Pelvic Floor Muscle Evaluation and Treatment

The Pelvic Floor MusclesThe pelvic floor consists of several layers of muscles that cover the bottom of the pelvic cavity. The muscles are located between the pubic bone and the tailbone. The pelvic floor muscles function to support the spine, pelvis and internal organs, control the bladder and bowel muscles, and enhance sexual appreciation.

Pelvic floor muscle exercises are known as Kegel exercises. Medical research indicates that after brief verbal or written instruction only 49% of women can correctly contract these muscles. An evaluation will assess your strength, muscle tone, control, and contraction ability, and includes instructions for proper exercise technique.

 

Evaluation consists of the following elements:

Subjective dialogue in which your medical history, pelvic floor function/dysfunction, current issues and possible precipitating factors are all reviewed.  During this time I will listen carefully to everything you are willing to share.  I’ve found that my patients are intuitive and often lead me to the problem which makes it easier to pinpoint and treat.

Physical therapy evaluation can also include analysis of pelvic joint alignment and movement activities that could cause your symptoms.

Evaluation Methods will consist of some or all of the following:

Biofeedback evaluation and training uses sensitive computerized equipment that enables you to see or hear how your muscles are responding to your instructions. The therapist and you can see and evaluate resting muscle activity as well as evaluate your muscle endurance and response to commands.

  • During the evaluation, sensors are used to monitor the muscle activity of your pelvic floor.
  • Sensors are externally placed around the anal opening or an internal sensor is placed into the vagina or rectum.

External observation and palpation of pelvic floor muscles

  • Is used to identify correct contraction and relaxation techniques
  • Identify trigger points and muscle spasm
  • Identify significant weakness or severe organ prolapse (dropping of the bladder or rectum)

Internal vaginal or rectal examination is different than a pelvic or prostate exam from a physician. It is performed to look at the musculoskeletal components of the pelvic region. The exam

  • Identifies muscle symmetry, strength, length, tone, and contraction / relaxation ability
  • Identifies myofascial restrictions, and coccyx and organ positions.

 

After the evaluation a Treatment plan is discussed

The evaluation helps design a specific treatment plan for your needs. By combining biofeedback with musculoskeletal examination findings and physical therapy techniques you can learn to relax tense muscles, strengthen weak muscles and coordinate muscle activity.

  • A plan based on the evaluation can retrain the muscles for essential control and support of the lower back, sacroiliac, hip or internal organs (bowel and bladder).

 

Treatment will consist of one or more of the following elements depending on what was found on evaluation:

  • Muscle reeducation to retrain muscles how to work properly
  • Biofeedback for muscle reeducation to decrease overactivity, improve control/coordination and/or increase pelvic floor muscle strength/endurance
  • Manual therapy to reduce spasms.  This manual therapy may be external to supporting musculature/fascia (ie. Low back, hips, buttocks, sacrum, ilum, thighs), vaginal or rectal for direct pelvic floor muscle treatments.
  • Exercise instruction to target specific restrictions and/or weaknesses.  Every effort is made to design an exercise program that fits into your life.
  • Education for ergonomics/body mechanics to reduce strain on the pelvic floor
  • Education and/or referral for various modalities (ie. Cold laser treatments, heat, ice)

 

Bump R, Hurt G, et al. (1991). "Assessment of Kegel pelvic muscle exercise performance after brief verbal instruction." Am J Obstet Gynecol 165: 322-329.

Lisa Lewis, PT, MS