What is pelvic floor manual therapy?
The pelvic floor is a group of ligaments, muscles, tendons, nerves, lymphatics and connective tissue that provides the base and support for the pelvic area. Manual therapy for the pelvic floor is a combination of external therapy including belly, back, hips and leg and intra vaginal (please note that while all humans have a pelvic floor, I work only with uterus-carrying females).
In females, the pelvic floor holds the bladder in the front, uterus at the top, and the vagina and rectum in the back. These structures sit within the pelvic bowl and are supported by muscles that are not accessible from the outside of the body but often are from within the vagina. These muscles act like a hammock attaching to the pubic bone in the front and the tailbone in the back. Working internally can access muscles in the pelvis that may be the source of or contribute to many lingering and chronic symptoms.
Could I benefit from manual pelvic floor therapy?
Manual therapy for the pelvic floor can be helpful for almost everyone since it is so foundational to musculoskeletal health. Manual pelvic floor work may be particularly helpful for those experiencing:
Orthopedic/structural pain
Vaginal pain
Enhance sexual health
Soft tissue-related incontinence, frequent urination, nocturia, and other urinary disfunction
Bowel incontinence
Endometriosis
Lymphatic congestion
Supporting EDS and Hyper-mobility by assisting with muscle awareness and tone
Vaginal and rectal hemorrhoids
Menstrual cramping
Surgery recovery including cancer, cesarian, hysterectomy
Supporting tissue health in perimenopause and menopause
Support tissues before and after childbirth
Developing or restoring pelvic awareness and healthy muscle tone
Pelvic floor bodywork is available in pregnancy and can help by:
making space for optimal fetal positioning by reducing soft tissue restrictions in the pelvis; optimally positioned babies have more straightforward births, with less need for intervention/augmentation
reducing negative associations from past childbirth and other clinical or otherwise negative touch experiences
increasing familiarity with sensations of stretching for labor preparation, reducing risk or severity of tearing and episiotomy
Pelvic floor bodywork can help during the postpartum period (at least 6 weeks after birth):
c-section recovery
scar tissue management of laceration
diastasis recti (a separation of the muscles of the abdomen)
identifying and reducing prolapse
bladder issues like urgency, frequency, and incontinence
recovering healthy muscle tone after vaginal delivery
Frequently Asked Questions (FAQs)
What are the requirements for a Licensed Massage Therapist to do this work in Oregon?
Per OAR 334-010-0029, internal cavity massage using universal precautions for communicable disease control is permitted by LMTs able to
present evidence of specialized supervised training
communicate a valid therapeutic rationale for this treatment which is acknowledged by the client
obtain written and verbal consent from the client
offer the client the choice between having a witness present or not
use appropriate draping techniques at all times
No person under the age of 18 may receive intra-vaginal or intra-anal manual therapy from a Licensed Massage Therapist in Oregon; please see a Physical Therapist trained in pelvic floor therapy instead.
I have an IUD. Can I receive internal pelvic floor therapy?
Yes! Be sure you let me know in advance on your intake paperwork so we can talk about it before your session.
I have a mesh. Can I receive internal pelvic floor therapy?
If you have had your mesh for at least one year, and have not experienced any problems with the mesh, yes, you can receive internal pelvic floor massage therapy. If you are having problems with your mesh, please talk to your doctor.
I’m at the bleeding part of my menstrual cycle. Can I receive internal pelvic floor therapy?
Yes! However, if you are having very heavy flow along with painful cramping, it may be more comfortable for you to wait until the cramping has subsided before receiving internal manual therapy. I also suggest that people with endometriosis, hypermobility/connective tissue conditions, or mast cell disorders wait until their bleeding is over or nearly over.
I am an abuse/trauma survivor. Is this work right for me?
It depends. This work can “stir the pot,” bringing up sensations, memories, and experiences, so it’s really important that abuse and trauma survivors are also working with a qualified mental health professional in tandem with receiving internal pelvic floor manual therapy.
I have herpes. Can I receive internal pelvic floor therapy?
Yes! However, if you are experiencing an active outbreak, we should wait until it has subsided to avoid aggravating inflamed tissues.
I have had cancer in my pelvic organs. Is pelvic floor therapy safe for me?
Yes. In most cases. Pelvic therapy can assist in returning the tissues to a healthier state following surgery and radiation, soften even old scar tissue and assist in healthy lymphatic flow. I may ask for detailed medical records or approval from your Doctor if you are still receiving treatment.
What to expect for your first session
It’s totally natural if you feel a bit anxious about pelvic floor therapy, especially if you are new to it. Please feel free to ask questions during our intake. I will work with you to decide what is appropriate for you. No two women are alike so your treatment and sessions will be specific to your needs. I don’t have a required or recommended number of sessions aside from suggesting a minimum of two sessions. A lot can happen in a short amount of time; one session might make a dramatic difference or it might take several. Session length varies, though please allow at least 1.5 hours for your first session.
We will begin with a private consultation. You are always welcome to bring someone along with you if that makes you feel more comfortable. We will discuss your history, symptoms, and treatment goals. After some typical external massage work, I will do a brief visual pelvic floor exam to look for congestion, vascular concerns, inflammation, scarring, skin conditions, or prolapse. Once that is complete, with your permission I will begin treatment. This usually involves a bit of breath work and relaxation visualization while I access the intra-vaginal structures and muscles. At this time you will be under a sheet and will remain so.
Of course this work is different than typical bodywork such as a back or knee massage, but mostly because it addresses a different part of your body. The treatment itself is the same. I will find and address tight, tender tissues, ask you to activate muscles, facilitate stretching, and apply pressure the same way I would another body part. Your comfort and privacy are top priority. Communication is critical. If at any time you feel uncomfortable and wish to end the session you can simply say so. While some of this work might be a bit physically uncomfortable, it doesn’t hurt. There are tender spots and congested areas can feel sore but this should not be a painful experience. The internal portion of your session might be as little as 10 minutes or as long as 30, the average being about 15.
I have the highest respect for your body and your process. I do not judge or have expectations and strive to create a safe, comfortable space for all women on their journey to pelvic wellness.
PELVIC HEALTH RESOURCES
Resources coming soon!