Pelvic Floor Physical Therapy

The pelvic floor is a group of muscles and connective tissue that support the bladder, bowels, and reproductive organs. Sometimes, pelvic floor muscles can weaken or become too tight. Pelvic floor weakness can occur at any point in life, but is more likely to occur with age. 

Other causes of pelvic floor weakness may include:

• Chronic coughing
• Frequent heavy lifting
• Exercises or sports that involve frequent jumping, running, or abrupt movements
• Menopause
• Surgery or radiation involving the pelvic floor, such as prostate surgery or cervical cancer
• Pregnancy and childbirth
• Straining on the toilet

Pelvic floor muscles can also become too tight or unable to relax. Pelvic floor tightness can occur with age or be caused by:

• A history of holding in urine or bowel movements
• Endometriosis
• Interstitial cystitis
• Irritable bowel syndrome
• Pelvic floor injury

Our pelvic floor physical therapists are part of a broader team that specializes in maintaining good pelvic floor health and correcting pelvic floor dysfunction. We work alongside urogynecologists, obstetricians and gynecologists, gynecological surgeons, oncologists, psychotherapists, pain specialists, urologists, gastroenterologists, physician assistants, and nurse practitioners. Pelvic floor physical therapy is often recommended before surgical treatments. If surgery is needed, physical therapy is often incorporated into your after-surgery care.

Physical therapy can be helpful for people of all gender identities, including male and female, if you’re experiencing symptoms of a weak or tight pelvic floor. Some common symptoms of pelvic floor dysfunction include urinary and fecal incontinence, feeling a vaginal bulge, penile pain, frequent urinary tract infections, and difficulty emptying your bowels during a bowel movement. Feeling as though something is falling out of your vagina can be a sign of prolapse. Painful sex, erectile dysfunction, pain in your pelvic area, or lower back pain can also be signs of pelvic floor dysfunction.

Pelvic Floor Muscle Strengthening
If your pelvic floor needs strengthening, Duke physical therapists will work with you on exercises that incorporate muscle contractions, such as Kegels -- an exercise that involves tightening and relaxing your pelvic floor muscles. You’ll receive an exercise plan tailored to you based on your examination and goals. It may also include different positions, such as sitting, standing, or lying down. 

Your physical therapist will teach you exercises to do at home, outside of sessions, so you can continue your care even after seeing the physical therapist. Pilates may be recommended to help strengthen the muscles around the pelvis. 

Pelvic Floor Muscle Relaxation Techniques
If your symptoms are due to difficulty relaxing your pelvic floor, your physical therapist may recommend lengthening, stretching, and other relaxation techniques, like breathing exercises. 

Pelvic Floor Muscle Coordination Training Exercises
Coordination training exercises focus on learning the appropriate times to tighten the pelvic floor (for instance, when you cough or sneeze) and when to relax the pelvic floor, like when you empty your bladder or have a bowel movement and work on how to do that effectively.

EMG Biofeedback Training 
To assess your pelvic floor health, your physical therapist may incorporate EMG biofeedback. This machine provides a visual signal of when you’re activating and/or relaxing your pelvic floor muscles. You’ll be able to identify when you are correctly tightening and relaxing your pelvic floor and learn exercises to strengthen, relax, and coordinate the muscles.

Rectal Balloon Sensitivity and Expulsion Training 
Rectal balloon sensitivity and expulsion training may be used if you have trouble having a bowel movement. Nerves in your rectum are responsible for signaling when you need to go to the bathroom. Sometimes, these nerves can be hypersensitive, meaning the rectum only holds a very small amount of feces before signaling to the brain that it needs to empty. In other instances, the rectal nerves may not be sensitive enough and too much waste builds up before the brain receives the signal that it’s time to go to the bathroom. Using this treatment, your physical therapist can help you learn what the appropriate time to defecate feels like.

Bowel and Bladder Training 
Some bowel and bladder problems can be improved through education, such as proper toilet posture or breathing exercises to help your muscles relax. 

Internal and External Manual Therapy Techniques 
These techniques range from trigger point release to manual stretching of the tissue. Depending on the technique, your physical therapist will work on the muscle externally on the pelvis or through the vaginal wall or rectum internally. 
 
Dry Needling
Using acupuncture-like needles, dry needling aims to reset trigger points in the pelvic floor muscles. The goal is to relax and retrain tight muscles so they work properly.

Specially Trained Pelvic Physical Therapists Offer Specialized Programs 
Physical therapists at Duke Health have completed extensive training to treat all pelvic health conditions to ensure expert and personalized care. 

Running Medicine and Performance Program
Whether you’re training for your first 5K, are a sprinter on your college track team, or are an elite marathoner, the last thing you want is an injury that stops you from reaching your running goal. Pelvic floor physical therapists work with a team of Duke running experts for injuries related to the pelvic floor. We offer unique and specialized programs, such as our postpartum "return to run" workshops held twice a year, which include complimentary evaluations to get you back to running safely after giving birth. 

Sexual Health and Intimacy Related to Cancer
Physical therapists are an integral part of the Duke sexual health and intimacy services offered to individuals with cancer. You’ll receive support individually or with a partner to work through the impact cancer may have on your sexual health.  

Pediatric Pelvic Floor Therapy
Pelvic floor physical therapy isn’t limited to adults. Physical therapists can work with your child for bladder and bowel concerns. 

A Team Approach
We frequently collaborate with urogynecologists, urologists, and other providers such as orthopedic surgeons, sports medicine providers, athletic trainers, psychologists, and nutritionists. Together we provide comprehensive care that’s tailored to you.