Pelvic Floor Physical Therapy

Often times the symptoms of pelvic floor dysfunction can mimic symptoms of a UTI. This includes burning with urination, frequent urination, strong urges to urinate, the inability to empty your bladder, weak or “hesitant” stream, straining to urinate, and bladder discomfort. These symptoms usually indicate pelvic floor tension and connective tissue restrictions. Treatment may include manual techniques and cupping to relax muscles and release restrictions, bladder training, motor control exercises, stretches, breathwork, postural education, bladder hygiene, and dry needling. Hormone balance and pelvic organ prolapse may also impact these symptoms and will be assessed and managed.

Constipation can be caused by pelvic floor muscles that are unable to relax or are uncoordinated. When you have a bowel movement, your pelvic floor muscles must be able to release and stay released in order to pass stool. When muscles don’t release or release in spasms you may have to strain to have a bowel movement or you may have pellets, pieces, or very thin stool. Treatment for this may include manual muscle release, breathwork, relaxation exercises, motor control exercises, stretching, bowel hygiene, postural education, cupping and dry needling.

Leakage of stool or uncontrolled gas can be caused by pelvic floor muscles that are over active and fatigued or under active and lax. Treatment is based on an assessment of the pelvic floor muscles as well as lifestyle and dietary considerations.

Strong, sudden urges to have bowel movements can be caused by impaired signaling from the nerves controlling bowel function. Nerves can be impinged, compressed, or pulled by connective tissue restrictions, spine restrictions, or muscle tension. Treatment may include spine mobilization, correction of pelvic alignment, connective tissue manipulation, mobility and strengthening exercises, cupping, dry needling, and muscle release.

Pain with sex can be caused by pelvic floor dysfunction, nerve irritation, connective tissue restriction, hormone imbalances, or pelvic organ prolapse. Tight pelvic floor muscles or fragile vulva tissue can make penetration uncomfortable or painful. If the nerves to your clitoris are compressed or pulled, stimulation may be uncomfortable or painful. Orgasms can be diminished or difficult to achieve if muscles are too tight or lax and weak.

Pain with erections or after ejaculation can be caused by pelvic floor muscle spasms and/or nerve irritation. Erectile function requires working pelvic floor muscles, good blood flow, coordinated nerve activity, and mobile skin to work well. When erections are difficult to achieve/maintain or lack fullness, each area requires assessment.

Pelvic pain can refer to burning, pressure, aching, throbbing, sharp shooting sensations, or discomfort in the genitals, perineum, rectum, abdomen, groin, hips, low back, or thighs. Symptoms may be caused by muscle imbalance, nerve irritation, connective tissue restriction, poor neuromuscular control, movement impairments, and postural issues. A full body assessment will help clarify what may be the cause of your pain and guide treatment.

Physical therapy can help mitigate urinary leakage, bladder symptoms, and sexual symptoms following pelvic surgeries such as prostatectomy, TURP, TUVP, or HOLEP. A single appointment before surgery will prepare your muscles and brain-body connection for a faster recovery process. You will be educated on what you can expect to feel and experience after surgery. We will also identify any current pelvic floor issues and address them before surgery to allow for the best possible post-surgical outcomes.

Gender affirmation procedures are major surgeries involving pelvic floor muscles, genital tissue, nerves, and blood vessels. Pelvic floor physical therapy can help hasten recovery and address common post-surgical issues.

Trans women: Following vaginoplasty it is essential to dilate so that the pelvic floor muscles do not close and cause a vaginal stricture or narrowing of the vaginal canal. Pelvic floor physical therapy can help to retrain your pelvic floor muscles and avoid vaginal narrowing requiring surgical revision. It can also help to mobilize scar tissue and reduce post-operative pain.

Trans men: Following a phalloplasty or metoidioplasty, you may have bladder symptoms such as frequent or painful urination, a strong or constant urge to urinate, or urinary leakage. You may experience post-operative pain due to inflammation, scar tissue and muscle guarding. Physical therapy can provide a faster, more complete return to pain-free function.

Chronic conditions that cause pelvic pain and impact urinary, bowel, and sexual function include interstitial cystitis (IC), endometriosis, chronic pelvic pain syndrome (CPPS), chronic prostatitis, chronic UTIs, small intestine bacteria overgrowth (SIBO), irritable bowel syndrome (IBS), and polycystic ovarian syndrome (PCOS). Chronic inflammation in the abdomen and pelvis causes muscle guarding, connective tissue restrictions, and nerve hypersensitivity all of which increase severity of symptoms. Pelvic floor physical therapy can help alleviate symptoms of these conditions and give you tools to manage symptoms when flares occur.