Pelvic Floor Therapy at Home in New York City

Just like all muscles in your body, through exercise and specifically,  pelvic floor therapy, you can strengthen your pelvic floor and thereby help prevent pelvic floor dysfunction and pain.  There are different strategies that can be used to perform pelvic floor therapy ranging from simple daily exercises to more specialized techniques guided by a physical therapist.  The good news is that we offer professionally guided pelvic floor therapy by a Physical Therapist in the comfort and privacy of your own home.  We come to you! 

Research (source, source) has shown that home-based pelvic floor therapy delivered in person by a physical therapist is just as effective as weekly visits to a traditional outpatient physical therapy facility.  Thus rest assured as you familiarize yourself with pelvic floor dysfunction and the inner workings of this region of your body – you can receive the full range of pelvic floor therapy, from the convenience, comfort and privacy of your own home. 

Could Pelvic Floor Physical Therapy At Home Benefit You?

Our physical therapist provides solutions to women suffering from: 

• Incontinence or urinary leakage when laughing, coughing or sneezing
• Pelvic Floor Pain while sitting, standing or walking for long periods
• Pain with Intercourse
• Pain During Pregnancy
• Postpartum Pain that is preventing their return to fitness activities such as running, yoga or lifting weights
• Endometriosis

Pelvic Floor Therapy at Home: What to Expect in Your First Session?

Whether your path to pelvic floor therapy was through a doctor’s referral, from a friend, or searching through Google,  We’re grateful to have an opportunity to be helpful to you.  We understand receiving a first time visit from a healthcare professional, especially to your home,  can feel daunting. This is particularly so with such a personal part of the body coupled with the uncertainty of what a fist visit will entail.  Mindful of these natural and valid concerns, we will touch on what to expect in an initial pelvic floor therapy session, in effort to shine some light and confidence on your pelvic floor journey. 

The first procedural step we’ll take in your initial evaluation will be conversational, history and aspiration learning; it’s where you share your story, concerns and goals.   Pelvic floor therapy best sets sail with patient education, clarity and recommendations of pivots or changes to behaviors, practices and/or movements.  

We might engage in a light ‘rehearsal’ of exercises to familiarize you with manual, or hands-on, therapeutic techniques both external to and internal to the pelvis. It’s also possible that we might demonstrate technology devices, such as biofeedback with SEMG, a system that enables you to visualize what muscles are contracting when working the pelvic floor.

Our session will culminate with you hearing our understanding of all you shared, the best treatment options aligned with your goals and we’ll address any questions or concerns you have.  We’ll have a concluding discussion and together craft a treatment plan outlining exercises, duration, and frequency.   

However before we get too far ahead on any of this – everything starts with a complimentary 30 minute “discovery session” which involves one on one time with our physical therapist.  This virtual call/ consultation will include discussion regarding your symptoms, education regarding what may be going on, and possible next step options.  

What Does Pelvic Floor Therapy at Home Involve?

While pelvic floor therapy can reduce if not eliminate a myriad of pelvic floor dysfunction symptoms, consistency is important in achieving good results.   Consistency is best achieved with your treatment taking place in the convenience, comfort, and privacy of your home.  As cited earlier,  research (source, source) has shown that home-based pelvic floor therapy is just as effective as weekly visits to a traditional physical therapy outpatient facility. If you’re experiencing symptoms of pelvic floor dysfunction some of the practices and techniques that be may be provided in your treatment plan at your own home include:

• Education — Learning the inner workings of pelvic floor functions aligned with your specific symptoms and how to best practice good self care habits.
• Pelvic floor exercises — Guided exercises focused on your specific circumstances to stretch and strengthen your pelvic floor muscles, improving muscle strength and flexibility.   Kegels are perhaps the most common pelvic floor exercise along with intentional pelvic floor contractions.  

Bridge exercises (above) are also popular and can be helpful for pelvic floor strengthening after a vaginal delivery or C-section, and can also build up your glutes.  The optimal pelvic floor exercises and treatment plan for you would be based on your unique circumstances and symptoms. 

• Pelvic floor manual therapy — Internal massage is often helpful in promoting posture, circulation, and flexibility.
• Vaginal dilators — Guidance on using these insertion devices to help stretch the vaginal tissues to relax or strengthen pelvic floor muscles.  
• Biofeedback — Guidance on this procedure of inserting a probe into your vagina to help you see how your pelvic floor muscles work. 
• Pelvic floor electrical stimulation — Guidance on using low-voltage electrical current to stimulate pelvic floor muscles to contract creating a muscular response similar to Kegels.  

Although abdominal and pelvic pain can be complicated and even discouraging at times – we are committed to working with you to understand your condition and help you along the path to recovery. If you have been experiencing abdominal and pelvic pain that won’t go away, let’s have a conversation, reach us for a free virtual consultation today. 

Pelvic Floor Therapy at Home for Pregnancy

Keeping your pelvic floor strong before, during, and after pregnancy helps minimize the damage these muscles endure under the strain  and term of pregnancy and childbirth.  Due to a stressed pelvic floor, prenatal pelvic floor dysfunction is commonplace with the slightest cough, laugh, or vomiting from pregnancy nausea leading to leakage.

Generally it’s during the second or third trimester, with the approval of the supporting OBGYN or midwife, that women explore including pelvic floor therapy into their pregnancy regimen. During pregnancy, treatment usually centers on optimizing coordination and range of motion of the pelvic floor muscles. Even though pregnant, it’s not unusual to improve incontinence issues and do manual release work of the muscles creating more space, relieving pain, and helping in birth preparation. 

Stretching and strengthening your pelvic floor muscles during pregnancy can help relieve your aches and pains — and alleviate stress and tension as well.  Prenatal pelvic floor therapy can also counterbalance the hormonal changes that further loosen already stressed muscles and connective tissues around the pelvic floor. 

Prenatal pelvic floor therapy can teach you effective breathing strategies,  how to coordinate abdominals with your pelvic floor for optimized pushing, and provide anatomical advice based on your pregnancy on why or why won’t certain body resting positions help you during pregnancy and your labor. In sum, a healthy pelvic floor better equips you for labor, which means less stress for you and your baby in birthing.  Also, whether you have a vaginal or C-section birthing, prenatal pelvic floor therapy facilitates a swift recovery of your pelvis region to its best health after child birth. Generally a prenatal pelvic floor therapy regimen will focus on optimizing the most important muscles while pregnant.

• The transversus abdominis: the innermost abdominal muscle encircling your trunk and often involuntarily contracts when you cough, sneeze, or laugh.   This muscle’s movement is forward and backward, compressing the abdominal cavity,  and helping you push during labor.

• The pelvic floor’s main muscle curves like a figure eight around the openings of the rectum,  urethra, and vagina.  Kegel exercises are effective in strengthening the pelvic floor muscles, which helps in preventing urinary incontinence.

Postpartum pelvic floor therapy tends to focus on the common outcomes of child birth to the pelvic region.  Many women cope with fecal or urinary  incontinence (leaking), painful sex or simply generalized pelvic pain with walking, sitting, or lifting.  Feeling a heaviness or a bulging in the vagina can be a pelvic organ prolapse.  Some women endure tears or episiotomies with a vaginal birth leading to scar formation producing discomfort and pain.  All of these postpartum outcomes to the pelvis region can be helped with pelvic floor therapy.  

We can help you prepare for a healthy pregnancy, delivery, and recovery at the convenience and privacy of your own home.  Here are a few sensible practices that will protect your pelvic floor health:

• Maintain a healthy weight and rate of weight gain during your pregnancy
• Avoid activities and exercises that exert excess pressure on your abdomen — particularly during the 2nd and 3rd trimesters
• Give yourself plenty of time to rest and fully recover after exercise or exertion
• Engage in safe pelvic floor stretches and exercises to improve muscle strength, such as bridges (example above), pelvic tilts and Kegel exercises.

What is the Pelvic Floor ?

The pelvic floor is a thin sheet of muscle fibers and connective tissues spanning the area underneath the pelvis forming a “supportive sling” or “hammock” from the frontal pelvic bone to the tailbone.  These muscle structures stretch and assist in supporting your bladder, uterus (women) and rectum, keeping these organs in place and stable as you stand and move about. 

What Pelvic Floor Muscles Do

Pelvic floor muscle contractions and relaxation help you control your bowel movements, urine flow, and sexual functioning.  More broadly, pelvic floor muscles:  

• Contract when you sneeze, cough, or strain, helping to prevent the involuntary urine leakage. 
• Are essential in supporting your organs in your abdomen, particularly when standing. 
• Protect your pelvic organs from external damage. 
• Help support pelvic organs in the correct position, such as your bladder. 
• Help manage control of passing gas, urine, and bowel movements.
• Are involved in sexual engagement during intercourse. 

What Can Happen if Pelvic Floor Muscles Become Weak

Pelvic floor muscle weakness may result in or worsen numerous problems including: 

(incontinence =  inability to voluntarily control bowel movements or urination)

• Urinary incontinence stress – the complaint of involuntary urine loss accompanying physical exertion or upon sneezing or coughing
• Urinary incontinence urge – the complaint of involuntary urine loss upon simply sensing a sudden need to pass urine 
• Mixed stress & urgency incontinence – the complaint of involuntary urine loss striking suddenly with sneezing, coughing, or  physical exertion
• Pelvic Organ Prolapse – a bulging of the bowel,  bladder, or uterus into the vagina or protruding out of the vagina in severe instances
• Sensing of vaginal looseness or feeling loss of sexual sensation

Why and How do Pelvic Floor Muscles Become Weak?   

• Like all muscles from under use.  Your pelvic floor muscles require exercise to work well.  Exercising your pelvic floor muscles should be a standard part of everyone’s fitness regimen and lifelong.
• Damage and stress to the muscles from surgery or over the course of a pregnancy and childbirth. 
• It’s theorized hormonal changes accompanying menopause can contribute to weakening the muscles. 
• Reduced muscle tone that comes with aging.
• Damage and stress to the muscles sustained over long-term straining with constipation, chronic coughing or obesity.

Pelvic Floor Therapy & Awareness of Your Core

Approximately one-third of adult women at some point in their lives experience pelvic floor dysfunction. Due to anatomy and functional complexity of the pelvic region, the underlying cause of pelvic floor dysfunction or pain can be difficult to identify.  Since pelvic muscle imbalances can be difficult to feel and perceive, treating the whole body is commonly part of the pelvic floor therapy healing and recovery process.

Your body’s center or ‘core’ encompasses your diaphragm (the muscle that controls breathing) and the muscles of your pelvic floor, abdomen, and back. Together, these muscles attach to your spine and pelvis.  As these structures can be very difficult to sense in the body, a key element of the healing process is awareness. With awareness of your body’s structures and the ability to gauge if they are performing correctly, you can now begin resolving your problems. As Physical Therapists we’re trained to identify muscular imbalances and then guide patients into proper exercise to maintain a healthy balance. Since the objective is to course correct the health of your pelvic floor in order to eliminate pain and encourage realignment, awareness of your approach to breathing is a great introduction to pelvic floor therapy.  

Pelvic Floor Therapy & Diaphragmatic (Deep Belly) Breathing

In addressing your body’s core, exercises centered on breathing will reduce strain while providing a gentle stretch across your pelvic floor.  Additionally this will enable your muscles to equally share the workload, better isolate and control the muscles of your pelvic floor to build strength.  

Though this exercise may initially appear to be low level, the research supporting it indicates its enormously effective for relaxing the pelvic floor.  In fact studies have proven how training your diaphragm muscle (breathing) is as effective as training your abdominal muscles and pelvic floor muscles in order to reduce pelvic floor dysfunction.

The diaphragm, a dome shaped muscle situated under the rib cage, is our main breathing muscle.  When breathing in, the diaphragm flattens out pushing on our abdominal region (stomach, bladder, intestines, etc), sending them downward to our pelvis.  Simultaneously, the abdominal muscles tighten slightly and the pelvic floor muscles lengthen slightly.  This enables us to manage the pressure increase that occurs in our abdomen when the diaphragm flattens out. While breathing out, essentially the opposite takes place:  the diaphragm now relaxing ascends upward to the heart, accompanied by the organs, as the muscles of your pelvic floor contract.  

Thus if you need to shout or cough – something requiring forcefully breathing out, the abdominal muscles will contract with force significantly increasing the pressure in our abdomen.  The muscles in your pelvic floor now must significantly contract, to keep internal things from being pushed downward.

For those struggling with continence (control of bladder or bowels), it is commonly this coordinated movement that is disrupted with muscles perhaps too tight (insufficiently relaxing) or too weak (insufficiently contracting).  An exercise called Diaphragmatic relaxing breathing or ‘deep belly breathing’ is optimal for engaging the right muscle pattern, lengthening the pelvic floor muscle, and helping you control your bladder and bowels.     

Here is a glimpse of the basic steps involved in deep belly breathing:

1 Rest on a flat surface in a comfortable position with your body firmly supported 

2 Place one hand on your lower stomach and the other hand on your breastbone. 

3 Gently breathe in through your nose and imagine the air filling your stomach so that your lower hand gently rises. You might also feel and note your ribs widening gently and move slightly upwards. 

4 Concentrate on breathing into your stomach so that your lower hand rises and falls as your upper hand remains relatively still.

5 Now exhale gently through your nose with awareness of the effects on the organs from the up and down motion of the diaphragm.  As you breathe out, allow the ribs and stomach to fall back gently to their original resting position. Try not being forceful in either breathing in or out.  When you take a deep belly breath allowing air to fill your lungs, the abdominopelvic cavity expands, the diaphragm drops down into the abdominopelvic cavity while the pelvic floor muscles drop down/lengthen – and then naturally recoils back up as you exhale.  As you start breathing deeply, the pelvic floor muscles should relax thereby allowing your urethra and anus to open more easily.

6 If you can, try to inhale to a count of 4 and similarly breath out for a count of 4, increasing this to 8 with practice.  Imagine the up and down motion of the diaphragm and the effects on the nearby organs.  Now with awareness on your pelvic floor muscles, when breathing out,  try and engage those muscles by squeezing them gently.   The key is to not only contract when you exhale, but also relax when you inhale.   If your pelvic floor muscles are not relaxing as they should, this may impair the mobility and function of the nerves and blood vessels, causing pain.  Also since pelvic floor muscles surround the openings of the urethra and anus, if they are super tight or if they are not able to appropriately relax down, it may be difficult to easily or completely empty the bladder or bowels.