By Molly Bachmann, DPT, PHRC San Francisco
Suzy came to Pelvic Floor PT during her second pregnancy in hopes of addressing some recent heaviness she had felt in her vagina. She also complained of urinating every hour and waking up two to three times a night to urinate. She hoped to prepare her body for birth and postpartum as well.
As she had progressed throughout her pregnancy she had been told these things should be expected but she didn’t realize that some of these symptoms could go away completely, even though she had experienced them since the birth of her first child.
After our exam, we identified some tightness in her deep pelvic floor muscles, some weakness in her pelvic floor muscles and hip muscles, and decreased endurance.
We started with three simple things: timed voiding, looking into a pelvic wand, and three exercises.
I had Suzy set a timer for every 45 minutes. When the timer went off, I asked that she get up and go to the bathroom whether she felt the urge or not. I encouraged her to really try to avoid using the bathroom other than when the timer goes off.
Once she decided to purchase the pelvic wand, I advised her to bring it into the clinic and I would show her how to use it.
For the exercises, I prescribed supine Hip Adduction Isometric with Ball, Supine Bridge with Pelvic Floor Contraction and Supine 90/90 Overhead Dumbbell Raise. These were designed to improve the power of her pelvic floor contraction and coordination with other pelvic muscle groups.
Suzy returned four weeks later and reported that she had no leaking of urine and that the heaviness she had felt improved drastically. When we checked her pelvic floor, her strength had improved as well as the tightness in her pelvic floor.
That session we updated her timed voiding to every 90 minutes during waking hours and taught her how to use the pelvic wand on her own. When it was clear she knew how to use it safely, I asked her to use it three to four times a week for five to eight minutes at a time. Because her strength had improved, we changed her home exercises to Tall Kneeling Hip Hinge, Hooklying Eccentric Sit Up and Copenhagen Hip Adduction with Chair.
Suzy then returned three weeks later and was in the final stages of her pregnancy, just a couple of weeks from the baby’s due date. At this time, she had no leaking, her urinary frequency was better than it had been before pregnancy, she no longer woke up at night to urinate, and did not feel any heaviness. Because she had such success, we changed our focus to preparing her pelvic floor for birth.
We practiced multiple breathing styles to identify which ones gave her the most amount of pelvic floor relaxation and power from her abdomen. She did really well with a “fogging of the mirror,” “MMMM” sounds on exhale and “WWAAAHHHH” sounds on exhale. I asked that she practice these at home just two times a week in multiple positions so that it felt instinctual when she was in labor.
To prepare her pelvic girdle, we practiced a Hip External Rotation Stretch, Adductor rocks, Deep Squat with Pelvic Floor Relaxation, Half Kneel Lateral Lunge and 90-90 rotations hip rotations.
Two weeks later, I got an email from Suzy that she had had her baby and despite an unexpected induction, she had no pelvic floor pain and the birth was uncomplicated! She pushed so easily that the doctors were impressed and she would be in for a check up at the six week mark!
______________________________________________________________________________________________________________________________________
Are you unable to come see us in person in the Bay Area, Southern California or New England? We offer virtual physical therapy appointments too!
Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. For more information and to schedule, please visit our digital healthcare page.
Do you enjoy or blog and want more content from PHRC? Please head over to social media!
FAQ
What are pelvic floor muscles?
The pelvic floor muscles are a group of muscles that run from the coccyx to the pubic bone. They are part of the core, helping to support our entire body as well as providing support for the bowel, bladder and uterus. These muscles help us maintain bowel and bladder control and are involved in sexual pleasure and orgasm. The technical name of the pelvic floor muscles is the Levator Ani muscle group. The pudendal nerve, the levator ani nerve, and branches from the S2 – S4 nerve roots innervate the pelvic floor muscles. They are under voluntary and autonomic control, which is a unique feature only they possess compared to other muscle groups.
What is pelvic floor physical therapy?
Pelvic floor physical therapy is a specialized area of physical therapy. Currently, physical therapists need advanced post-graduate education to be able to help people with pelvic floor dysfunction because pelvic floor disorders are not yet being taught in standard physical therapy curricula. The Pelvic Health and Rehabilitation Center provides extensive training for our staff because we recognize the limitations of physical therapy education in this unique area.
What happens at pelvic floor therapy?
During an evaluation for pelvic floor dysfunction the physical therapist will take a detailed history. Following the history the physical therapist will leave the room to allow the patient to change and drape themselves. The physical therapist will return to the room and using gloved hands will perform an external and internal manual assessment of the pelvic floor and girdle muscles. The physical therapist will once again leave the room and allow the patient to dress. Following the manual examination there may also be an examination of strength, motor control, and overall biomechanics and neuromuscular control. The physical therapist will then communicate the findings to the patient and together with their patient they establish an assessment, short term and long term goals and a treatment plan. Typically people with pelvic floor dysfunction are seen one time per week for one hour for varying amounts of time based on the severity and chronicity of the disease. A home exercise program will be established and the physical therapist will help coordinate other providers on the treatment team. Typically patients are seen for 3 months to a year.
What is pudendal neuralgia and how is it treated?
Pudendal Neuralgia is a clinical diagnosis that means pain in the sensory distribution of the pudendal nerve. The pudendal nerve is a mixed nerve that exits the S2 – S4 sacral nerve roots, we have a right and left pudendal nerve and each side has three main trunks: the dorsal branch, the perineal branch, and the inferior rectal branch. The branches supply sensation to the clitoris/penis, labia/scrotum, perineum, anus, the distal ⅓ of the urethra and rectum, and the vulva and vestibule. The nerve branches also control the pelvic floor muscles. The pudendal nerve follows a tortuous path through the pelvic floor and girdle, leaving it vulnerable to compression and tension injuries at various points along its path.
Pudendal Neuralgia occurs when the nerve is unable to slide, glide and move normally and as a result, people experience pain in some or all of the above-mentioned areas. Pelvic floor physical therapy plays a crucial role in identifying the mechanical impairments that are affecting the nerve. The physical therapy treatment plan is designed to restore normal neural function. Patients with pudendal neuralgia require pelvic floor physical therapy and may also benefit from medical management that includes pharmaceuticals and procedures such as pudendal nerve blocks or botox injections.
What is interstitial cystitis and how is it treated?
Interstitial Cystitis is a clinical diagnosis characterized by irritative bladder symptoms such as urinary urgency, frequency, and hesitancy in the absence of infection. Research has shown the majority of patients who meet the clinical definition have pelvic floor dysfunction and myalgia. Therefore, the American Urologic Association recommends pelvic floor physical therapy as first-line treatment for Interstitial Cystitis. Patients will benefit from pelvic floor physical therapy and may also benefit from pharmacologic management or medical procedures such as bladder instillations.
Who is the Pelvic Health and Rehabilitation Team?
The Pelvic Health and Rehabilitation Center was founded by Elizabeth Akincilar and Stephanie Prendergast in 2006, they have been treating people with pelvic floor disorders since 2001. They were trained and mentored by a medical doctor and quickly became experts in treating pelvic floor disorders. They began creating courses and sharing their knowledge around the world. They expanded to 11 locations in the United States and developed a residency style training program for their employees with ongoing weekly mentoring. The physical therapists who work at PHRC have undergone more training than the majority of pelvic floor physical therapists and as a result offer efficient and high quality care.
How many years of experience do we have?
Stephanie and Liz have 24 years of experience and help each and every team member become an expert in the field through their training and mentoring program.
Why PHRC versus anyone else?
PHRC is unique because of the specific focus on pelvic floor disorders and the leadership at our company. We are constantly lecturing, teaching, and staying ahead of the curve with our connections to medical experts and emerging experts. As a result, we are able to efficiently and effectively help our patients restore their pelvic health.
Do we treat men for pelvic floor therapy?
The Pelvic Health and Rehabilitation Center is unique in that the Cofounders have always treated people of all genders and therefore have trained the team members and staff the same way. Many pelvic floor physical therapists focus solely on people with vulvas, this is not the case here.
Do I need pelvic floor therapy forever?
The majority of people with pelvic floor dysfunction will undergo pelvic floor physical therapy for a set amount of time based on their goals. Every 6 -8 weeks goals will be re-established based on the physical improvements and remaining physical impairments. Most patients will achieve their goals in 3 – 6 months. If there are complicating medical or untreated comorbidities some patients will be in therapy longer.