Pelvic floor physical therapy: 5 questions answered

Nikki Samms, DPT, knows the region of the body she treats can make people uncomfortable.

As an MD Anderson pelvic floor physical therapist, Samms spends her days helping patients navigate a wide range of pelvic floor issues ranging from trouble using the bathroom to pain with intercourse to organ prolapse.

“Our society puts a lot of taboo on discussing all things pelvis,” she says. “A lot of my patients feel like they're sort of suffering in silence or they're the only human on earth experiencing the problems that they are because we've just put so much shame around our pelvises.”

Thankfully, pelvic floor physical therapy can help those who are experiencing pelvic floor issues. Ahead, Samms answers questions about the pelvic floor and pelvic floor physical therapy, including what treatments are used, who might benefit and what happens during an appointment. 

What is the pelvic floor?

First things first: What exactly is the pelvic floor? Where is it? And what does it do?

Samms describes the pelvis as a ‘tight neighborhood’ housing a variety of organs including the bladder, rectum and, for women, the uterus. 

There are three layers of muscles at the bottom of the pelvis. These muscles are called the pelvic floor, and they are used for many everyday activities. 

“These muscles are very special. They stabilize your spine, they hold up your internal organs, they help you with pooping, peeing, sexual function, potentially being pregnant and giving birth,” Samms says.

How do you know if you need pelvic floor physical therapy?

Because the pelvic floor has so many different roles, there are many reasons someone might need pelvic floor physical therapy.

Samms says these might include: 

• urinary or fecal incontinence
• constipation
• pelvic organ prolapses
• tailbone pain 
• anal-rectal pain
• pain with intercourse
• pain during vaginal exams
• sacroiliac joint pain 

Because other medical concerns can cause symptoms similar to those caused by pelvic floor issues, patients are often screened for other health concerns before being referred to pelvic floor physical therapy.

“We want to be aware of what's within our wheelhouse but appreciate that it's not just muscles. There are organ systems there. We have to say, ‘Hey, what's really happening?’ with a good thorough interview or an examination,” she says.

What happens during the examination at a pelvic floor physical therapy appointment?

Before a pelvic floor physical therapy appointment at MD Anderson, your provider will review your chart to better understand your situation.

At a patient’s first appointment, Samms says she shares information about the pelvic floor muscles before asking patients questions about any pain they may be experiencing, as well as their bladder, bowel and sexual function. 

Then, it is time for a physical exam. This may include an external examination of the pelvis during which the provider lightly touches the region to determine if a patient feels pain or tenderness. This may be followed by an internal examination of the vaginal or rectal canal to determine whether there is any pain, tenderness or restrictions. During an internal examination of the pelvic floor, a provider may ask you to activate, or squeeze, certain muscles to better understand how they are functioning. 

From there, Samms works with her patients to create a unique care plan that enhances their quality of life. 

Success looks different for every patient: some will measure success by their ability to better control their bladder or bowels, others by their ability to have pain-free intercourse.

“We come up with a very individualized, tailored, thorough plan,” Samms says.

What kinds of exercises are used in pelvic floor physical therapy?

Pelvic floor physical therapy might draw to mind pelvic muscle strengthening exercises such as Kegels, or biofeedback, which uses computers to assess the body while a patient performs exercises.  

While Samms notes that Kegels and biofeedback are components of pelvic floor physical therapy, it also includes many other exercises and modalities that can be customized for each patient based on their symptoms and goals. 

“Those are just such small tools in the toolbox of a pelvic floor practitioner,” she says.

Pelvic floor physical therapy might also include exercise, muscle strengthening or coordination training. 

Additionally, Samms uses pain neuroscience to help her patients better understand pain and the role it plays in protecting the body from harm. 

Pelvic floor physical therapy also considers nutrition, sleep hygiene and mental health.

"Pelvic floor physical therapy is really best when it is holistic and takes into consideration partners and we're not working in silos and we're considering the whole mind-body machine,” Samms says.

What is the role of pelvic floor physical therapy in cancer treatment?

There are many reasons someone undergoing cancer treatment may be referred to pelvic floor physical therapy. Patients may have preexisting pelvic floor health issues or only begin experiencing them as side effects from cancer treatment such as chemotherapy, radiation or surgery. 

Chemotherapy can affect the bladder and urinary system and lead to urinary incontinence.

Additionally, radiation shortens muscles and connective tissue making it harder for them to move. This can cause urinary incontinence, constipation or pain with intercourse.

Surgery can also impact organs in the pelvis and the pelvic floor. For example, if the prostate is removed during prostate cancer treatment, it can alter the body’s anatomy and lead to urinary incontinence. 

“If you remove that prostate from underneath that bladder, that urinary support is no longer there. Whereas you did have a star quarterback for you for urinary incontinence, now you have to use your backup players, which are the pelvic floor,” Samms says. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.