Should you see a pelvic therapist?

As you get older—and especially if you’ve gone through childbirth—your pelvic floor may get weaker; something as simple as a laugh or a sneeze can lead to a temporary loss of bladder control. While solutions can range from wearing daily pantyliners to medical and surgical treatments, you may also want to consider pelvic floor therapy.

Pelvic floor therapy has grown in popularity in the last few years. It’s a way to treat various forms of pelvic floor conditions that can lead to incontinence and other issues like pain with sex or constipation. Deborah Weber, MPT, a Honolulu-based physical therapist, sheds some light on this form of therapy.

Who might benefit from pelvic floor therapy

Pelvic floor therapy is a form of physical therapy that focuses on the pelvic floor, a group of muscles that act like a sling to support organs such as the bladder, uterus (in those with female reproductive organs) and bowel. These muscles help control the flow of urine and bowel movements, as well as sexual function. Although most pelvic floor therapy is prescribed for those with female reproductive organs, people who have undergone prostrate surgery or have conditions that can weaken the pelvic floor (such as diabetes) may also benefit from it.

Weakness of the pelvic floor, which can be caused by childbirth, hysterectomy, straining from chronic constipation or coughing, overweight, aging, or even genetics, can lead to a number of issues. These include pelvic pain, urinary or bowel incontinence or constipation, and pain with sexual intercourse. A healthcare provider (HCP) can evaluate your symptoms prior to your seeking pelvic floor therapy to make sure they don’t indicate other conditions, such as fibroids or bladder issues. Once these are ruled out, your HCP may diagnose pelvic floor weakness or other conditions and suggest pelvic floor therapy. Some physicians may work directly with patients on pelvic floor strengthening exercises instead of referring them to a specialist.

One serious condition that can be caused by pelvic floor weakness is pelvic organ prolapse. If the pelvic floor is unable to support the reproductive organs, they can drop down. This can cause urine leakage or issues emptying the bladder completely, trouble having bowel movements and lower back pain. In some cases, the pelvic organs may bulge out from the vagina or anus. This can be treated not only with pelvic floor therapy, but also with removable devices that can support the organs or surgery to repair the pelvic floor.

What to expect during treatment

In Weber’s practice, pelvic floor therapy begins by talking to patients about their current medical conditions and health history. She also provides education on specific conditions that a patient may be concerned about, such as constipation.

Then, she will perform a manual pelvic examination to assess muscle tone. (Be sure to check your therapist’s credentials before scheduling an appointment—only those specifically trained to give pelvic exams, through an organization such as the American Physical Therapy Association (APTA) or Herman & Wallace Pelvic Rehabilitation Institute, should perform these physical exams). This step can help the therapist assess the issue and determine the best course of treatment, but remember, you always have the right to refuse a pelvic exam if you’re not comfortable with it.

Weber also uses electromyography (EMG) during her assessments to check muscular function. “EMG reads what your pelvic floor muscles are doing, just like an EKG reads how your heart is working,” she explains. Not all physical therapists will use EMG, but manual physical examinations and manipulation are common in pelvic floor therapy.

The timetable for treatment varies for each patient. Typically, Weber will see patients for 8 to 12 sessions, assigning homework with specific exercises and helpful videos to watch between appointments.

“Mostly, what we do in pelvic therapy is create body awareness, teaching the person how to find and access these places in the body, whether they’re just trying to empty their bowels, control their urine or have a baby,” says Weber.

To Kegel, or not to Kegel?

Kegels, or pelvic strengthening exercises, are often touted as the solution for all pelvic issues. But the truth is that not everyone should do Kegels, Weber cautions.

“Some people, for whatever reason physiologically, have very high muscle tone in their pelvic floor,” she explains. “It starts to mimic things, like having a urinary tract infection [UTI]. So, they'll experience symptoms similar to UTIs like frequent urination, burning with urination and pain. We try to find and correct the source of these overworked muscles to decrease symptoms.”

Kegels may not help people with high pelvic muscle tone, though pelvic relaxation techniques might. Unless these people are specifically evaluated for their muscular composition, the muscle tone issue is often missed. This can lead to unnecessary treatments for UTIs or other conditions that the person doesn’t actually have.

“If the person does not have a history of pain with sex, doesn't have a history of bladder retention or chronic constipation, doesn't have a history of pain with gynecological exams, or things like pain with inserting a tampon—if those things are clear, then they will probably be safe doing Kegels,” Weber explains.

She points out, however, that many people don’t do these exercises properly. As a result, they’re ineffective. Weber says she has seen patients who say they’ve been doing Kegels for years and have experienced no improvement in their symptoms. “A lot of times, I’ll get them in here, and they’re doing absolutely the wrong technique,” she notes.

The ‘right way’ to do Kegels

For people with female reproductive organs, Kegel exercises activate three regions in the pelvic floor that can be considered front, middle and back muscles.

The front muscles control the flow of urine. You could isolate these muscles by imagining that you are stopping and re-starting urination midstream. (It’s important to avoid actually doing this while urinating since it can cause urinary issues.)

The middle muscles make up the vagina. One way to identify these muscles is to insert a clean finger into the vagina. Then, try to squeeze your finger with your vaginal muscles.

The sphincter muscles are the back muscles. Imagine the feeling of holding in gas—that’s the feeling of contracting the sphincter. Note that you do not need to contract your gluteal (buttocks), abdominal or inner thigh muscles to activate rear pelvic muscles.

Kegel exercises will work on contracting these three muscle groups to strengthen them over time. Exactly how you should perform these exercises and how often will depend on your specific health concerns. A pelvic therapist can help identify which of the three muscle groups you should work on and create a routine designed to meet your specific needs.

Yoni eggs

There has been a lot of buzz about yoni eggs—egg-shaped objects made of semiprecious stone and placed in the vagina. Some celebrity web sites claim yoni eggs can enhance sexual performance and pleasure and help strengthen and tighten pelvic floor muscles in a way similar to pelvic floor therapy. However, experts warn that not only is there no research to support these claims, but the eggs could also be dangerous to use, potentially increasing the risk for infections, toxic shock syndrome, and damage to pelvic floor muscles.

“I feel like it's the same as telling somebody just walk around all day with a five-pound weight in your hand, and you're going to have awesome biceps,” says Weber of the egg’s dubious health claims.

When it comes to strengthening the pelvic muscles, there is no magic egg-like cure. It takes regular exercise and therapy to help them get back into shape.