DO I need pelvic floor Physical therapy?

What is the pelvic floor?

The pelvic floor is a system of muscles, ligaments and connective tissue inside of your pelvis that help you to urinate, defecate and have sexual intercourse.  They also provide postural support for your pelvic organs, low back and hips and coordinate with breathing. 

What is Pelvic Floor Physical Therapy?

Pelvic floor PT restores normal, pain free function to the pelvic floor through the use of manual techniques, exercise, patient education, and other tools such as dry needling.   I practice a movement-based, hands-on, whole body approach to treating pelvic pain, urinary, bowel, and sexual dysfunction and pregnancy and postpartum care.   Or, as normal people say, issues with pooping, peeing, pregnancy and sex.  People of all ages can have pelvic floor dysfunction with or without a history of pregnancy.   Additionally, people of any gender can experience pelvic floor dysfunction, but I currently only treat women or people with female anatomy with pelvic floor dysfunction.

What can Pelvic Floor Physical Therapy treat?

If you have difficulty with any of the following areas, pelvic floor PT can help!  You don’t have to “just deal” with these problems, and I will do my best to help restore your pelvic floor to its optimal function. 

Pooping:

• frequent constipation or diarrhea

• straining or pain with bowel movements

• difficulty emptying bowels fully

• leaking or staining stool

Peeing:

• leaking pee with a strong urge on the way to the bathroom or with coughing, sneezing, laughing or exercise

• pain during or after peeing

• peeing more often than every two hours or multiple times at night

• difficulty starting your stream of urine

• difficulty emptying your bladder fully

Sex:

• pain with initial or deep penetration

• pain with or inability to orgasm

• pain with external stimulation

• pain after sex

• unwanted sensations of genital arousal without sexual desire that cause distress

Pregnancy and Postpartum:

• any of the above issues with pooping, peeing or sex during pregnancy

• low back, hip, tailbone or pubic bone pain during pregnancy

• perineal pain postpartum

• c-section pain postpartum

• diastasis recti (separation of abdominals) postpartum

Other issues:

• sensation of heaviness or like something is falling out of the vagina

• tailbone pain

• rectal pain

• low back pain or hip pain that doesn’t get better with orthopedic physical therapy

• pain with pelvic exams or tampon insertion

• severe pain before, during or after your period

• abdominal pain post hysterectomy or endometriosis surgery

What should you expect from your first Pelvic Floor Physical Therapy appointment?

Symptom Assessment

In order to understand how best to treat your condition and to develop an individualized plan for you, I will begin by hearing your story to get an overall understanding of your pelvic floor function.  This will include questions about your menstrual cycle, water and fiber intake, any pregnancies and deliveries you’ve had, how your bladder and bowels function, your current tolerance for sexual activity and your goals for PT.

Physical exam

The exam is an assessment of the mobility and strength of your low back, hip and pelvic joints and muscles, an evaluation of your functional movements and breathing mechanics, and an external and an internal pelvic floor examination. 

The external pelvic floor examination is performed to see how different muscles of the pelvic floor function voluntarily and involuntarily.  I will ask you to perform exercises or motions (like a kegel, coughing and bearing down) to see if you can fully relax and contract the pelvic floor muscles correctly. I will also identify any painful muscles or tissues of the vulva.

With your permission, I will perform an internal pelvic floor muscle examination, similar to an exam by your gynecologist but without stirrups and speculums.  The muscles of the pelvic floor should be resting with a little tension in order to keep sphincters closed to keep pee and poop from coming out when you don’t want them to.  Too much or too little resting tension of these muscles can cause dysfunction.   The internal exam provides essential information on resting tone, muscle function, mobility and tenderness of your pelvic floor muscles in order to determine the best exercises and techniques for you.  The exam will be explained to you step by step and is only performed to your comfort and pain level.    The internal exam does not have to be performed on the first visit if you’re not ready.   It can be performed if you are on your period as long as you feel comfortable.

What Is Functional Dry Needling?

Functional dry needling is a technique performed by a physical therapist with special training where a thin, flexible needle is inserted into a muscle. It can treat a tight muscle with a painful, taut band, or treat a weak muscle that isn’t activating as it should. Think of it like a control-alt-delete for a muscle. It resets the muscle–brain connection, improving muscle activation and range of motion and decreasing pain and improving function.

Why is it called dry needling?

It’s called a “dry” needle because there is no reservoir inside the needle for medication or blood to travel through like there is in a hypodermic needle that is used for drawing blood or receiving a vaccination. Because of this, it’s much thinner in diameter and more comfortable than a hypodermic needle.

Is it the same as acupuncture?

Common misconception, but no, it is not! Functional dry needling and acupuncture look similar and use similar fine filament needles, and while they are both safe and effective ways to treat pain, they are different approaches performed by practitioners with different training. Acupuncture is based in Eastern medicine and treats energy flow, or Qi, while dry needling is based in Western medicine that directly treats the muscle and has been clinically proven to provide relief.

What does it feel like? Does it hurt?

Functional dry needling can be a little uncomfortable. The needle insertion can feel like a small, sharp prick, or it may not be felt at all. The discomfort occurs when the needle goes into a taut band of muscle. Usually, the patient reports an achy sensation that lasts a second or two and then dissipates significantly. Sometimes a “twitch response” can be felt as well, where the patient feels a “jumping” sensation in the muscle. Once the treatment is complete the muscle should immediately feel less tense and painful. Occasionally, it can also feel a little sore, like after a workout, for the remainder of the day. Most of the time clients report that the discomfort was less than expected and request dry needling in future sessions.

How quickly does it work?

Patients usually experience immediate relief with decreased pain to palpation, decreased muscle tightness, decreased pain during movement, and improved muscle activation.

Are there risks associated with dry needling?

The biggest risk is a pneumothorax, or a punctured lung. This is extremely rare and only applies if dry needling is being performed around the thorax, or rib cage area. This risk is minimized through proper training and extensive knowledge of anatomy. There are many muscles around the ribcage area that are safely dry needled regularly that provide a significant benefit.

Infection. This risk is again very small. The fine filament needles used are sterile, but they do break the skin. Dry needling should not be performed on someone with an active infection or within six weeks of a surgery without a physician’s consent.

Nerve injury and bruising. The anatomy of large vessels (arteries, veins and nerves) are similar from person to person and injury to these are avoided through proper training and knowledge of anatomy. Tiny, superficial capillaries vary from person to person and insertion of a needle close to these can cause a drop of blood to appear upon needle removal and later — a bruise.

Vasovagal response. This is a sudden drop in blood pressure and heart rate caused by a reaction to things like trauma, fear, or other emotional upset. A small percentage of people may feel lightheaded, sweaty or nauseous with dry needling due to a vasovagal response. This is not harmful and usually resolves within a few minutes.

Who should not receive dry needling?

Women in their first trimester of pregnancy, people who are immunocompromised (i.e. in active cancer treatment), people with an active infection, or anyone who has had surgery within the last 6 weeks. People on prescription blood thinners have an increased chance of bleeding or bruising at the site of needle insertion. Women in the second and third trimesters of pregnancy can receive dry needling with significant benefit, but not in muscles of the abdomen, lumbar spine or pelvic floor.

What is electrical stimulation? What does it feel like?

Electrical stimulation, or e-stim, is an enhancement to the dry needling technique that involves sending a mild current through a muscle to override pain signals, activate a muscle, or improve blood flow. Many people are familiar with electrical stimulation used in a TENS unit used for back pain. A lot of muscles that can be dry needled can also be dry needled with e-stim to enhance the benefits of dry needling. E-stim can feel a little strange, but should not be painful, and actually should reduce soreness! First, you will feel a slight tapping sensation like a heartbeat in the muscle being dry needled, and then you may feel the muscle start to “jump” as it contracts. E-stim is not for people with a cardiac pacemaker, implanted electrical devices, or over cancerous areas.