Pelvic Floor Muscle Strengthening
If your pelvic floor needs strengthening, Duke physical therapists will work with you on exercises that incorporate muscle contractions, such as Kegels -- an exercise that involves tightening and relaxing your pelvic floor muscles. You’ll receive an exercise plan tailored to you based on your examination and goals. It may also include different positions, such as sitting, standing, or lying down.
Your physical therapist will teach you exercises to do at home, outside of sessions, so you can continue your care even after seeing the physical therapist. Pilates may be recommended to help strengthen the muscles around the pelvis.
Pelvic Floor Muscle Relaxation Techniques
If your symptoms are due to difficulty relaxing your pelvic floor, your physical therapist may recommend lengthening, stretching, and other relaxation techniques, like breathing exercises.
Pelvic Floor Muscle Coordination Training Exercises
Coordination training exercises focus on learning the appropriate times to tighten the pelvic floor (for instance, when you cough or sneeze) and when to relax the pelvic floor, like when you empty your bladder or have a bowel movement and work on how to do that effectively.
EMG Biofeedback Training
To assess your pelvic floor health, your physical therapist may incorporate EMG biofeedback. This machine provides a visual signal of when you’re activating and/or relaxing your pelvic floor muscles. You’ll be able to identify when you are correctly tightening and relaxing your pelvic floor and learn exercises to strengthen, relax, and coordinate the muscles.
Rectal Balloon Sensitivity and Expulsion Training
Rectal balloon sensitivity and expulsion training may be used if you have trouble having a bowel movement. Nerves in your rectum are responsible for signaling when you need to go to the bathroom. Sometimes, these nerves can be hypersensitive, meaning the rectum only holds a very small amount of feces before signaling to the brain that it needs to empty. In other instances, the rectal nerves may not be sensitive enough and too much waste builds up before the brain receives the signal that it’s time to go to the bathroom. Using this treatment, your physical therapist can help you learn what the appropriate time to defecate feels like.
Bowel and Bladder Training
Some bowel and bladder problems can be improved through education, such as proper toilet posture or breathing exercises to help your muscles relax.
Internal and External Manual Therapy Techniques
These techniques range from trigger point release to manual stretching of the tissue. Depending on the technique, your physical therapist will work on the muscle externally on the pelvis or through the vaginal wall or rectum internally.
Using acupuncture-like needles, dry needling aims to reset trigger points in the pelvic floor muscles. The goal is to relax and retrain tight muscles so they work properly.