Women talk! Especially when it comes to health issues. But some things may be a little embarrassing to have a conversation about. You know…like sneezing in the grocery store and having to run to the bathroom. I have friends who have had that happen to them on a regular basis. But there is help out there. I talked to Rakhi Srivastava, MOT, OTR/L, from The Christ Hospital Physical and Occupational Therapy Centers about pelvic floor therapy. This is something that can help avoid those "accidents"—and so many other issues.

What is pelvic floor therapy?
That was my very first question! I really did not know what it was, but Rakhi cleared it up for me. She explained, "Pelvic floor therapy seeks to evaluate various pelvic floor dysfunctions and create a customized treatment program based on a person's specific needs or symptoms. The occupational or physical therapist's evaluation will include taking a detailed social and medical history with special attention given to issues associated with the bladder, bowel, or sexual dysfunction. The therapist will do a postural evaluation, look at gait patterns, assess core/hip strength and movement restrictions, and (with consent) conduct an internal vaginal or rectal muscle evaluation.

They will assess for pain and tailor their treatment program accordingly. An internal muscle evaluation is not always necessary but is often the best way to fully assess for functional deficits and get the full picture of the problem. Treatment sessions will include such things as exercises to strengthen the pelvic floor in instances of weakness and loss of bladder or bowel control; stretches and strategies to reduce tension in the pelvic floor in instances of pelvic or abdominal pain; biofeedback or electrical stimulation to improve muscle contraction, relaxation, and awareness; soft tissue mobilization to address muscle imbalances; postural correction; recommendations for diet, hygiene, lifestyle, or behavior modification to improve symptoms."

Who can benefit from pelvic floor therapy

I am getting to that "age," and I have also had two children. I am fortunate not to have experienced problems yet, but I have heard from a lot of my friends that have. One thing that I was surprised to learn is that pelvic floor therapy can actually help people of all ages. Rakhi said, "Here at Christ, I treat all genders, and my patients have ranged in age from 16 to over 100. There are even pediatric pelvic floor therapists, and many children benefit from therapy in this area (think constipation and bedwetting as the most common issues in children). Common pelvic floor dysfunctions include urinary frequency and urgency, urge incontinence (the 'gotta go right now' feeling), stress incontinence (bladder leakage with coughing/sneezing/laughing/moving), constipation/diarrhea, bowel or gas incontinence, pelvic pain and pressure, pain with sexual intercourse or other sexual activity, pelvic organ prolapse, and tailbone/lower back/hip pain, among others."

She says that pelvic floor therapy can also help women while they are pregnant and after childbirth. We have all known someone who has admitted to sneezing or laughing in public and it didn't turn out so well. She says that is not normal, and it's never too late to seek pelvic floor therapy.

When will you see a difference?
The friends that I know that have had pelvic floor therapy have seen the difference pretty quickly, while another said it took her a bit longer. That is exactly what Rakhi said. She told me that basically every case is different. She elaborated, "My patients typically require between 6-12 visits, but I've had patients who only need one session and others who have more chronic and complex issues that I have treated for over a year."  In this day and age, time is essential, but I was told that sessions last only about 30 minutes to an hour, and patients typically are seen once a week, which, to me, is not a long time to do something that can seriously improve your quality of life.

Can you do at-home exercises?
Okay, I'll admit the first thing I think of when I hear about pelvic floor therapy: Kegel exercises. But, according to Rakhi, that's really not the case at all. She had this to say about Kegel exercises: "Everyone comes to pelvic therapy expecting to be sent home with Kegel exercises. What I will say is that Kegel exercises are definitely not for everyone! In fact, for a patient who has pelvic or bladder pain, they can be very damaging. People also are often not doing them correctly. There are many other exercises that can help strengthen the pelvic floor besides Kegels. And even if they are appropriate, they will not be useful as a stand-alone exercise." She also advises, just like anything, staying active and maintaining a healthy weight will help. Also, drinking lots of water is a good thing!

As a woman, I know that talking to anyone about this kind of problem can be embarrassing, but it shouldn't be! Rakhi urges you to talk to your primary care doctors, OBGYNs (and midwives), urologists, urogynecologists, gastrointestinal, and colon and rectal surgery doctors, who are all quite familiar with these issues.

She gave me one last tip. "It helps to avoid the 5 C's—constipation, caffeine, citrus, carbonation and chocolate. I'm always surprised when people don't realize that that second cup of coffee may be the culprit for their bladder issues. Also, most people need a Squatty Potty in their lives. You'll thank me later!"

Learn more about The Christ Hospital Pelvic Floor Center.