Asking for a Friend: Pelvic Floor Physical Therapists Answer Your Questions About General Pelvic Health

Alexandra Guevara: “In this model, you can see the pelvic floor. We really teach patients that those muscles, they help to support all those internal organs. They span from the front of that pubic bone or that pelvis, and they come all the way to the back towards that tailbone. These muscles are really important for bowel, bladder, and sexual function as well as around that time that we’re giving birth or delivering. What pelvic floor physical therapists or pelvic health physical therapists can help to do is to really evaluate what’s happening at your pelvic floor so we can really help to manage those symptoms.”

Charley Peterson: “Bladder prolapse is when the bladder shifts down into a lower position and it leans back against the front wall of the vagina. This can be really mild or more severe. Some people have no symptoms and other people might have symptoms such as a heavy pressure feeling, a bulging, or falling out feeling, or they might notice more urine leakage or even difficulty urinating.”

“The pelvic floor muscles, they act like a little hammock to help support the organs from below. We know that pelvic floor training can help reduce the symptoms of pelvic organ prolapse and may help improve the position of the organs. We don’t have enough research yet to know for sure if pelvic floor muscle training can prevent prolapse. The risk factors for prolapse include things like parity, which is a pregnancy that reaches at least 20 weeks, vaginal delivery, obesity, connective tissue disorders, menopausal status, and chronic constipation. While it makes sense that improving your pelvic floor muscle strength and health is helpful for the support of the pelvic organs, we don’t really know if it’s enough to counteract some of these other risk factors for everybody.”

Alexandra Guevara: “The first step is really understanding a little bit more about your pelvic floor. Can you feel yourself contracting that pelvic floor or lifting up and in? Can you feel yourself relaxing that pelvic floor? Oftentimes, we have people that come in and see us and they really think that they’re doing something correctly when, in fact, they’re doing something a little bit different than what should be done. Everyone’s pelvic floor is a little bit different, so your exercise routine might be a little different than my exercise routine, and I think really understanding some of those motions of the pelvic floor can be really helpful.”

“If you’re really concerned about how to do those pelvic floor exercises at home, we are the ones that you can come and see and really get a specialized and tailored plan so that way you know that you are performing those exercises correctly at home.”

Charley Peterson: “Absolutely. That’s actually a pretty common reason that we see patients. The pelvic floor muscles are an often overlooked cause of issues with sex, and especially pain with sex, and pelvic floor or pelvic health physical therapy can be really effective at helping with pain with sex. It’s also important to talk to your medical doctor, too, because there are other things that can cause pain with sex that you want to make sure you’re ruling out.”

“I also think it’s really important to recognize that our emotions, our beliefs, our identities, and our relationships play a huge role in our sexuality. There are these amazing people called certified sex counselors and therapists who help people process and talk about these issues, and you can find one on the American Association of Sex Educators, Counselors and Therapists website at aasect.org. I definitely see patients where it’s a combination of approaches that helps them, so they might be seeing us for pelvic floor physical therapy, and they might be talking to their doctor, keeping them updated at the same time, and working with a counselor or therapist.”