In some cases, vaginal weighted cones or biofeedback might help. To use a vaginal cone, you insert it into your vagina and use pelvic muscle contractions to hold it in place during your daily activities. During a biofeedback session, your doctor or other health care provider inserts a pressure sensor into your vagina or rectum. As you relax and contract your pelvic floor muscles, a monitor will measure and display your pelvic floor activity.

_{Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.}
During the internal exam, your physical therapist will place a gloved finger into your vagina or rectum to assess the tone, strength, and irritability of your pelvic floor muscles and tissues. Internal exams and internal treatment are invaluable tools that are taught to pelvic floor physical therapists. It can tell us if there are trigger points (painful spots, with a referral pattern or local); muscle/tissue shortening; nerve irritation and/or bony malalignment that could be causing your pain directly or inhibiting the full function of your pelvic floor muscles. We can also determine if your pelvic floor has good coordination during the exam. A pelvic floor without good coordination, may not open and close appropriately for activities such as going to the bathroom, supporting our pelvis and trunk, sexual activity, and keeping us continent.
^{“I would recommend that people call the facility and maybe schedule the first appointment and see how you feel about it. I also think patient support groups tend to have closed Facebook groups and they can recommend people in certain geographical areas. I know people call [our practice] a lot and we try and get them paired up with somebody we trust in their area,” Prendergast says.}
Issues with the pelvic floor can arise from a multitude of reasons. Infections, previous surgeries, childbirth, postural and lifting problems, and trips and falls can all bring on pelvic floor dysfunction. Pelvic floor pain can persist well after the cause of it has been removed. So it is entirely possible to feel the effects of an old infection, surgery or injury, days to years after they occur. Anyone who has had long standing abdomino-pelvic pain, or pain that they can’t seem to get rid of after seeking the help of medical doctors or other healthcare providers is a good candidate for a pelvic floor physical therapy evaluation and possible curative treatment.

The pelvic floor is a group of muscles--in both men and women--that support your spine, help control your bladder, and help with sexual functions. By identifying your pelvic floor, performing Kegels (a popular pelvic floor exercise), and practicing other pelvic floor exercises, you can rehabilitate these muscles. In time, you can gain the benefits of a strong pelvic floor, including reduced urinary incontinence, less back pain, more control of your core, and better sex.

“I intentionally try and distract you during treatment, so that you don’t focus too much on the pain of the treatment. Furthermore, talking during our sessions continues to build rapport which is so important — it builds trust, makes you feel more comfortable, and also makes it more likely that you will return for your follow-up visits so that you will get better,” she says.

Biofeedback is a modality that allows you to learn how to better control your muscles for optimal function. Biofeedback shows you what your muscles are doing in-real time. It is helpful to teach patients to lengthen and relax the pelvic floor for issues like general pelvic pain, painful sexual activity and constipation or to contract the pelvic floor in order to prevent leakage with activities like coughing, laughing, lifting, running or moving heavy objects. However, biofeedback does not demonstrate shortened muscles and tissues; therefore, in certain cases the biofeedback may seem to be within normal limits but yet the patient has 10/10 pain. In these incidences, manual palpation is more appropriate to identify restricted and shortened tissues and muscles, and myofascial trigger points.
But while “vaginal massage” is a general, nonspecific term, it may be used to treat the musculoskeletal system of the pelvic floor, notes Dr. Huang. Sometimes this may be internally through the vagina or anus, though the target isn’t the vagina itself, but rather the muscles. “Some muscles, like hip rotator and pelvic floor muscles, are better accessed internally,” she says. (Imbalances in other muscles like those found in the abdominal wall or hip girdle are best treated from the outside.)

Once we determine the cause of our patient’s pelvic floor dysfunction, we design a plan tailored to the patient’s needs. At Beyond Basics, we have a diverse crew of physical therapists who bring their own training and background into each treatment. What is really beautiful about that, is that all teach and help each other grow as practitioners. It will be difficult to go over every single type of treatment in one blog post, but we will review some of the main staples of pelvic floor rehab.

Nicole Davis is a writer based in Madison, WI, a personal trainer, and a group fitness instructor whose goal is to help women live stronger, healthier, happier lives. When she’s not working out with her husband or chasing around her young daughter, she’s watching crime TV shows or making sourdough bread from scratch. Find her on Instagram for fitness tidbits, #momlife and more.