You might think of seeing a physical therapist when you have shoulder or knee pain…but where do you go for pelvic pain and dysfunction?

Most people don’t even know that pelvic floor physical therapy exists.

Pelvic floor physical therapy works to recondition the pelvic floor muscles by not only strengthening and stretching them to alleviate pain and dysfunction, but also making sure that the entire pelvic floor/core/breathing system is working together appropriately.

Sometimes the pelvic floor is just a symptom, not the root cause. 

Pelvic floor therapy can be beneficial for a wide variety of pelvic floor disorders – keep reading to see if it might be right for you. 

Pelvic Floor Physical Therapy

The pelvic floor is made up of the muscles that support your pelvic organs (reproductive organs, bladder, bowels) and allow for control of your bladder and bowels. 

The pelvic floor is made of muscles, which means it can be injured, lack coordination, become weak, become stiff, or have areas that are painful to touch…. just like any other muscle group.

The goal of pelvic floor physical therapy is that of any other physical therapy- to get these muscles operating properly and making sure they are strong enough, AND can relax enough; to improve their function, alleviate pain, and eliminate your symptoms for good.

At MOVE, we start by learning about you and your goals, what activities you want to be doing and how your symptoms are impacting you, along with educating you about how the muscles, organs and tissues of your pelvic floor work together. After understanding your needs, we immediately get to work creating and starting a plan to relieve any pain or dysfunction.

What are the muscles of the pelvic floor?

Well, they come in two parts. The first part is called the levator ani, and it's like a big, broad sheet of muscles found in your pelvis. This group is made up of the puborectalis (puboanalis), pubococcygeus, and iliococcygeus muscles. Now, the second part is the coccygeus muscle, and it's shaped like a triangle. You'll find it at the bottom of the pelvic floor, just behind the levator ani muscles. When you put these two parts together, they form something called the pelvic diaphragm.

But what do these muscles do? Well, they have some really important jobs. They help keep your pelvic organs, like your bladder, bowel, and uterus, in the right places. Imagine them like a strong support system, holding everything up and in place like a hammock. But that's not all – these muscles also play a key role in helping you control when you pee or poop, or even let out gas. They also contribute to sexual pleasure and are directly related to orgasm and orgasm strength. 

As we journey through life, sometimes these muscles can become weaker due to various reasons. Things like getting older, going through pregnancy and childbirth, carrying extra weight, or having a persistent cough can all contribute to weakened pelvic muscles. When these muscles aren't as strong as they should be, it can lead to issues like leaking urine or stool, or even pelvic organs moving from where they should be.

What are the Nerves of the Pelvic Floor and what do they do?

Imagine your brain wants the pelvic floor muscles to do something, like support your organs, do things during intimacy, or hold in (or let out!) your pee, poop, and gas.

Nerves are like the phone lines that carry the message. The nerves tell the muscles what to do, they also allow you the ability to feel things. Without them, you wouldn’t be able to use your muscles or feel a thing.The major nerve that goes to the pelvic floor is the Pudendal Nerve. The Pudendal Nerve controls movement and feeling in your genitals and anus. It also controls the sphincter muscles that help you pee and poop.

The Pudendal nerve comes from the sacral plexus, which is a group of nerves that come out of the sacral part of your spine. The sacrum is also connected to your pelvis. 

What symptoms might I have with a Pelvic Floor issue?

Symptoms may include:

• discomfort or pain in the pelvic region
  
  
• pain during sex
  
  
• pain with urination or bowel movements
  
  
• unexplained pain in the lower back or abdomen
  
  
• urinary incontinence or difficulty controlling urine stream
  
  
• fecal incontinence or difficulty controlling bowel movements.
  
  
• Unwanted loss of gas
  
  
• Feelings of “heaviness” or things “falling out” in the pelvis or anus
  
  
• A variety of issues may cause pelvic floor pain, including:
  • muscle spasms or cramps in the pelvic floor muscles
  • nerve irritations
  • Infection
  • Inflammation
  • problems with other organs in the pelvis, such as the uterus, bladder, or rectum.

If you are experiencing any of these symptoms, you should seek pelvic floor physical therapy.

What conditions can pelvic floor physical therapy treat?

Our pelvic floor physical therapists are experts who specialize in treating a range of conditions that can affect your pelvic area. These conditions can vary in symptoms and causes, and here's a breakdown of some common issues they can help with:

• Urinary incontinence, urinary urgency, fecal incontinence, fecal urgency:

Ideally, you don’t want to lose urine or feces (fecal incontinence) unless you’re trying to go to the bathroom (on purpose!) You also should aim to be able to control fecal and urinary urgency (no rushing to the bathroom!), and “just in case” pees. 

 Pelvic floor physical therapy can help with urinary urgency and involuntary loss of urine, which is commonly known as leaking. Leaking can happen with walking, lifting, sneezing, coughing, running, etc. 

• Pelvic organ prolapse:

Pelvic organ prolapse is a common diagnosis treated in pelvic floor physical therapy. Prolapse occurs when organs in the pelvis, like the bladder, rectum or uterus, shift down into the vagina or anus  area. This might cause discomfort, trouble urinating or having a bowel movement, a sensation of something "fallen", or a feeling of “heaviness” in the pelvis or anus.

This feeling of heaviness or fullness in the pelvic region may occur while you’re lifting. Sometimes athletes will also feel this when they are bearing down and bracing.

 Pelvic floor physical therapy can help alleviate and prevent symptoms of pelvic organ prolapse.

• Pelvic Pain: 

Pain in the pelvic region as a whole is treated in pelvic floor physical therapy. This pain might occur with exercise, during sex, with running or other exercise/ athletic activities, at rest, going to the bathroom, or during or after pregnancy. 

This pain is most commonly described as deep pain, but also  as shooting, burning, or pulsating. It can even be described as hip or back pain.

Pain in the pelvic region can stem from various causes, such as childbirth, ovarian cysts, endometriosis, or pelvic floor muscle or nerve issues. Pelvic floor physical therapy can work with you to manage and get rid of this pain.

• Endometriosis:

Endometriosis is when the tissue usually found inside the uterus grows outside it. It can lead to pain, fertility challenges, and heavy periods. Pelvic floor physical therapy can be part of a holistic approach to addressing endometriosis symptoms so you can live without the pain.

• Ovarian Cysts:

Fluid-filled sacs on or inside the ovaries are known as ovarian cysts. They can cause pelvic pain, bloating, and issues with fertility. Pelvic floor physical therapy can help manage discomfort related to ovarian cysts.

• Menstrual cramps:

Menstrual cramps should not be debilitating. Cramping that is debilitating should not be normalized by your healthcare provider. Pelvic floor physical therapy can help decrease your menstrual discomfort.

• Pelvic Floor Dysfunction:

When your pelvic floor muscles are either weak , too stiff, or not working properly, it's called pelvic floor dysfunction. This can lead to a range of issues, including pain, incontinence, constipation, and prolapse. Pelvic floor physical therapy can guide you in restoring balance to these muscles, and progressing you back to full on, pain and symptom free exercise and life.

• Pregnancy and postpartum: 

Pelvic floor physical therapy can help expectant mothers have a pain-free pregnancy and improve birth outcomes (reduce the possibility of needing a C-section, improve adaptations of the pelvic floor, and reduce the risk of tearing during birth).

Pelvic floor physical therapy can also improve the pregnancy and birth experience educating moms along the way so they are aware of the entire birth process, and performing  specific pelvic floor mobility and exercises. 

So many expectant mothers also do not know what they should or should not be doing for exercise. Pelvic floor physical therapy can prescribe strength and fitness programs to maintain health, fitness, and strength during pregnancy! 

Both childbirth and pregnancy can impact the pelvic floor muscles, ligaments, and nerves. This might lead to concerns like incontinence, prolapse, and pain. Pelvic floor physical therapy can aid in maintaining a healthy pelvic floor throughout pregnancy, recovering pelvic health after these life stages, and getting back to fitness and exercise without pelvic floor symptoms. Yes, even if it was 30 years ago.

• Constipation:

Struggling with having bowel movements on a regular, consistent basis? That's constipation. Having a hard time passing bowel movements? That’s also constipation. Anyone who has experienced this knows just how painful and uncomfortable it can be. Pelvic floor physical therapy can address and eliminate constipation and the discomforts that come with it. 

• Menopause:

Menopause can bring changes to pelvic floor muscles, potentially causing incontinence, pain, and discomfort. Pelvic floor physical therapy can play a large role in managing these changes.

• Painful Intercourse and Bladder Issues:

Painful intercourse can result from various factors, including endometriosis, ovarian cysts, pelvic floor dysfunction, or scarring from surgery. Pelvic floor physical therapy can help address discomfort during and after intercourse. Additionally, conditions like painful bladder syndrome and interstitial cystitis, which cause bladder discomfort and inflammation, can also benefit from pelvic floor physical therapy.

• Tailbone or pubic symphysis pain:

 Pain in the tailbone region can occur after falling on it, known as coccydynia, or as a result of tight or stiff pelvic floor muscles

• Diastasis recti (abdominal separation): 

Diastasis recti is when separation occurs between the two sides of the abdominal muscles. A common myth is that this only happens with postpartum women. While it is common with postpartum women, it can occur in anyone and we see a lot of MEN with diastasis recti.

 With an appropriate pelvic evaluation and a holistic, functional plan of care the separation can be decreased, allowing for both aesthetic and functional improvements.

• Core stability and performance: 

The pelvic floor is a key component of core stability and pressurization. With treatment related to your specific sport or fitness style we’re able to improve your ability to effectively use your core and manage core pressure (AKA increase your PRs!😉 ).

If you’re a Crossfitter, you need to be CrossFitting in rehab. If you’re an Olympic weightlifter, you NEED to be hitting the Oly lifts in rehab. If you’re a powerlifter, you NEED to be hitting the big 3 in rehab. If strongman/strongwoman, runner, or yogi…you get the picture.

Getting you off the table and into the gym as soon as possible should be a high priority in any pelvic floor physical therapy.

• Erectile Dysfunction, Painful Erections, Painful Ejaculation

Pelvic floor physical therapy is often thought of just for women. In fact- we see a great deal of men as well! Erectile dysfunction, pain with erections, and painful ejaculation are all common symptoms we treat in men. In fact, pelvic floor physical therapy has been shown to be more effective in treating erectile dysfunction than cialis or viagra! 

• Post Surgical Prostatectomy

It is very common after a prostatectomy for men to experience erectile dysfunction and urinary incontinence. Most men that we see after a prostatectomy are coming in because they don’t want to wear a diaper to the gym. If you suffer from erectile dysfunction or urinary incontinence after a prostatectomy, pelvic floor physical therapy can help.

How do I know if I should get pelvic floor physical therapy:

If you’ve ever said or thought the following (things we hear all the time!)….you should get pelvic floor physical therapy.

“I pee my pants when I laugh, cough, and sneeze!”

“I want to do whatever I can to have the best birth outcomes.”

“I feel a lot of heaviness in my pelvis, especially after sitting and standing for long periods.”

“My menstrual cramps are terrible”

“I'm leaking while I'm pregnant and after birth.”

“I want to get back to lifting and running after birth, but I'm not sure how to safely do that.”

“I have pain with intercourse/intimacy.”

“I skip heavy lifting days because I'm afraid I'm going to pee.”

“I can't go to the trampoline park with my kids.”

“I used to run, but I feel a lot of heaviness and pain in my pelvis when I try to run now.”

“I had a baby years ago and I just haven't felt normal since.”

“I have to pee every time I hear water running!”

“I don't leave the house without a pad or liner (or diaper!).”

“How can I rehab from a c-section safely?”

“How can I exercise safely while I'm pregnant?”

“I really want to strengthen the correct way after I give birth.”

“I need to make sure everything is okay "down there".

“When will my mommy tummy go away?”

“I can’t connect to my core since I had my baby.”

Athletic Performance and Pelvic Floor Health 

When we delve into the realm of performance optimization, an often overlooked but crucial aspect is the well-being of the pelvic floor.

When discussing core stability, oftentimes people think of bearing down and engaging the 6 pack abdominal muscles. It’s a bit more complex than this. 

Imagine your abdomen as a sealed soda can- your core canister. Just as crushing the sides of the can increases the pressure within, the contraction of these 'core' muscles generates pressure inside the abdomen, contributing significantly to core stability. 

However, we cannot forget that the can has a top and a bottom too. The top part is the diaphragm, while the bottom represents the pelvic floor. These often-forgotten parts play a massive role in managing the pressure within the abdomen, AKA core stability.

Think of your body as a tree – your trunk is the core. If the trunk isn't strong, the branches (your arms and legs) have to work extra hard. It's like having strong branches on a wobbly trunk – not a good mix.

Sometimes, people hold their breath to make their core stronger. This does help, but it has downsides. First, it puts too much pressure on your belly and pelvic floor, which isn't great. The pressure generated needs an outlet – as a result, the pelvic floor are subjected to excessive strain. Second, holding your breath means you're not breathing properly, which affects how well you perform. When breathing is compromised, so is overall performance.

Beyond performance, the state of our pelvic floor health also hinges on these principles. Less than optimal breathing patterns and poor pressure management can lead to pelvic floor dysfunction. 

This manifests in various ways – from leakage issues (urinary, fecal, or gas) to discomfort in areas such as the pelvic region, rectum, hips, and lower back. Sexual discomfort and difficulties with bodily functions may also arise. Yes, these things spill over from your exercise to the rest of your life!

If the goal is to enhance athletic performance, a holistic approach is paramount. Ignoring the pelvic floor and core functionality would be akin to leaving a crucial puzzle piece out of the picture. By addressing these aspects, you not only boost your physical performance but also promote pelvic floor health and overall well-being.

MOVE Athletics’ approach to pelvic health:

It is very common for clients to come to our clinic having been told before that whatever they are experiencing is “normal” and they will “just have to live with it”.

Just because something is common, does not make it normal. Just because that person does not know how to help you, does not mean you have to “just live with it”. 

“Just wear a pad”, “everyone deals with this”, “just get used to it” is all terrible advice. 

You don’t have to live with it, get used to it, or accept it. If other people around you are okay settling for a life like that, it does not mean that you have to as well. 

If you’re looking for an actual long-term solution, we’re your people, even if you feel you’ve tried everything. That’s our specialty!  

We strongly believe that spending your entire session on the table is not the answer. You need to be prepared for life and whatever it throws at you. This means we need to get you off the table as soon as possible so you can have confidence moving, lifting heavy, running, jumping, and doing whatever else you want without worrying about your pelvic floor.

MOVE Client testimonial:

"Working with MOVE has changed my life. I have been seeing them for pelvic floor physical therapy for the past 3 months. I have had very limiting fecal incontinence and pelvic pain for the last 5 years. I have been to many other medical professionals, had surgeries, been told I was put together poorly on the inside, and worked with many other PTs over the years.

 Other PTs gave me exercises that helped, and didn’t seem geared towards my goals. I was told I needed to limit my physical movements and life to avoid pain and symptoms. In 3 months, MOVE had me pain and symptom free, lifting weights, running, and living my life without worrying about my pelvic floor symptoms. I cannot recommend them highly enough and can’t thank them enough for changing my life when I had given up hope."

Inside a MOVE Athletics Pelvic Health Physical Therapy Evaluation:

Wondering what goes on in a pelvic health physical therapy evaluation at MOVE? 

At MOVE, our approach involves in-depth care with 60-minute one-on-one sessions.

During your first visit, your pelvic floor physical therapist will review your health history and experiences. 

Unlike most providers, we're dedicated to understanding you as a human and your complete story; every piece of information matters.

Moving forward, an external evaluation takes place, where we examine your back, hips, abdomen, and pelvis. This assessment covers areas such as mobility, stability, and strength. 

Depending on your individual needs and comfort level, an internal examination might be recommended to explore the same aspects within the pelvic floor muscles.

An internal examination is never mandatory. 

Your comfort and consent are of the highest importance. Your pelvic floor therapist will consistently seek your consent and respect your right to withdraw consent at any point.

The internal examination, if chosen, involves your therapist gently assessing pelvic floor muscle tension, weakness, and coordination internally during various movements and activities.

This will NEVER involve the use of a speculum.

While the internal examination is considered the gold standard for understanding and treating pelvic floor muscles, it's important to know that it's not a mandatory procedure. If you decide against it, treatment will be based on the external assessment.

We cannot emphasize enough that the pelvic floor examination process at MOVE is NOT the same as a gynecological visit, it’s not even slightly similar.

Pelvic health follow-up sessions at MOVE are designed much like our orthopedic sessions, where we consider your entire body during examinations and treatments, and are heavily focused on movement geared towards your goals.

One of the standout aspects of our approach is our commitment to helping you regain your desired activities, all of our pelvic health physical therapists are athletes themselves, and coaches as well.

For instance, if your goal is to resume jump roping without leaks, our sessions will focus on that. If CrossFit is the goal, we will focus on that. At MOVE, pelvic floor physical therapy encompasses a comprehensive approach that extends far beyond just pelvic floor muscles.

You might be wondering about exercises like Kegels and kegel weights. While Kegels are well known, they're not the sole focus of pelvic floor physical therapy. Actually, many times they are the WRONG answer. That’s why you know so many people who do them without improvement.

 At MOVE, we offer a range of exercises tailored to your unique needs.

So, when seeking to enhance your pelvic floor health, remember that MOVE provides a personalized, comprehensive approach that goes above and beyond the ordinary.

How to get started 

Looking to get started with pelvic floor physical therapy? The first step is to hop on a totally free 15 minute consultation call with our team. We dedicate this time to focus on you 100%.

The purpose of this call is to make sure we can help before you come in and answer any questions you may have. We will ask questions to find out what’s going on, how it’s affecting you, what you may have tried in the past, what your goals are.

All you have to do is click this link, select a time, and submit your contact info. 

So what are you waiting for?

Take the first step to changing the rest of your life.