The Greater Baltimore Center for Rehabilitation Medicine

Many people—men and women of all ages—do not seek treatment for pelvic conditions, such as pelvic pain, overactive bladder and urinary incontinence, because they are embarrassed or feel that it is a normal part of the aging process. Although these conditions are very common, it does not mean that they are normal. GBMC’s pelvic physical therapy team has specialized, advanced training in pelvic rehabilitation utilizing a vast array of services. Our therapists will work with you to design an individualized treatment plan to address your specific concerns. 

Pelvic floor physical therapy can address a variety of pelvic conditions and dysfunctions such as:

• Urinary incontinence (stress, urge, mixed)
• Overactive bladder
• Urinary frequency (day and/or night)
• Pelvic organ prolapse
• Interstitial Cystitis
• Painful intercourse/dyspareunia
• Vaginismus
• Pelvic pain
• Fecal incontinence
• Constipation
• Dyssnergia
• Coccydynia
• Prenatal and postpartum conditions include
  • Pelvic pain
  • Low back pain
  • Sacroiliac joint dysfunction or pain
  • Pubic symphysis dysfunction or pain
  • Diastasis recti
  • Sciatica
  • Carpal tunnel syndrome
  • Scar tissue management from episiotomy
  • Perineal tearing or cesarean

Treatments options for pelvic conditions may include:

• Strengthening of pelvic floor muscles and core
• Downtraining/muscle relaxation
• Use of biofeedback tool to assess pelvic floor muscles and retrain
• Electrical stimulation to strengthen very weak muscles or relax overactive/tense muscles
• Manual Therapy techniques to release restrictions in pelvic floor and associated muscles
• Personalized program for strengthening and flexibility to facilitate a healthy and active pregnancy
• Continued explanation of diagnosis
• Diet adjustments
• Positioning education for toileting, pain reduction, pressure relief
• Bladder and/or bowel retraining
• Management and modifications for pelvic organ prolapse
• Habit/trigger identification and retraining
• Urgency suppression techniques
• Pain management strategies
• Proper body mechanics for lifting, exercise and other activities
• Ways to decrease night time voiding
• Support belts and/or taping techniques for prenatal and postpartum

Frequently Asked Questions:

What is the pelvic floor? 
The pelvic floor actually consists of several layers of muscle, ligaments and connective tissue. These muscles are responsible for supporting the bladder, rectum, vagina and uterus. They help to keep you continent of urine and stool as well as having a role in sexual appreciation. Your pelvic floor sits at the bottom of your pelvis, like a hammock, attaching to your pubic bone in front and to your tailbone in back. 

Why do I have a pelvic floor dysfunction? 
The pelvic floor can be weakened or become painful due to many different factors such as pregnancy/childbirth, surgery, heavy lifting, chronic constipation, the effects of aging, obesity, stress, abuse/trauma, and chronic medical and neurological conditions. Over time, these factors can lead to the development of one or more pelvic floor disorders or dysfunctions. 

What should I expect at my evaluation? 
You will be working one on one with a female pelvic physical therapist and all treatment rooms are private. You are more than welcome to have a chaperone accompany you to your appointment. For your first day, the therapist will spend time talking with you and asking questions in order to obtain your medical history and to learn more about your condition and symptoms. She will perform a musculoskeletal examination which may consist of assessing your spine, hips, pelvic alignment as well as evaluate the strength, range of motion and flexibility of your muscles. Your therapist will likely need to perform an internal and/or external pelvic floor muscle examination and some special tests specific to your symptoms. The therapist will take time to discuss and explain the evaluation and all that will be involved, allowing you to ask any questions prior to participating. Your first session will take between 60-90 minutes. 

What should I wear to my first visit? 
Your attire is not important on your first day. Feel free to wear whatever clothing is comfortable and convenient. 

What should I expect during subsequent treatment sessions? 
It is difficult to predict or generalize how long a patient will need therapy prior to performing a thorough evaluation. During your evaluation session, your physical therapist will determine a personalized treatment plan based on the evaluation findings. This treatment plan will be executed throughout your treatment sessions. These follow up treatment sessions typically take about 60 minutes. 

What is biofeedback and how will it be used for my pelvic floor? 
Biofeedback is used as a muscle retraining tool to help patients learn to strengthen or relax pelvic floor muscles in order to improve bowel/bladder function and decrease pain. It is a painless, non-surgical process that uses an internal sensor and computer monitor to display information about your muscle activity. As you tighten or relax the correct muscles, changes will be seen on the computer monitor. Being able to visualize this information helps you to identify the correct muscles and learn to make changes that are needed.