bathroom not much urine is voided. Treatment for UI is a combination of patient education regarding the causes, bladder behavior retraining to interrupt the pattern of urgency and frequency, a review of dietary habits that may be contributing, and strengthening or relaxation of the pelvic floor muscles. Patients tend to note significant improvement in six to eight visits.
Tailbone (Coccyx) Pain
Coccygodynia, tailbone pain, results from injury after a recent or past fall and/or tightness of the pelvic floor muscles, as the coccyx is an attachment site for some of these muscles. Treatment includes manual therapy to loosen the pelvic floor muscles, gentle mobilization of the coccyx to correct its position, specific exercise, and patient education.
Pregnancy and Postpartum
The body undergoes many changes during and after pregnancy. Some of these changes include weakness in the pelvic floor and abdominal muscles, pelvic mal-alignment, postural problems, and unhealthy movement patterns developed both during pregnancy and during care of the newborn. Less common but also possible are diastasis recti, which is a separation of the abdominals caused by stretching of the rectus abdominis, and stress incontinence as mentioned previously. Treatment addresses the symptoms and underlying causes and includes a combination of manual therapy, education, movement modification, and exercise to correct muscular and biomechanical dysfunction.
Prolapse occurs when the supportive tissue for the bladder, rectum, uterus or urethra, becomes weak. The result is that the organ will descend into the vaginal cavity. The subsequent pressure of the organ in the pelvic cavity will often feel like something is "falling out." Other symptoms may include urinary or fecal incontinence, pelvic pain, and/or low back pain. In cases where the pelvic floor is weak, simply strengthening can help to reduce the symptoms. If the supporting tissue is significantly damaged, a device called a pessary, can help improve internal support.
Low Back Pain
Unresolved low back pain may have a component of pelvic floor muscle dysfunction, as these muscles form a sling or hammock across the bottom of the pelvis and support the bladder, vagina, and rectum. Tightness or imbalance in these muscles can contribute to low back pain. Physical therapy is most effective in treating this by combining manual therapy, exercise, and modalities. Manual therapy is done to correct the position of the pelvis and loosen the pelvic floor muscles; exercises are aimed at stabilizing the pelvis via abdominal and pelvic floor strengthening; modalities such as electrical stimulation, biofeedback, and ultrasound may be used as an adjunct to other treatment techniques.
Do you leak urine with laughing, coughing, sneezing, or exercise?
Do you have moments when you really, really, need to use the restroom, but are unable to get there in time?
Do you have pelvic pain?
Do you have pain with intercourse?
Are you unable to have a pelvic exam?
Do you have tailbone pain or difficulty sitting?
Are you having difficulty getting pregnant?
Do you have a "falling out feeling" with standing or other movements?
If you've answered yes to any of these questions, a Physical Therapist trained in Women's Health may be able to help!
Life in Balance Physical Therapy & Pilates 5410 California Ave SW, Ste 101 , Seattle, WA, 98136 913-8082 1800 SW 152nd St, Ste 200, Burien, WA, 98166 743-8942