What is pelvic floor therapy? Follow these exercises for best practices

UAB News
Posted 11/16/22

Nearly a quarter of women in the United States are affected by one or more pelvic floor disorders, according to the National Institutes of Health. The disorders can lead to difficulty tolerating …

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What is pelvic floor therapy? Follow these exercises for best practices

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Nearly a quarter of women in the United States are affected by one or more pelvic floor disorders, according to the National Institutes of Health. The disorders can lead to difficulty tolerating pelvic examinations, pain during and after pregnancy, discomfort with sexual intimacy, constipation, incontinence, and a variety of other issues that many women assume are normal.

To help combat these issues in the local Birmingham community, UAB Medicine partnered with the University of Alabama at Birmingham Spain Rehabilitation Center to hire a physical therapist who specializes in women's health to launch the pelvic floor therapy program. Jennifer "JJ" Fagen, UAB's pelvic floor therapist, collaborates with physicians in the UAB Department of Obstetrics and Gynecology.

"When I started specializing in pelvic floor therapy, I realized how many women of all ages and backgrounds experience some sort of pelvic floor dysfunction," Fagen said. "I also realized many did not even know pelvic floor therapy existed and that it is a great way to treat these disorders as well as be proactive with your pelvic health."

What is pelvic floor therapy?

Studies show that a multidisciplinary approach is the most effective way to manage pelvic symptoms. Pelvic rehabilitation focuses on the pelvis, hips, sacroiliac joints and lower back. Fagen notes it is a great first step to treating pelvic floor dysfunction because it provides a conservative and holistic approach.

Who benefits from pelvic floor therapy?

"All women can benefit from pelvic floor therapy and exercises," Fagen said. "Not only can it treat pelvic floor disorders, but it can also help women strengthen and stabilize their bodies as a whole."

Fagen recommends pelvic floor therapy for women who:
- Are pregnant or postpartum
- Are experiencing pelvic organ prolapse

- Have chronic constipation or bowel/bladder dysfunction
- Have chronic pain in the pelvic region, hips, sacroiliac joints and lower back
- Have had surgery in the pelvic region such as a cesarean section, episiotomy, hysterectomy or hemorrhoidectomy

What should patients expect?

Patients referred to Fagen will first undergo a physical therapy evaluation that includes a review of their medical history, diagnosis, concerns from the patient and a full musculoskeletal evaluation.

Depending on a patient's conditions and goals, treatment plans could include:
- Postural, body mechanics, dietary and behavioral education
- External and internal soft tissue mobilization, trigger point release, deep tissue massage, and tissue manipulation
- Modalities such as electrical stimulation, ultrasound, and hot/cold therapy
- Strengthening and stabilization exercises

- Therapeutic dry needling, kinesiotherapy taping and cupping

How can every woman benefit from pelvic floor therapy?

"Most of my patients come to me because they are already experiencing pain or discomfort, which pelvic floor therapy can help alleviate," Fagen said. "However, I want to encourage everyone, of all ages and stages of life, to incorporate good pelvic floor practices into their everyday lives."

Most pelvic floor exercises can be done at home or in the gym and require little or no equipment. Fagen suggests being proactive and starting by incorporating five simple exercises into your daily routine that can help prevent pelvic floor dysfunction.

Simple exercises include:

Happy baby
1) Lie flat on your back
2) Keeping your head on the ground, bring your knees towards your chest at a 90-degree angle and aim the soles of your feet towards the ceiling
3) Grab and hold the inside or outside of your feet and spread your knees apart, slowly bringing them to your armpits
4) Gently rock from side-to-side while inhaling and exhaling deeply

Pretzel stretch
1) Lie on your back at the edge of table
2) Drop outside leg off, grab ankle with hand and pull back to feel a stretch in upper thigh
3) Grab other leg with the other hand and pull towards same side shoulder to feel stretch in buttock
4) Breathe deeply

5) Switch to other side of table and perform with opposite side

Sphinx pose
1) Lie on your belly with your legs extended behind you
2) Set elbows under shoulders and forearms on the floor
3) Inhale and lift your upper torso and head away from the floor

4) Stay for several breaths then slowly release your belly and lower your torso and head to the floor

Child's pose
1) Come to your hands and knees on the floor
2) Spread your knees outside the width of your hips keeping your feet pressed to the ground and big toes touching
3) Sit backwards over your feet allowing your stomach to rest between your thighs and forehead

4) Take several deep breaths then return to your hands and knees

Frog squat
1) Stand with feet outside of shoulder-width and hold hands in front of body
2) Push hips back and down, bending at the knees into a squat with your hands coming to a praying pose in front of you and keeping your back straight
3) Take several deep breaths

4) Push through the heels and return to a standing position

Another preventive step people can take is to avoid certain activities and exercises that increase the risk of pelvic floor issues.

Activities recommended to avoid include:
- Any movement that causes one to use the Valsalva maneuver
- Going to the bathroom "just in case"
- Practicing Kegels while using the bathroom

To make an appointment with UAB's pelvic floor therapist, visit uabmedicine.org.

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