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Spotlight on Local Pelvic Floor PT: Katie Moise

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What is the pelvic floor and how can pelvic floor physical therapy help you?


We all have a pelvis, but many of us do not know exactly where our pelvic floor muscles are or what they do. Did you know both men and women have a pelvic floor, and most of the muscles are exactly the same!



Anatomy of the Pelvic Floor


Your pelvis is made up of two bones that are joined together in the back by your sacrum (the lowest part of your spine). These bones are held together by ligaments, tendons, muscles and connective tissue. When the bones join together, they form a bowl. At the base of this bowl are your pelvic floor muscles. You can think of them as forming a hammock that runs from the front (your pubic bone) to the back (your tailbone). Your pelvic floor consists of three layers of muscles and they play an important role in bladder, bowel and sexual dysfunction. Let’s chat about the different jobs of the pelvic floor.



Role of the Pelvic Floor


Bladder function:


These muscles allow urine to be stored in the bladder and keep it inside your bladder until you are ready to urinate. They also have to relax fully to release around the urethra to allow complete emptying of your bladder. They work to make sure you aren’t peeing your pants before you get to the bathroom or when you are chasing after your kids on the playground.



Bowel function:


The pelvic floor muscles also keep your poop (and gas) inside of your rectum until you are ready to have a bowel movement. These muscles then relax to allow poop to exit your body without any straining.



Sexual function:



The pelvic floor plays a role in both arousal and pleasure. The muscles need to relax around the opening of the vagina to allow for penetration. They also quickly contract and relax during orgasm.



Support + Stability:



This group of muscles are responsible for holding your internal organs (bladder, rectum and uterus in females) inside of your body. Therefore, they play an important role in supporting a growing baby (and uterus) when you are pregnant. Lastly, they play a role in stability, giving your spine support to do all the activities you love.



What happens when these muscles aren’t working optimally?



Sometimes, your muscles can be too tight, or overactive. This may lead to pelvic pain, constipation, pain with sex, tailbone pain or a slow urinary stream. Other times, the pelvic floor muscles may be weak which may lead to urinary leakage, difficulty holding back gas or pressure/heaviness in your pelvis. It is helpful to know whether your muscles are too weak or too tight as not everyone needs to be doing kegels!



This is where seeing a pelvic floor physical therapist can be super helpful. If you are experiencing any urinary urgency/frequency, stress incontinence, pelvic pain, constipation or pain with sex, you should reach out to a local pelvic PT to see how they can help. You can use this directory to find a pelvic PT near you. I’d also be happy to assist you if you are having trouble finding anyone in your hometown.


Now that you know where your pelvic floor muscles are and how they function, let’s chat a little more about what to expect with pelvic floor physical therapy.




Getting To Know You


The first part of a pelvic floor physical therapy appointment involves sitting down with your PT and discussing your symptoms and goals. I typically spend a large majority of the first visit getting to know my patients. It is super important to have a good understanding of your history. It does not have to be intimidating and all of my sessions are done in a private treatment room. This allows you to share what brings you in, what some of your concerns are and what your goals are for your treatment.


Other questions might include:


How often do you pee?


How often do you poop?


Do you have any straining when you pee or poop?


Are you noticing any leakage of urine- with activity (laughing, coughing, sneezing) or when you walk to the bathroom, or really any other time of day


Are you sexually active? Do you have pain?





Looking at the Big Picture


After getting to know you and some of your concerns, the next part of our session includes seeing how your body moves, assessing your strength and how your pelvic floor muscles function. Here are a few things I look at:



Watching you walk


Observing your standing posture


Looking at how you breathe


Checking your pelvic alignment


Assessing for tender spots in your abdominal wall


Looking at hip mobility and strength


Checking for tender spots in your hip muscles


If you are postpartum, checking for diastasis recti (DRA) or separation of abdominal wall


Performing external and/or internal assessment of pelvic floor muscles for tenderness, strength and endurance



The pelvic floor is just one part of your body and it is important to see how this group of muscles functions with the rest of your body.





So, what is an internal assessment of your pelvic floor?


Some people come into my office dreading an internal assessment. They’ve either read something online or fear they will be in stirrups. Many times, they assume the experience will be similar to ones at their doctor’s office.


First, this part of the assessment is only performed with your consent and you should feel 100% comfortable. It is by no means required and a lot can be done without this part of the exam. It does give me (as the PT) a lot of good information. I will use my index finger, lots of lubricant and insert 1 finger into your vagina. It does not last long, but does give me an idea about how well your pelvic floor muscles are functioning.


What’s next?


After gathering all of this information, it’s time to put the pieces of the puzzle together! I spend a lot of time educating my patients. Often, the topics we cover are things most people don’t talk about. No one tells you how to breathe properly while pooping or what types of food/drinks may be irritating your bladder. After the education, we will then discuss next steps. Some people need some breathing, relaxation and stretches while others may need strengthening. Each plan is specific to you and your needs!


We want to be a resource to you and answer all of your pelvic floor related questions. You can email us at info@atlpelvichealth.com or schedule a discovery visit to learn more.



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