The pelvic floor refers to all the structures within the space between our pelvic bones and lower torso. It includes muscles, ligaments, fascia, organs, nerves, lymph nodes and blood vessels. Everyone has a pelvic floor. The muscles are sometimes called pelvic floor muscles or Kegel muscles. The organs include the reproductive stuff along with urinary and bowel structures. The fascia surrounds it all. The term “floor” comes from the idea that all these structures, especially the pelvic floor muscles, form a base between our pelvic bones and structurally help hold up all the organs above. Sounds pretty important if you ask me!

Many experience fear and anxiety about the possibility of pain with genital touch or penetration. These events can occur with intercourse or intimate adventures and can also occur during medical testing and procedures. One event or multiple events of pain or trauma can begin the cycle of fear, anxiety and pain re-occurrence. Once the traumatic experience(s) happen, your body will try to protect you the next time in anticipation of the trauma occurring again. This usually results in the muscles tensing and natural lubrication failing. Both of which make pain more likely. If this goes on long enough the muscles can get stuck tight and the sensory nerves can become too sensitive. There is a high likelihood the pain will continue with every future experience unless you can find a way to reset these guarding mechanisms. Working with a pelvic floor physical therapist is one of the best ways to learn how to resolve these issues.

Prolapse is when one of the pelvic organs, like the bladder, experiences enough strain and pressure that it gets pushed down toward the vaginal canal. The displacement can be a single large event or can occur in repeated small events. As the displacement happens, the walls of the vaginal canal experience stretch and weakness and this can result in a permanent or continued displacement that results in symptoms and diagnosis of pelvic organ prolapse.

The bladder is not the only pelvic organ that can experience this displacement. The rectum, uterus, urethra and intestines can also become displaced. The symptoms vary and the severity of the prolapse does not always correspond with more severe symptoms. Some people can have a very large prolapse and no symptoms at all.

Symptoms can include: urinary frequency, urinary urgency, challenges with urinary emptying, vaginal/abdominal/ back pain, and constipation. Many also describe the feeling like they are sitting on a golf ball or just experiencing annoying pressure.

The most common causes of prolapse are pregnancy, vaginal child delivery, chronic constipation, chronic coughing, and a lifestyle of repetitive or heavy lifting. Prolapses can take awhile to develop and start showing symptoms. This development is more likely when you combine one of the above causes with menopause.

If you think you have a prolapse you should talk to your doctor about being evaluated. Your primary care doctor may be able to evaluate it themselves or refer you to a gynecologist for evaluation. There is also the option in the state of Maine to seek an evaluation with a pelvic floor physical therapist without a referral. Depending on your symptoms and how severe the prolapse is when evaluated - your physical therapist may still recommend seeing a gynecologist to make sure there are no urgent issues that need to be addressed.

The sooner you start receiving pelvic rehab treatments the more likely you are to reverse the prolapse without requiring medical devices or surgery!

Orthopedic physical therapy refers to rehabilitation, improvement, or enhancement of muscle, skeletal and/or neurological systems that are not performing as well as they should be. The locations of these anatomical imbalances are the spine and limbs. All physical therapists graduate with a degree that has trained them to deal with these locations and conditions.

Once the locations start including the abdomen, pelvis, organs/viscera and genitals, a pelvic floor physical therapist is best qualified to work with because they have received additional training to better understand the needs for evaluation and treatment in this patient population. This also includes training to complete internal vaginal and rectal assessments and treatments which can be crucial to successful rehabilitative outcomes.

Pelvic floor physical therapists are trained to evaluate and treat using internal vaginal and/rectal manual applications when medically necessary. Not everyone needs these types of assessment or treatment. At Mainely Pelvic Physical Therapy, we are dedicated to using highly involved trauma informed care and approaches. This includes creating a safe and secure environment, detailed explanation, informed consent, and ability to pick up on cues with body language and verbal expression.

Internal vaginal and rectal manual techniques simply means we use our fingers to assess the inside of these areas. Based on how the inside structures feel to us and you we can map out values and compare them to what we know to be normal. These values can include muscle tone and tension, position and flexibility of the structural components, pain sensitivity, general sensation, reflexes, scar tissue, and abnormal changes with anatomical presentation. Our manual assessment can also include asking you to contract, relax or push with your muscles to assess coordination, sensation, symmetry, structural support and pain. All of this information is very valuable to helping us determine the root cause of your symptoms and creating a successful treatment program.

Internal treatment is utilized when we believe it is the best option. At Mainely Pelvic Physical Therapy we never have the intention or clinical goal of inducing stimulation or arousal with any external or internal treatment completed in the clinic. We are simply trying to normalize the issues found during assessment that we believe are contributing to your symptoms. We rarely use tools and if we do it’s usually to train you on self application of manual techniques for home or to address major muscle or sensory deficits.

Internal assessment and treatment is always a conversation first so if there is any hint of hesitation, all you need to do is tell us and we work with you to resolve it if possible.

Many experience challenges with getting pregnant. Sometimes these challenges are due to physical conditions happening in the body like muscle tension, scar adhesions, or impaired circulation to name a few. Pelvic physical therapy can offer treatment for these conditions and increase your chances of getting pregnant. Through these ventures we can also help improve the chances of carrying the pregnancy.