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Pelvic Floor Therapy

Updated: Feb 24, 2022

I had the honor of taking a weekend training course entitled "Healing the Root: Pelvic Floor Level One" hosted by Dr. Kathryn Kloos in Edmonds, WA a few weekends ago. It was an introduction to pelvic floor therapy and the myriad ways we can help support our patients by assessing and treating pelvic floor imbalances, as well as uterine massage. The course was very comprehensive, so I wanted to highlight some of the topics and techniques that I learned from the training, as well as indications and contraindications for pelvic floor therapy.


First, let's get some background information on all of this:


What is the Pelvic Floor?

The pelvic floor muscles are located between the tailbone (coccyx) and the pubic bone of the pelvis. The bowel, bladder, uterus and vagina are supported and held in place by these muscles. The openings from these organs- the urethra from the bladder, the vagina from the uterus and the anus from the bowel- all pass through the pelvic floor. Muscular bands (called sphincters) encircle the urethra, vagina, and anus as they pass through the pelvic floor.


What Can Cause Pelvic Floor Weakness or Dysfunction? ¹

  • vaginal childbirth – particularly following delivery of a large baby or prolonged pushing during delivery

  • heavier body weight

  • constipation (due to excessive straining to have a bowel movement)

  • repeated heavy lifting

  • excessive or chronic coughing (as in asthma, smoking, or other chronic lung conditions)

  • changes in hormonal levels at menopause

  • connective tissue disorders

  • surgery

  • growing older


Topics and Techniques for Pelvic Floor Therapy:

  1. Kegel Prescriptions for urge/stress incontinence:

  • identify the correct muscular engagement of the pelvic floor muscles with intravaginal assessment

  • prescribe slow twitch kegel exercises for individualized repetitions and sets (holding kegels for endurance)

  • prescribe fast twitch kegel exercises for individualized repetition and sets (shorter kegel contractions to be done after the sustained endurance kegels)

2. Internal myofascial techniques to release pelvic floor muscles:

  • myofascial technique to release tension in the fascia due to postural imbalance, trauma, or inflammation.

  • This is helpful to use in conjunction with kegels, to ensure the pelvic floor muscles are firing appropriately.

3. Exercises to strengthen and tone pelvic floor and core muscles, as well as exercises and breathing techniques to relax the pelvic floor. Indications for Pelvic Floor Therapy:

  • Pelvic pain: vaginismus, vulvodynia, endometriosis, interstitial cystitis, vulvar vestibulitis

  • Pelvic organ prolapse (uterine prolapse, cystocele, rectocele)

  • Postpartum recovery

  • Urinary incontinence

  • Lumbar or coccygeal pain, hip pain

  • Sexual issues, dyspareunia, infertility

  • Chronic BV

  • Connection to self

Contraindications for Pelvic Floor Therapy:

  • Infection (STIs)

  • First trimester of pregnancy

  • Heavy bleeding (menstrual cycle) during appointment

  • Less than 6 weeks postpartum

  • Very friable vaginal tissue


Image above: Here's an example of a gloved hand inserting through the vagina to reach the pelvic floor muscles, as one would do during a pelvic floor therapy session.

Here is the website of Kathryn Kloos, ND if you were curious to learn more about her practice and the trainings she offers: https://www.drkathrynkloos.com/



Citations:

  1. American College of Obstetricians and Gynecologists. (2017). Pelvic support problems. Retrieved February 23rd, 2022, from https://www.acog.org/Patients/FAQs/Pelvic-Support-Problems?IsMobileSet=false



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