January 27, 2020

The Untapped Power of Pelvic Physical Therapy

By Erin Glace PT, MSPT, PRPC, BCB-PMD 


The potential role of pelvic physical therapy in alleviating pelvic floor dysfunction and pain is, unfortunately, commonly overlooked. 

Problems with the bowl-shaped set of muscles that supports the bladder, bowel, small intestine, rectum and uterus can contribute to multiple health conditions, many of them embarrassing and harmful to a patient’s quality of life.  

Specialized exercises can help relax or strengthen these muscles, which are crucial to core stability. The concept is no different from using physical therapy to heal damaged muscles in orthopaedic cases. 

Over time, pelvic floor muscles can either weaken and loosen or tighten, contract abnormally and shorten. Contributing factors can include aging, pregnancy, childbirth, hormonal changes after menopause, surgery, excessive straining during bowel movements, and obesity. 

Depending on the health of the muscles, patients may suffer from: 

Urinary issues, including leakage and stress incontinence,

frequent urge to urinate, difficulty emptying the bladder,

bedwetting in children, and sometimes chronic urinary tract infections.   

Bowel problems, including loss of control or chronic constipation. 

Mild, moderate or severe pelvic pain and pressure, including painful intercourse, sexual and erectile dysfunction, and cramps similar to those experienced during menstruation. In men, pain can manifest in the genital area. 

Unexplained back pain. 

Since this muscle dysfunction often doesn’t appear on tests or scans, a diagnosis can be elusive. Physicians and patients should be aware that specialized physical therapy, using external and/or internal manipulations and stretches, can be prescribed separately or alongside other treatments or medications. 

Patients can learn a variety of at-home techniques – some of which draw on yoga principles – and breathing exercises that can activate muscles in the pelvis as well as the abdomen.  

Many people have heard of Kegel exercises, often taught to pregnant women as a way to keep their pelvic floor muscles in good condition. However, a large group of patients are doing these incorrectly and benefit from proper instruction. In addition, people whose symptoms do not improve with Kegels actually may need to learn to relax their pelvic floor muscles instead. 

A specially-trained pelvic floor physical therapist can assess each individual’s muscles and tailor exercises to him or her. Most patients can master these techniques during a handful of in-office appointments, although the speed of potential results varies widely based on the case.  

My passion is to empower people with education. We truly can change lives with relatively simple solutions; I myself have witnessed many patients crying from relief.  

Another hope is that we can normalize these health concerns so that people are neither embarrassed to discuss them, nor to assume they are an inevitable consequence of aging. Correcting pelvic floor dysfunction should be no different than, say, working on a shoulder after a rotator cuff injury. Hopefully, we will reach more and more of these patients in the future.

Erin Glace is a Physical Therapist with the Pelvic Physical Therapy Center at Urology of Virginia.  urologyofva.net.