People are typically referred for pelvic floor physical therapy when they have incontinence, pelvic pain, pain during intercourse, and difficulty with bowel movement or urination. Pelvic Floor Dysfunction physical therapy is performed by a trained physical therapist who has gone beyond the normal education to become a physical therapist for another 1-2 years. This therapy is typically done through the anus and/or vagina to work on the muscles of the pelvic inlet, the inside of the pelvis (shaped like a bowl). There are devices used internally and externally to assist in relaxing the muscles of the pelvic floor.
Some pelvic floor physical therapists evaluate the patients’ posture and walking (gait) to see the extent of involvement of the external ‘influencers’ such as the hips, lower back, and pelvic bone on the floor position. Unfortunately, pelvic floor dysfunction is on the rise and the number of trained physical therapists for pelvic floor dysfunction is not enough to support the need. Therefore, in most offices, the work of the physical therapist is then primarily focused on the internal manual treatment.
Pelvic Floor Manual Therapy Limitations
Manual therapy has its limitations for obvious reasons. For instance, there is only a finger length access through the anus and/or vagina in all directions. That is a big limitation because as you see in the photos below, there are quite a few muscles, connective tissue, and soft tissue that simply cannot get reached through the two access holes (one in men).
People in general, who are recommended to have Pelvic Floor Dysfunction Physical Therapy done are also not enthused about the procedure as it may be embarrassing and uncomfortable to them.
At times, there is no choice but to work those muscles just as massage is to a lower back pain patient. Just as in the massage example, while it helps the lower back, it won’t help long term; using manual physical therapy to address the weak and tight muscles of the pelvic floor may not be long lasting. Physical Therapy of the floor is especially helpful in the case of non-relaxing pelvic floor dysfunction.
Benefits of Pelvic Floor Physical Therapy
When in conjunction with other modalities such as biofeedback and lifestyle modifications, manual work that is done internally will go a long way. While manual PT is used for all pelvic floor dysfunctions, non-relaxing incontinence seems to be the one that benefits the most.
What is the Alternative to Manual Physical Therapy?
At our clinic, we use the Emsella Chair which provides 11,200 Kegel exercises in a 28-minute session. This will assure a strong floor which provides a more secure and ‘put together’ pelvis to build on. 
Pelvic Floor Dysfunction is not just an issue related to the pelvic floor, which is the muscles lining the inside of the pelvis. The dysfunction is a result of the whole complex of the floor and its influencers, the lower back, hips, sacroiliac joints, lower ab, and the lower portion of your mid-back.
You cannot have a pelvic floor weakness without impacting the whole area and treating just the muscles that line the inside of the pelvis is not effective, to put it mildly. The only way to strengthen the muscles of the floor is through Kegels and if you think doing 10, 20, or even 30 of them a few times a day is going to do it, you are mistaken. It helps, but there is more that needs to happen so years are not spent working on strengthening just the inner lining of the pelvic muscles.
With the Emsella Chair, 11,200 kegels per 28 minute session will get you jump-started. That along with the Developmental Kinesiology (DNS) exercises that do NOT require any bands, weights, or gyms (the exercises we all did as babies from newborn to age 4 or so) we build not only strength but coordination of the function of each muscle to others during movement. I strongly suggest you pause and read about DNS.
Pelvic Floor dysfunction appears in many forms in different people, but in all cases, it causes limitations and changes in the quality of life. It is easy to get distracted by the many gadgets and treatments that are out there so make sure you seek the treatment that makes sense to you.
To understand more about the Emsella Chair and our treatment for Pelvic Floor Dysfunction, explore the other blogs we have written on the subject.
Dr. Shakib