InforMS: What is pelvic floor physical therapy?
Nikki Dority: Pelvic floor physical therapists work with patients primarily on pelvic floor musculature. The pelvic floor supports the pelvic organs and is constructed of muscles, connective tissue, and nerves. Think of it as a hammock that supports the bladder, rectum, and sex organs. Pelvic floor disorders happen when the pelvic floor muscles become weak or get damaged. This can cause problems with bowel, bladder and sexual functioning.
Many things can affect the pelvic floor musculature. For example, if someone has had chronic low back pain and a hip problem, they probably have pelvic floor muscles that are imbalanced. is imbalance will affect bowel and bladder control and, potentially, their ability to have pain free intercourse and to achieve orgasm.
InforMS: In MS, the most common sexual problems are pain, decreased sensation, erectile dysfunction, and an inability to achieve orgasm. Can these problems result from an imbalanced pelvic floor?
ND: Yes, although these problems can have other causes. Lack of arousal is often secondary to other things—like medication—but the pelvic floor muscles in someone with MS might also be imbalanced and this could certainly contribute to the problem.
For example, the right side of the body might have more tone (spasticity) because of lesions on the left side of the brain. In therapy, we can work to down-regulate and relax the pelvic floor to improve blood ow to the whole area and an increase the chance of having better arousal. On top of their neurological problems, some people with MS probably also deal with the impact of trauma.
We don’t have great statistics but I would say that one in three women has had some sort of trauma to the pelvic region, from childbirth trauma to more aggressive trauma like sexual assault. All these things can cause pelvic floor imbalance, too. Having a baby is another thing that can really affect pelvic floor musculature—having a baby is huge.
InforMS: So what kinds of things do you actually do when you work with patients? How long do you generally see someone?
ND: I do a biomechanics evaluation, address muscle imbalances, do biofeedback, and some of the standard glute and ab exercises. I do a lot of visualization and breathing and quieting and relaxation exercises. Bowel and bladder problems are also common with MS and related to pelvic floor problems—the muscles don’t move properly. I would say that 50 percent of people don’t know the difference between relaxing their pelvic floor muscles and contracting them and most people who think they are relaxing are actually contracting them. We work a lot on that, what it actually feels like so they can relax the muscles and allow the sphincter to relax.
On average I see people initially for six to eight sessions over a period of ten to twelve weeks. And after that, I see them as needed or for occasional maintenance visits.
InforMS: Many problems contribute to sexual dysfunction. Some of them are pretty hard to fix. Are there people you just can’t help?
ND: That’s a good question. I don’t think most of us, ever in our lives, have a conversation about our pelvic floor. So I would say that every single person who comes in actually learns something. Long term, how much we can help someone is a little more gray. It’s probably at least worth a look-see, simply because nobody else does this. The Ob/Gyns don’t necessarily do this and not everyone goes to a urologist, and even if they do, urologists don’t look at the mechanical function of the pelvic floor musculature.
InforMS: I have been in the MS world for a long time and worked with lots of physical therapists, but I’ve not heard much about pelvic floor PT. Why is that?
ND: Every single person who comes into my office says, “I never knew anybody did this.” Some of that is cultural. For example, in France, every single woman who has had a baby and receives postpartum care—and that’s the majority—receives pelvic floor physical therapy. In the United States, the way you get into women’s health and pelvic floor PT is usually through the orthopedic door. I think even fewer people get into this work through the neurologic door.
InforMS: We have talked mostly about women. Does this work also apply to men?
ND: There are a lot of pelvic floor PTs for men. Men can have similar problems from too much muscle tone. Problems with the pelvic floor affect bowel, bladder and sexual functioning in men, too. In fact, there is a huge men’s health pelvic floor clinic right on Wall Street because many of those men have such high stress and high tone that they need this work.
InforMS: How does someone get to you?
ND: Most of my patients are referred by gynecology, urology, and urogynecology, and by therapists. People can also access physical therapists directly, at least in Colorado. I see a lot of direct access and a lot of friends and family referrals.
InforMS: Are you a good place for someone to start or are you a good place to end?
ND: I think we are a good place to be with a multidisciplinary team.
Nikki Dority is a women’s health and orthopedic physical therapist. When she was a medical service officer in the US Army she worked closely in the arena of women’s health, which gave her the impetus to further pursue her education and focus on women’s health and biomechanics-infused physical therapy.