Addressing Pelvic Floor Dysfunction: Do You Need a Pelvic Floor Therapist?
Pelvic Health Series with Dr. Angie Mueller
Addressing Pelvic Floor Dysfunction: Do You Need a Pelvic Floor Therapist?
Is the Position of Your Uterus Affecting Your Period? Pelvic Floor Q&A with Dr. Angie Mueller
In part one of this two-part pelvic health series, we’re chatting with Dr. Angie Mueller about addressing pelvic floor dysfunction. We’re also answering the question, “Do I need a pelvic floor therapist?” so that you can recognize the signs of pelvic floor dysfunction and confidently choose a qualified pelvic floor specialist.
So before we dive in, I need to go on a bit of a tangent here. Recently, a friend was excited about a pelvic floor therapist who taught one of the prenatal workouts she’s been going to. And I was so excited to hear this so I pulled up the instructor’s website and it was all about lunging while doing a Kegel and she didn’t have any sort of certifications or degrees that had anything to do with the pelvic floor. It turns out she had taken a course on pelvic floor therapy but wasn’t certified or trained in it.
So I asked Dr. Angie, what does it actually take to be a pelvic floor specialist? What does the certification process look like? And how important is it for your pelvic floor specialist to be fully certified?
It turns out there are many different levels of specialization in the realm of physical therapy. So to be a physical therapist, nowadays, you get a doctorate degree. And then with a physical therapy degree and license, you know a little bit about everything. So beyond that, to really become a pelvic floor or women's health specialist, you then need to take further certifications after you've graduated. “A weekend class is definitely not enough.” Dr. Angie told me.
The American Academy of Physical Therapists is one of the organizations that you can be certified through. But there are several other ones as well. And there are different levels of certification too. The other thing that's very key in specializing in women's health and pelvic floor therapy is that you have a mentor, which is tough to find sometimes. So somebody who's currently practicing and can really mentor you and you can share patients and you know, go back and forth like that is, is really important as well.
How to choose a pelvic floor therapist
You have to test them out. If you go to the physical therapist, and they only talk about doing Kegels and just hook you up to a biofeedback machine and watch you contract and relax your pelvic floor. That's pretty standard physical therapy nowadays, and it's not effective because it only addresses the voluntary muscle fibers of the pelvic floor.
Your pelvic floor is primarily involuntary, so you actually have no voluntary control over 80% of the muscle fibers of your pelvic floor! So the typical physical therapy that trains you in voluntary pelvic floor contractions, also known as a Kegel, is really only accessing 20% of your pelvic floor muscle fibers.
Also, the pelvic floor cannot be isolated. It is part of a bigger system, and it's part of your entire body. So to access those involuntary muscle fibers of the pelvic floor, you have to elicit reflexes to trigger that involuntary muscle activation like we naturally do with our breathing and posture. So your pelvic floor therapists should immediately, on day one, start talking about your breathing and your posture.
You should be getting whole-body exercises and they should be looking at how your pelvic floor muscles are working with your abdominal muscles and with your respiratory muscles. They should be looking at your spinal position and your pelvic position.
You can also actually tell a good pelvic floor physical therapist by their intake. That's actually the one thing you can look at before you even go in, is the intake paperwork. First of all, do they have intake paperwork? And then how in-depth is it? They should be asking you really in-depth questions about your bladder habits, your menstrual cycle, the color of your period blood, your sex life, your history of pregnancies, your exercise, your diet, and your lifestyle. Because as we know, you can't isolate the pelvic floor. So a good pelvic floor therapist understands how the pelvic floor works with the other muscles of the core and with the other muscles of the body. And it's just one part of the whole picture.
How do I know if I need a pelvic floor therapist?
There are six key roles that the pelvic floor plays in our body, and any issues related to any of these roles are indicators that you might need to look deeper into the health of your pelvic floor.
Role #1 - Bladder and Bowel Control
So the first role is to control voiding - bowel and bladder. So do you have any problems emptying your bowel and bladder? Do you push or strain? Is it painful to empty your bowel or bladder, or do you have any leakage?
This also includes incontinence and there are two types of incontinence - stress incontinence and urge incontinence. Stress incontinence is leakage when you cough, laugh, sneeze, jump, run, or any sort of quick movements like that.
That particular type of incontinence has actually been really normalized. In our culture, we think, ‘Oh, I've had a baby, so I'm just gonna pee when I jump on the trampoline with my kids forever.’ It’s even become really normalized in the CrossFit world, where some circles think you didn't work hard enough if you didn't pee your pants, which is just insane. So if you leak when you exercise, that exercise is damaging your pelvic floor, and it's damaging your bladder. Dr. Angie explains that you shouldn’t even be leaking even if you're pregnant. That’s a sign that something needs to change. Either in your self-care routine, your exercise routine, or your lifestyle.
The other type of incontinence is urge incontinence. That's when you leak on the way to the bathroom. And that's typically a little bit more related to your level of hydration and the tone of your pelvic floor muscles.
Within that is also sphincter control. Constipation, hemorrhoids, fissures, and digestive issues can be a sign of pelvic floor dysfunction or core muscle spasms. Your pelvic floor and core muscles should always be moving with your breathing and with your movements throughout the day. And this actually acts to detoxify your organs and bring necessary circulation and lymph flow to them. So any sort of digestive issues, IBS, constipation, Crohn's disease, those sorts of things can be a sign of pelvic floor and core dysfunction.
Role #2 - Organ Support
The next role of the pelvic floor is support. The pelvic floor should support all of your internal organs. It helps to support your hips, as well as your lower back and spine, and your abdominal muscles. So any issues that have to do with that can be a sign of pelvic floor dysfunction.
The most obvious one would be prolapse when the bladder or the bowel or the uterus falls down into the vagina. Other issues that are related to the support role could be hip pain, low back pain, pelvic pain, lower abdominal pain, or any sort of pelvic alignment issues like if your SI joint goes out, or you have a rotated spine or any sort of imbalances within your pelvis can create issues with your pelvic floor’s ability to support your organs and your spine.
Role #3 - Circulation
Another role of the pelvic floor is circulation. It moves like a piston inside of your abdomen with your diaphragm and so they're always moving together as you breathe. When you inhale, your pelvic floor relaxes and moves down, and every time you exhale, your pelvic floor lifts. That motion with your diaphragm creates this really nice pumping action and provides circulation to all of your organs. So varicose veins, pelvic congestion syndrome, and those sorts of circulatory issues can be a sign of pelvic floor dysfunction.
Role #4 - Sexual Function
Another role of the pelvic floor is, of course, sexual function. If you have pain with intercourse, difficulty having an orgasm, vaginal dryness, all of those could be signs of pelvic floor muscle dysfunction.
Role #5 - Breathing
The pelvic floor is sort of the diaphragm’s sister, they're always moving together. Your respiratory diaphragm is pulling air inward and so is the pelvic diaphragm. So if you have issues with breathing such as shallow breathing, that can have to do with the pelvic floor. Asthmatics often have pelvic floor dysfunction because their diaphragm muscles spasm, which makes them feel like they can't bring enough air into their lungs so the diaphragm muscle gets very tight. And anything that's happening in the diaphragm is also happening in the pelvic floor. So often people with respiratory issues also have pelvic floor dysfunction.
Role #6 - Menstrual
And of course, your pelvic floor muscles help to support your uterus and its position in your pelvis. So if your pelvic floor muscles aren't working appropriately with your abdominal muscles and your diaphragm, your uterus can actually move out of its best position. It can lean forward or backward, which in medical terms is anteverted or retroverted. Or sometimes it’s just called a tipped uterus. It can lean to the left or the right but if it’s not in the ideal position, it won't get adequate blood flow, lymph flow, or nerve flow which can lead to menstrual irregularities, painful periods, and even fertility issues.
Pelvic floor specialists are a piece of the whole-health puzzle
“A pelvic floor physical therapist is one person in the team of healthcare providers that could help you find a solution to a problem.”
For example, someone who is spotting about a week after their period ends may wonder if this is a muscular issue, a hormonal issue, a nutrition issue, etc. And the trouble is, the current US health system operates on specialization, which means your doctors may be very knowledgeable but they tend to view your health through a very narrow scope.
We all agree that spotting after your period is an indication that something is off, but it takes a team of professionals to view your health, lifestyle, medical background, and all these things to understand what might be the culprit. We talk a lot about this on the Balancing Hormones Naturally Podcast, that your health protocols and plans need to be based on a very personalized understanding of your body and lifestyle.
This is also something that we dive much deeper into within the Hormone Reset Premium Access Program, where we look at your individual lifestyle and your labs so that we can develop a completely personalized protocol to address your needs.
Free 3-day video series!
Get instant access to the free training.
If you are struggling with painful periods, hormonal migraines, and losing weight, this training will help you take the next steps on your health journey.
The recommendations presented in this blog are not a substitute for medical advice from a qualified doctor. Before making any changes to your diet and lifestyle, please consult with your health care provider.
Some of these links contain affiliate links.
