Pelvic Health

What is Pelvic Health Physical Therapy?

Pelvic Health, also commonly referred to as pelvic floor and women’s health, refers to the muscles, ligaments, bones, nerves, and organs of the pelvis and the surrounding supportive tissues including your hips, thighs, abdominals, and back. All genders have a pelvic floor and therefore can benefit from pelvic health physical therapy. Dr. Cunkle and Dr. Madrigal have received specialized training to treat the pelvic region, including internal assessment and treatment as needed to optimize function.

A referral to a Pelvic Health Physical Therapist would be appropriate for anyone with:

  • Pelvic, Vaginal, Penile, Perineal, Groin, Hip, Abdominal, and/or Back pain
  • Urinary/Fecal Incontinence (all types of urinary incontinence)
  • Constipation/Diarrhea
  • Interstitial Cystitis
  • Pain associated with scars (episiotomy, Cesarean section, abdominal, and back surgeries)
  • Pain with intercourse (dyspareunia)
  • Pain with pelvic exams or use of tampon 
  • Musculoskeletal issues related or unrelated to bed rest
  • Diastasis recti (separation of the abdominal muscles)
  • Pelvic organ prolapse (uterine, bladder, and/or rectal prolapse)
  • Coccydynia
  • Pudendal Neuralgia
  • Post Hysterectomy 
  • Post-surgical prolapse repair
  • Post Prostatectomy 
  • Post cancer treatment in abdominal/back/pelvic region 
  • And more! Not sure if you are appropriate for pelvic health physical therapy? Contact us! 

How can Physical Therapy help pelvic floor conditions?

  • Patient education to improve understanding of condition and treatment process
  • Motor retraining to improve coordination 
  • Exercise for strength and endurance
  • Functional retraining (lifting, running, etc. without pain or incontinence)
  • Manual therapy including soft tissue and joint mobilization
  • Habit modification
  • Home exercise program that is tailored to patient’s needs 
  • Bracing/support
  • Biofeedback and/or electrical stimulation to retrain pelvic floor coordination
  • Modalities

What to expect at your first visit:

Your therapist will have a thorough discussion with you about your current symptoms and medical history, as well as about your goals with physical therapy. Following this discussion your physical therapist will assess your posture, mobility movement patterns, muscle strength, coordination, and endurance, and anything else your therapist deems appropriate. For pelvic conditions, an internal vaginal or rectal exam will likely be performed in order to assess the function of your pelvic floor. Our ability to perform internal exams and treatments separates us other physical therapists as it provides us valuable information and ability to fully treat you. To finish, the therapist will summarize her findings and educate patient on treatment plan. Lastly, your therapist will implement exercises and/or strategies for you to perform at home to begin reaching your goals. 

Pelvic pain

Pelvic pain refers to pain in the pelvis, groin, genital, and/or rectum area.  

Patients with pelvic pain may experience pain with:

  • Pelvic exams
  • Intercourse or other sexual activities
  • Tampon use
  • In the groin, buttock, low back, hip, sacroiliac joint, tailbone, abdomen, vagina, and/or rectum
  • Scars from surgery and/or birthing process
  • In the lower extremity with symptoms that include shooting, burning, or tingling
  • Straining to void on toilet

Or have difficulty with:

  • Normal activities such as sitting, standing, or walking
  • Recreational activities
  • Pressure distribution resulting in diastasis recti and/or prolapse
  • Incontinence
  • Urinary urgency, frequency, or retention
  • Chronic constipation or difficulty passing a bowel movement
  • Diarrhea
  • Arousal/intercourse

Incontinence

Incontinence is involuntary loss of urine or stool resulting from a decrease in coordination of the pelvic floor muscles. Incontinence can range from a drop to the soiling of underwear and can occur in all people, regardless of age and gender. Incontinence is classified as stress, urgency, or mixed incontinence, depending on the reason it occurs. Physical therapy interventions are successful in decreasing the symptoms of all types of incontinence by rehabilitating not only the pelvic floor muscles, but also addressing any deficiencies in the rest of the body, most specifically the hips, abdomen, and back. Pelvic health physical therapy also includes patient education on their condition and additional habit changes to assist the patient in achieving their goals to improve their quality of life. 

Causes of Incontinence include:

  • Poor coordination of the pelvic floor muscles
  • Poor strength and/or endurance of the pelvic floor muscles
  • Hyper- or hypotonicity of pelvic floor muscles
  • Food and liquid habits
  • Injury or trauma
  • Surgery in the abdomen, vagina, penis, rectum, and low back
  • Poor voiding habits
  • Overactive bladder
  • Decreased tissue density
  • A combination of factors

Pregnancy and Postpartum Care

Pregnant women and women who are postpartum may suffer from pain, incontinence, and/or prolapse (“heaviness”) due to the natural changes that occur in the body when pregnant and may not “return” or “reverse” postpartum. These conditions are common but are symptoms that do not need to be experienced long term. Physical therapy is successful in addressing these conditions and related symptoms. 

Frequently Asked Questions:

  • What do I wear?
    • Wear comfortable clothing you can move in. 
  • Do you treat men?
    • Yes! Men also have pelvic floors. The anatomy of a man’s pelvic floor is nearly identical to that of a woman’s pelvic floor. 
  • Do you treat those who identify as nonbinary, transgender, and those who are preparing for or have undergone gender confirmation surgery?
    • Absolutely! Here at Balance Physical Therapy we are allies to the LGBTQI community!
  • Does the physical therapist have to do internal exam?
    • An internal exam is not nearly as scary as it sounds. It provides the therapist with valuable information in regards to the function of your pelvic floor which allows her to provide the most tailored treatment to meet you and your body’s needs. With that being said, an internal exam is only performed with patient consent. Your therapist will be happy to answer your questions about the evaluation and treatment process during your appointment. 
  • Is pelvic health therapy just Kegels?
    • Great question! Definitely not! Kegels refer to the contraction of the pelvic floor muscles. This is often what women are told to perform if they are experiencing incontinence. However, usually the function of their muscles is not evaluated, so “Kegels” may not be the appropriate treatment option. Furthermore, men also have a pelvic floor and therefore can perform “Kegels.” While learning how to correctly perform a pelvic floor contraction may be a part of the treatment process, it is not the only component. Your therapist will evaluate you and treat you as a whole person, meaning she will address any related dysfunction that may be affecting your pelvic floor. Commonly, mobility and strength deficits in rib cage, back, abdomen hips and thighs contribute to pelvic pains and dysfunctions. 
  • I’m pregnant, can I still be evaluated/treated?
    • Women who are pregnant can be treated by a physical therapist. However, for internal evaluation and treatment, approval from your medical doctor is required.
  • I’m on my period, can I still be evaluated/treated?
    • Absolutely! Menstrual flow does not impede treatment. Often sessions focus on external factors that are contributing to pelvic floor dysfunctions.
  • Do I need to shave?
    • No additional grooming is required.

Meet Our Pelvic Health Physical Therapists

Dr. Byanca Madrigal PT, DPT

Dr. Renee Cunkle PT, DPT

Dr. Lexie Reinbolt PT, DPT, CSCS

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