Therapist

Uw health pelvic floor physical therapy

When the pelvic floor is working the way it should, it gently supports the openings of the bladder, vagina, and rectum all the time, relaxing when we want to empty the bladder or rectum and holding more tightly when we are exercising, laughing or sneezing. Pelvic floor dysfunction happens when the pelvic floor stops working the way it should.

The pelvic floor can become weakened with age, childbirth, or chronic coughing or straining, and can lead to problems with bladder or bowel leakage, or vaginal bulging (also called pelvic organ prolapse).

The pelvic floor can also become too tense, causing symptoms of pain in the pelvis or vagina, or difficulty emptying the bladder or bowels.

Pelvic Floor Physical Therapy

You have been referred for pelvic floor physical therapy. The physical therapist you will work with specializes in the pelvic floor. Pelvic floor therapists are trained to be sensitive to the personal nature of these topics and this part of your body. 

Conditions Treated by a Pelvic Floor Therapist Include:

  • Bladder urgency (sudden need to use the bathroom)

  • Bladder frequency (using the bathroom often) and unplanned loss of urine

  • Unplanned loss of stool or constipation (straining or infrequent bowel movements)

  • Pelvic organ prolapse (dropping or bulging of the bladder, uterus, rectum or other organs)

  • Pelvic pain, including pain with intercourse

  • Pregnancy & postpartum issues

  • After pelvic surgery or pelvic radiation

What are my pelvic floor muscles?

In women, the pelvic floor is made up of muscles, ligaments, tissues and nerves. They support the bladder, uterus, vagina and rectum. The pelvic floor assists in bladder and bowel control. It aids in sexual performance (orgasm) and gives stability to the pelvis. 

What to expect at the first appointment:

The first appointment will start by talking with the therapist about your symptoms. You will be asked about your bladder, bowel function, health history and lifestyle. 

Exam

The therapist will perform an exam of your pelvic muscles. This is usually done internally (inside the vagina). They will gently feel the different pelvic muscles with a gloved finger. This is done to check for any pain or muscle tightness. They will also check how well you can squeeze and relax these muscles. This exam may also include biofeedback. This is where a computer is used to see how well you can tighten and relax your muscles. Together, you and your therapist will decide which exam is best for you. The therapist may also examine your back and hip motion, muscle strength, posture and balance. These areas are linked to your pelvis and can relate to your symptoms.

Treatment Plan

Your therapist will come up with a treatment plan based on exam results. The plan may include:

  • A home exercise program adapted to your specific needs. 

  • Hands on therapy to your spine, hips and/or pelvic floor muscles in the clinic. 

  • Educational tools which may include biofeedback to increase your awareness and function of the pelvic muscles. 

Your therapist will work with you to set goals for treatment. They will work with your doctor if any issues or symptoms remain.

UW Health orthopedic physical therapists have advanced training and expertise in working with patients who have pelvic floor disorders.

What is the pelvic floor?

The pelvic floor is a bowl-shaped part of the body consisting of muscles and other non-muscular soft tissues located in the lower pelvis. It supports the abdominal organs, facilitates urinary and bowel continence and aids in sexual satisfaction.

Physical therapy and the pelvic floor

Through the normal movement and stresses associated with daily living, the pelvic floor can weaken and become lax. It is also an area that can carry increased tension and stress. When the pelvic floor weakens or carries undue stress, individuals may experience urinary or bowel urgency, incontinence, constipation and pelvic pain or pain with intercourse.

Physical therapy can often break into those dysfunctional cycles with education, behavior modification, modalities and exercises to facilitate normal coordination of pelvic floor muscles.

Our evaluation process

An initial evaluation usually includes an extensive history interview, examination of the spine and lower extremities, biofeedback assessment of the pelvic floor muscles and abdominal muscles, an internal pelvic floor assessment, education and initiation of a home program of exercises.

The parking program at UW Medical Center – Northwest was introduced to make parking both faster and more accessible to our patients and visitors. The program helps ensure patients and visitors will find parking on campus that is convenient to their hospital destination.

Parking kiosks at the main entrance make it easy to ask for directions and provide an additional level of security at the hospital.

Visitor and patient parking on the UW Medical Center – Northwest campuses is inexpensive. There is no charge for visitors who drive on campus to drop off or pick up family and friends (a grace period of 30 minutes or less is allowed). For those who are on campus for scheduled appointments or who will be visiting for longer periods of time, the rates below apply.

Some physician offices and clinics provide validation at no charge. Please check with your physician or clinic directly before arriving on campus to see if they validate parking. The following are the current rates for parking on the main UW Medical Center – Northwest campus and the Northwest Outpatient Medical Center.

Length of Stay  Rate 0 to 30 Minutes  FREE 30 to 60 Minutes $4 1 to 2 Hours $6 2-4 Hours $8 Over 4 hours $10 All-Day Pass  $10 (includes in-and-out privileges) Weekday Pass  $32 (includes in-and-out privileges) Weekends  FREE

These rates are effective 6:00 a.m. to 10:30 p.m. on weekdays on the main hospital campus and from 6 a.m. to 7 p.m. at the Northwest Outpatient Medical Center. Weekends are free on both campuses.

Pelvic floor muscles can sometimes become weak, overworked or stiff: resulting in urinary, bowel, and sexual difficulties. It can affect all genders at any time throughout their life span.

The specially trained physical therapists at UW Medicine recognize how conditions of the pelvis can affect your everyday life. We can address these conditions by helping patients learn about their body and address tissues that are restricted or need more support as well as improve how you move throughout the day. We conduct sessions in a private environment where patients learn to regain muscular control, decrease pain and restore their active lifestyles.

Our Pelvic Health Physical Therapy providers help patients with the following diagnoses, among others: Pelvic pain, dyspareunia, vaginismus/anismus, pudendal neuralgia, vulvodynia, vulvar vestibulitis, interstitial cystitis, Endometriosis, urinary incontinence, Fecal incontinence, Constipation, Pelvic Organ Prolapse, Pregnancy/post partum care, Gender affirming care.

Treatment includes:

Evaluation and education about the pelvic floor muscles and pelvic girdle as a whole
Exercise recommendations for self care and progression back to desired activities/fitness
Manual therapy
Treatment modalities including biofeedback
Recommendations for behavior modifications and activity re-training

A physician’s referral is required.

What is a female pelvic medicine and reconstructive surgeon?

A Female Pelvic Medicine and Reconstructive Surgeon is one who specializes in the care of women with pelvic floor disorders. The pelvic floor is a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that provides support for a woman’s internal organs, including the bowel, bladder, uterus, vagina and rectum.

Why should I see a Female Pelvic Medicine and Reconstructive Surgeon?

Female Pelvic Medicine and Reconstructive Surgeons are board-certified specialists with additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs. In addition to a four year residency in OB/GYN or a five year residency in urology, specialists have completed an additional two to three year fellowship that focuses on the surgical and non-surgical treatment of gynecologic and urologic problems.

What is the pelvic floor?

The pelvic floor is a bowl-shaped part of the body consisting of muscles and other non-muscular soft tissues located in the lower pelvis. It supports the abdominal organs, facilitates urinary and bowel continence and aids in sexual satisfaction.

What is pelvic organ prolapse?

A: Pelvic organ prolapse occurs when the pelvic floor muscles and ligaments are stretched or become too weak to hold organs in the correct position in the pelvis. As it progresses, women can feel bulging tissue protruding through the opening of the vagina.

What are the symptoms of pelvic organ prolapse?

Symptoms of pelvic organ prolapse include:

  • Pressure and heaviness in the pelvic area

  • Bulging (feeling a lump in the vagina)

  • Urinary problems (difficulty starting to urinate or slower stream of urine)

  • Bowel problems (chronic straining or pushing to have bowel movements)

What is urinary incontinence?

Urinary incontinence affects women of all ages, from young to elderly. It is the inability to control the flow of urine and involuntary urination. There are two types of urinary incontinence. Stress incontinence is common in younger women. It is characterized by urine leakage that happens with coughing, laughing, exercising or other vigorous activities. The other type of incontinence is urge incontinence, also known as overactive bladder. It is the sensation of strong urge to urinate all of a sudden. Often the ”urge” is so strong that individuals are not able to make it to the bathroom resulting in small leakage or complete urine loss.

What are the treatment options for urinary incontinence?

There are many treatment options available depending on the severity of incontinence. Treatment options include:

  • Pelvic floor physical therapy: This can include Kegel exercises to strengthen the pelvic floor and bladder muscles.

  • Biofeedback: This is the use of vaginal devices placed in the vagina temporarily to track and improve pelvic floor/bladder muscle strength.

  • Pessary fitting: A pessary is a device that is inserted into the vagina that can improve symptoms of prolapse and urinary incontinence.

  • Peri-urethral bulking agents

  • Urethral sling surgery

  • Posterior tibial nerve stimulation

  • Intravesical injection of Botox®

  • Sacral neuromodulation: This is used for urge incontinence that doesn’t respond to behavioral treatments or medications. This involves stimulation of the nerves to the bladder via an implanted device.

What is the benefit of pelvic floor physical therapy?

When the pelvic floor weakens or carries undue stress, individuals may experience urinary or bowel urgency, incontinence, constipation and pelvic pain or pain with intercourse. Physical therapy can break into those dysfunctional cycles. Education about normal anatomy and function, behavior modification therapy, as well as exercises all work to restore normal coordination of the pelvic floor muscles.

What is accidental bowel leakage?

Accidental bowel leakage is also known as fecal incontinence. It is the impaired ability to control gas or stool and can range in severity from mild difficulty with gas control to severe loss of control over liquid or formed stools on a daily basis. It is not an uncommon condition and it often coexists with urinary problems.

What are the treatment options for accidental bowel leakage?

There are medications and dietary changes that can help with accidental bowel leakage. Pelvic floor physical therapy is also an integral part of treatment. For people whose symptoms do not improve with these first line therapies, there are innovative approaches including nerve stimulation, bulking injections and surgery to repair muscle disruption.

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