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It’s more common than people realize that they have pelvic floor dysfunction. It no longer fits the stereotype of affecting only women who are older, overweight, have undergone childbirth, or are smokers!! Almost every adult in the United States has some form of pelvic floor dysfunction, thanks to our sedentary life. Pelvic floor dysfunction has many faces which you can learn about in my blog. This blog focuses on identifying who to see for treatment and what the holistic treatment of pelvic floor dysfunction should include. Whether you have pain, discomfort, or other symptoms, seeking the right clinician is crucial for effective treatment and finding out who treats pelvic floor dysfunction.

What is Pelvic Floor Dysfunction?

Pelvic floor dysfunction is any dysfunction related to the pelvis. Most often, it is looked at as if it is only the pelvic floor. In reality, the pelvis itself and what is connected to it play a role in the formation of pelvic floor dysfunction which later on can actually impact the health of the organs that it holds. The pelvic floor is a group of muscles that form a hammock-like structure at the base of the pelvis. This supports the bladder, uterus, prostate, ovaries and rectum. This plays a crucial role in bowel and bladder control, sexual function, and overall stability. Focusing solely on the pelvic floor without paying attention to the stability of the pelvis-the foundation supporting it-is, in my opinion, one of the main reasons why the symptoms and issues of pelvic floor dysfunction often become chronic.

Pelvic floor dysfunction can manifest in different ways, such as:
  • Pelvic pain,
  • Urinary or fecal incontinence,
  • Painful intercourse,
  • And even lower back pain.

You can find the subtle and not so subtle signs of pelvic floor dysfunction in my blog. Seeking professional help is essential. Unfortunately, many times, too many symptoms are looked at by themselves instead of being related to pelvic floor dysfunction.

For example:
  • You see a urologist for UTI and pelvic pain, receive antibiotics and pain medication.
  • You see a chiropractor for lower back pain and a physical therapist for your chronic knee injuries.

And not for a moment think you have pelvic floor dysfunction!

The right clinician is the one that:
  • Will listen to your history.
  • Has a clear understanding of pelvic floor dysfunction signs and symptoms.
  • Treats you holistically vs chasing the symptoms.

Pelvic floor dysfunction treatment has to involve pelvic stability because without its stability, not only the floor but the whole pelvis and what else is connected to it is compromised. This means postural stability, which is hardly ever looked at in the generic treatment of pelvic floor dysfunction.

Who Treats Pelvic Floor Dysfunction?

Pelvic floor dysfunction treatment can be done by many different types of providers, They all have to have the training related to a more in depth understanding of the pelvic floor and its associated anatomy and symptomatology.

  • Physical Therapists

Physical therapists specializing in pelvic floor dysfunction are experts at assessing and treating musculoskeletal issues. Almost all physical therapists that work on the pelvic floor do internal manual work addressing the muscles they can reach with their index finger. There is always some work on coaching how to breathe and some exercises that their patients are shown to do, but the majority of the work is done internally.

  • Chiropractors

Chiropractors focus on the musculoskeletal system and its impact on overall health. Some chiropractors undergo additional training in pelvic floor therapy with the focus on stabilizing not only the pelvis but the whole spine and functionality in movement. At our clinic we use postural neurology and developmental exercises which work on the whole body, postural presentation and stability in movement.

  • Occupational Therapists

Occupational therapists are trained to help individuals achieve independence in daily activities. Those specializing in pelvic health can provide valuable insights into how pelvic floor dysfunction may affect daily life and offer strategies to manage symptoms effectively.

  • Nurses

Some nurses undergo specialized training in pelvic floor therapy, particularly in women’s health or urology. They play a crucial role in patient education and provide guidance on lifestyle changes. This may assist in coordinating care with other healthcare professionals.

  • Physicians Trained in Pelvic Floor Therapy

Certain physicians, such as urologists, gynecologists, or physiatrists, may have additional training in pelvic floor therapy. They primarily recognize the correlation between the symptoms that would otherwise be missed by other physicians as separate and unrelated conditions.

How Do You Choose the Right Clinician?

My best recommendation is to do your due diligence. I recommend that you read the website, reviews and contact the office to talk to the receptionist. Make sure your questions are answered and that you are not just another ‘number’. Ask if you can meet with the clinician for a short time. This gives quite a bit of insight as to whom you will be working with.

Do not use your insurance coverage as the determining factor. Insurance companies are businesses and look for profit. Their set of criteria is different from what yours is and most often, in-network providers have to keep the insurance-imposed guidelines in mind when treating patients. This means most likely ‘stream lining’, becoming the routine; it is much easier and faster to attend to an issue sooner than later, so keep that in mind when seeking care. Caring for a more complex condition takes longer and more money than when looking into the right treatment in early stages.

What is the Holistic Treatment of Pelvic Floor Dysfunction?

As outlined in my blog, ” Are Yoga Exercises Right For Pelvic Floor Dysfunction?“, The following list outlines the factors comprising the holistic approach for effectively treating pelvic floor dysfunction.

  • “Behavior modification: is always part of the solution list to all issues (your behavior in life changes how you do everything in life). This is not going to correct any dysfunction fully but addresses some of the contributing factors of the problem.
  • Postural Neurology: Movement is like a concert and the body parts are like the musicians; in that, the musicians not only need to know their part but to know when to chime in and phase out. That means the pelvis and pelvic floor need to know how to ‘play’ with the rest of the body if they are to sustain their strength and integrity. This is what Postural Neurology is all about.
  • Functional Movement: Common sense says that the most authentic way to move is the way babies move. After all, all babies from all over the world go through the same developmental stages of movement (Developmental Kinesiology), which means that we are hard-wired to move that way. So, if the issue is movement-related or supported, then we should see how we compare it to the way we moved as babies. All discrepancies are then highlighted and can be corrected through Dynamic Neuromuscular Stabilization (DNS) exercises, which are baby movements.
  • Kegels? There are machines like the Emsella Chair that do 400 Kegels per minute involving all of the muscles of your pelvic floor and not the ones that you hope to be activating. Note that Kegel exercises are not for all types of incontinence and pelvic floor muscle issues.
  • Breathing is what babies do automatically. That is what we need to do in order to sustain the bottom of the breathing apparatus, the pelvic floor!
  • Internal manual work which ideally should be done to assess the muscles inside the pelvis, BUT does not have to be done in all cases.
  • Nutrition:  Avoid citrus, caffeine, soda, artificial sweeteners and spicy foods. Take collagen, Vit. C, Vit. D, Omega 3 and  protein if there is no conflict with any other conditions that suggest their avoidance.
  • Ergonomics: Sit on an exercise ball vs a chair. Get a keyboard that is as wide as your shoulders. Limit your sitting to no more than one hour and alternate with standing. Make sure the middle of your monitor is at eye level.
  • Postural Awareness: It is important to pay attention to posture and catch yourself when doing the following. Not standing on both feet, slouching, shifting the pelvis forward and in front of the ankles. Best to associate the increase in attention with activities done each day. For instance, when talking to someone, pay attention to your feet and pelvis positioning.
  • Sleeping habits: do not sleep on the stomach and if you are a stomach sleeper, get a body pillow to minimize that.”

If you have pelvic floor dysfunction or suspect you do, contact me.

Dr. Shakib

Recommended Reading:

HyperMobility, Pelvic Floor and Pelvic Pain

Jaw and Pelvic Floor Connection