When I first heard of pelvic floor manipulation, I was at a house party with a bunch of people in the medical community: doctors, nurses, firemen, and physical therapists. Two of the people I was close friends with (an EMT and a nurse) were talking about a woman I hadn’t met yet. She was a physical therapist “who specializes in pelvic rehabilitation” they explained to me, both rolling their eyes in exaggeration.
As someone who has spent a decent amount of time in the medical field myself (my dad was a doctor, I graduated with a B.S. in health science, and I was a personal trainer for years), I found it odd that they would think it was so weird for a P.T. to specialize in the pelvis and the muscles attached to it.
It sounded hardly unreasonable. After all, the pelvic floor is directly responsible for hip rotation, posture, stabilization, walking, and sitting. In other words, it’s a pretty important part of the musculoskeletal system, and any EMT or nurse worth their salt would know that.
So why would they be making fun of a profession that seemed completely legitimate?
It wasn’t until the woman they were referring to showed up to the party later that I realized that this woman was trained in a vastly different field of therapy than what I had initially assumed.
My conversation with her went something like this:
Me: “So, you are a physical therapist?”
Her: “Yep. Been working in my own private clinic for about 2 years now. I love it.”
Me: “Yeah, I was told your focus is on pelvic wall strengthening and stretching.”
Her (kind of laughing): “I mean, it sounds a lot more glamorous when you put it like that. I pretty much just stick my finger up people’s private parts all day.”
(In the movies, the DJ playing the music would bring the record to a screeching halt, and everyone in the room would just glare in disbelief). I was dumbstruck.
The physical therapist laughed, waving off my reaction. “Yeah, that’s pretty much how most people react when I tell them what I do. It’s obviously a lot more clinical and mechanical than I just explained, but that’s the layman breakdown of my profession. I manually enter a person either through their rectum or their vagina so I can access the muscles interiorly.”
“But… but… but… why?” I asked, still dumbstruck yet equally fascinated.
“Because it’s impossible to access the deep muscles of the pelvic region unless you actually manually manipulate them – and the only way to do that is from inside a human being.”
As we talked about her profession, the more and more intrigued I became. Though I had never heard of manual pelvic physiotherapy (shockingly “fingering butt-holes and vaginas is not the clinical term for it), it’s been a field of rehabilitation for many years – but has only recently become part of the mainstream. I’m always interested in learning new things, so after the party, I went home and did some homework on this form a physical therapy and here is what I found out:
What I am referring to are issues of the pelvic area like groin pain, pain when you have sex, frequent urges to urinate, incontinence, bladder leakage, and irregularity – you know, “the fun stuff,” the stuff we used to laugh about as kids, but now we’re grown-ups and it’s not so funny anymore. Some of these conditions are the result of identifiable medical conditions. For example in some women, the rigors of childbirth can leave the body a little worse for wear. Or for men, an enlarged prostate can literally and figuratively be a real “pain in the butt.” For both sexes, there are various physical issues and the like, some of which are caused by something as simple as bad posture.
WHAT EXACTLY IS MANUAL PELVIC PHYSIOTHERAPY?
Pelvic floor physical therapy is a series of internal and external soft tissue release techniques to relieve unwanted tension in the pelvic floor muscles and fascia.
WHY DO PEOPLE NEED THIS FORM OF THERAPY?
The pelvic floor is a cluster of muscles that connect to the pelvic bone and is found at the base of your spine. This particular group of muscles is susceptible to negative tension and pain due to it continually being activated. Pain and inflammation of this area is largely due to poor posture, poor seating, continual holding patterns, “emotional” contractions due to stress, childbirth, constipation, bowel disorders, and urinary tract infections. Some patients may not experience any of the above, yet still suffer from extreme pelvic tension and tightening. Often, people think doing strength-tightening exercises such as kegels is a productive way to help with stabilization, but strengthening an already tight pelvic floor can be counterproductive and lead to more pelvis-related impediments.
HOW DOES MANUAL PELVIC PHYSIOTHERAPY WORK?
Pelvic floor manual therapy is a series of internal and external soft tissue release techniques. It helps to relieve tension in the pelvic floor muscles by breaking down the build-up of fascia. By having a professional insert fingers into the rectal or vaginal area and gently massage internal muscles, a sufferer should feel relief and more mobility after a series of treatments. This form of muscle manipulation should also result in an increased ability to both contract and release, improving timing in the muscles and pelvic organ position.
Though unconventional, this form a therapy and rehabilitation has proven effective with stress incontinence, pelvic organ prolapse, urinary urgency, urge incontinence, bowel disorders, chronic pelvic pain and sexual disorders. The first few sessions may prove uncomfortable or even painful, in some cases. However, by continuing active treatment, the mobilization of these muscles should prove to be much less painful, and the patient should not experience post treatment pain or discomfort.
WHAT KIND OF TECHNIQUES ARE USED?
Pelvic Floor Manual Therapy uses a wide variety of massage techniques to treat the muscle areas that are particularly tight and inflamed. Techniques may include stretching and trigger point treatment.
Common Mobilisation Techniques Include:
– Myofascial Trigger Point Therapy (including the trunk and abdominal area)
– Dry Needling (including the trunk and abdominal area)
– Connective Tissue Manipulation to the external perineal tissue, abdomen and pelvis
– Manual therapy where a PT uses hands-on massage or stretching by inserting a few fingers inside the patient.
– Pelvic Floor Exercises where patients are taught to contract and relax pelvic floor muscles in relation to other muscles. This includes breathing and timing techniques. This helps stretch tight muscles, strengthen weak ones, and improve flexibility.
– Pelvic Floor Biofeedback which helps patients understand how the pelvic floor muscles are working. A probe is inserted into a woman’s vagina or a man’s anus and results are displayed on a computer screen.
– Electrical stimulation in which a low voltage electrical current may be used to help coordinate muscle contractions.
– Vaginal dilators, which are just plastic devices, can help women learn to relax their pelvic muscles to allow easier penetration. Women who have suffered from gynecological cancer may also find this instrument effective for vaginal rehabilitation after treatment.
Though unconventional, manual pelvic physiotherapy has proven to be a very effective and successful means of physical therapy and relief. This form of rehabilitation might be something to consider if you are suffering from a host of health complications related to your digestion, bowel movements, bladder, prostate, or reproductive organs. Even if you don’t have complications related to overuse of the pelvic wall muscles, you may still benefit from seeing a professional. As the science and medical field continue to expand their knowledge and understanding of the body, new therapy techniques seem to be pivoting from a drug course-of-action to a more natural, safe, and long-term therapy.