10 Common Misconceptions About Pelvic Physical Therapy

I had never heard of pelvic physical therapy prior to beginning my doctoral program at Duke University. I remember very clearly when I first learned that some physical therapists did “that.” One of my fellow students had completed a small half-day observation at a local clinic, and excitedly told us all about his day watching the “Pelvic PTs.” We were blown away. We had always assumed physical therapists treated back pain, helped patients after surgery, worked with people who had strokes…but pelvic pain? Urinary incontinence? Sexual dysfunction? This was shocking and new.

Not surprisingly, I was not the only person surprised to hear of this *new* specialty. Of the new patients I see, I estimate that 90% of them have never heard of pelvic PT… and in that, there are a TON of misconceptions people have about my profession. I thought it would be helpful to share a few of the top misconceptions with you today.

1. The only people needing to see a Pelvic PT are women after childbirth.
The interesting thing about this one, is that of the patients I treat, only about 5-10% are post-partum women! The other 90% includes young (with our youngest being 8 years old) to old (with our oldest being 95) men and women experiencing a big variety of symptoms: urinary incontinence, difficulties in urination, bowel incontinence, constipation, abdominal pain, low back/SI pain, sexual dysfunction, pelvic pain or coccyx pain, vaginal or rectal pain, penile or testicular pain, as well as men and women prior to or after having pelvic surgery.

2. Pelvic PTs do not treat men.
False. We treat many men. Now, I will admit that at our specific clinic, we see more women than men, but this is not true of every pelvic physical therapy clinic. Currently, I would estimate 20-30% of my schedule is men. The most common diagnoses we treat for men are post-prostatectomy related incontinence as well as variations of male pelvic pain—however, we also treat men with bowel dysfunction, sexual related pain, urinary dysfunction and tailbone pain.

3. If a person is leaking urine, they definitely need kegel exercises (pelvic floor strengthening).
We have discussed this in the past in other blog posts, but this really is a very common misconception I often have to fight with my patients. Urinary incontinence is a failed system, not just a failed muscle. From a musculoskeletal standpoint, a person needs a well-functioning pelvic floor muscle group, abdominal muscles, hip muscles, diaphragm and low back muscles. People need strong, but flexible muscles that tighten when they need to and relax when they need to. If a person has a shortened, irritated pelvic floor, they may have just as much difficulty holding back urine as the person with a weak pelvic floor. It is important to trust your physical therapist to prescribe the specific exercises necessary to help YOU.

4. If a person has tried “kegel exercises” and they did not work, Pelvic PT won’t be able to help them.
As a Pelvic PT, I take great offense to that… I mean, honestly, do you think I would need a doctoral degree, 100+ hours of additional continuing education, and a board specialization to teach a person Kegel exercises? That all to say, rehabilitation for the pelvis is much more involved than simply strengthening a muscle group. It involves restoring function—improving muscular support around the pelvis, improving behavioral/dietary habits, and re-training body movements to allow for optimal organ and structural function.

5. If your mother/grandmother/great-grandmother also had constipation/urinary incontinence/diarrhea/etc., then it must be genetic and can’t be helped.
Also, not true! Now, I won’t say there aren’t genetic components which may cause a person to be more likely to experience certain conditions than others—but that being said, there is always something that can be done to help! It is important to work with a team of healthcare professionals including physicians, nurses, physical therapists, psychologists and nutritionists to ensure a person gets comprehensive and holistic care to achieve optimal health.

6. People can major in “physical therapy” and become a pelvic PT right after they graduate.
I wish that were true—it would have saved me several years of work! Actually, the profession of physical therapy has changed significantly in the past 20 years. Currently, most practicing physical therapists have a Masters or Doctoral degree in physical therapy, and the majority of the current educational programs in physical therapy in the United States are doctoral programs. In order to specialize in pelvic PT, a person must have an advanced degree (doctoral/masters) as well as attend continuing education to gain the knowledge and clinical skills necessary to treat this complex population. This equals a total of 7 years of formal education after high school as well as significant amounts of continuing education.

7. If a person has already had surgery OR is planning to have surgery, pelvic physical therapy won’t help them.
The truth is that physical therapists usually work very closely with surgeons to help patients achieve optimal recovery. Surgery will often correct an anatomical problem, but it is important to have improved muscular control and function to help a person attain optimal outcomes after surgery. Research has shown that physical therapy prior to and after surgery improves patient outcomes as well as reduces the need for future surgery.

8. A physical therapist doing vaginal or rectal exams is weird and NOT conventional.
Physical therapists specialize in working with the musculoskeletal and neuromuscular systems of the body. The pelvic floor muscles run around the opening of the urethra, vagina (in women) and rectum. The only way to truly assess the pelvic floor muscles is via an examination which is performed with one gloved finger inserted into the vaginal or rectal canal. Although this may seem “untraditional” to some, there is a strong anatomical basis for the exam. Pelvic physical therapists are trained in both internal and external evaluation and treatment techniques, and current medical research supports these techniques in the treatment of this patient population.
**Pelvic Guru side note- A physical therapist can assess general function of the pelvic floor by using external observation with cues and/or something called surface emg biofeedback. However, an internal assessment is the “gold standard” for fully assessing the pelvic floor if indicated. If patients are not comfortable with this, they do not have to have this type of evaluation. Some patients are reluctant at first and then choose to do this after a few visits.

9. If a person has a “medical cause” of his/her pain, physical therapy will not help.
Often times, certain diagnoses can have musculoskeletal involvement. For example, if a woman has endometriosis which has caused significant pelvic pain she will often have severe trigger points, connective tissue restrictions, and muscular restrictions in all of the muscles around the pelvis as a result of that pain. In many cases, if the endometrial tissue is removed via laparoscopy, but the soft tissue restrictions remain, pain will not go away. That to say, a multidisciplinary approach to pain tends to be the best to help people achieve optimal recovery.

10. A person’s habits (eating, drinking, etc) are not related to pain, urinary or bowel dysfunction.
This may seem obvious, but this thought is more common than you would think. Many people believe that if they have had certain habits for a long time, it cannot be related to the problems they are experiencing. Unfortunately, that is not the case. Often times, habits such as drinking coffee, eating fried food, exercising too vigorously, or sitting at a computer for long periods of time can strongly influence a person’s symptoms—even if the symptoms are new. It is important for your physical therapist to evaluate all of your habits to help you understand the steps you can take to improve your health.

Written by: Jessica Powley, PT, DPT, WCS

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