But MS can also cause symptoms in areas of the body that aren’t related to movement. It can affect your vision and speech, and also lead to problems with bladder and bowel control, as well as sexual function. For many people with MS, problems with bladder, bowel, and sexual function are more than just a potentially embarrassing inconvenience — they may cause substantial discomfort or pain, and can diminish your quality of life, as you live in fear of having an “accident” at any moment. These symptoms are not uncommon, either: One survey of 9,397 participants living with MS, published in the International Journal of MS Care, found that approximately one-third of respondents reported experiencing moderate to severe symptoms of bladder, bowel, or sexual function disorder. (A majority of respondents were white and female, which may have impacted results.) Physical therapists who specialize in pelvic health are trained to address a wide variety of conditions, from neurological disorders like MS to problems stemming from pregnancy, traumatic injury, surgery, or older age. No matter what causes it, pelvic floor dysfunction can lead to some of the same problems with bowel, bladder, and sexual function in both women and men. When seeking out pelvic floor PT for MS, it’s highly recommended that you look for someone with advanced training in pelvic conditions. A division of the American Physical Therapy Association (APTA), APTA Pelvic Health, offers several levels of advanced training in pelvic health, culminating in the Certificate of Achievement in Physical Therapy for pelvic health (CAPP-Pelvic). Each level of training consists of courses along with written and clinical testing. You can find an online CAPP Recipients List for pelvic and obstetric health, or ask your healthcare provider what kind of training in pelvic health a physical therapist has undergone. Here’s an overview of how pelvic floor PT can address problems stemming from MS in the pelvic area, what to expect from it, and how to decide if it’s right for you.
What’s the Benefit of Pelvic Floor Physical Therapy?
Pelvic floor PT may be helpful for anyone with MS whose pelvic floor muscles have become weakened or spastic. The main reasons people seek out a pelvic floor physical therapist include pain associated with bladder, bowel, or sexual function, as well as a desire to improve bladder control, according to Cameron Barber Pikula, a physical therapist and pelvic floor specialist at the Cleveland Clinic in Ohio. “A lot of times, goals for patients are decreasing pad usage, decreasing trips to the bathroom during the day or at night, and also making sure they can empty their bladder all the way,” says Pikula. Pikula explains that the pelvic floor muscles need to be able to completely contract to keep urine in and completely relax to let the bladder empty. Pelvic floor PT may focus on both aspects of muscle function. When it comes to pain, Pikula notes that in people with MS, the pelvic floor muscles can become overactive when they lose the ability to contract or relax completely, leading to a pain response. “It could be pain in the lower abdomen, or it could be specifically vaginal or rectal pain. In a male, it could be testicular or penile pain,” she notes. This pain may be associated with activities like urination, defecation, or sex. Most muscles in the pelvic floor work in tandem to control bladder, bowel, and sexual function, so PT exercises may help address more than one problem in the area — something that Pikula sees in many patients. “For patients who are having significant difficulty with either urine or bowel control, you typically see an overlap,” she says, even if someone initially tells her about just one problem. “With further questioning, a lot of times both systems can be involved.” One reason multiple systems are often involved? “They’re so close together,” says Pikula. “Imagine for a patient who’s having constipation, the bowel system is applying extra pressure on the bladder system, and the bladder system can’t work as effectively.”
What to Expect at Your Pelvic Floor Physical Therapy Appointment
At your first visit, your pelvic floor physical therapist will ask about your problems and concerns, and try to determine how your pelvic floor muscle function is related to them. “The first visit is a very extensive interview,” says Pikula. “It’s a lot of questioning to get a baseline sense of the systems.” In addition to getting a history of your symptoms and asking about your goals, your therapist will perform a physical assessment of your pelvic floor muscles. At your therapist’s discretion depending on your needs, this may involve a manual internal exam, whereby the therapist inserts a gloved finger into your vagina or rectum as appropriate. Another option is an external exam, which uses two fingers to evaluate the muscles from the outside. Following these initial assessments, your therapist will build an individualized home exercise program to help you make progress. You’ll learn these exercises and “talk about expectations of how long we think this is going to take to get better, based on what we find during an evaluation,” Pikula explains. Your program may include exercises to strengthen your pelvic floor muscles, as well as to help them relax. For pain-related concerns, “we’re thinking about getting those muscles to relax. It’s relaxation techniques, teaching stretching,” says Pikula. In some cases, your therapist may recommend manual therapy during your appointment to help certain muscles relax. You may also learn manual techniques to use on your own, such as an abdominal massage to address pain or tension. If strengthening muscles is the main goal of your exercises, these techniques may target not only your pelvic floor but also other muscles in areas such as your back, hips, and core. During your appointments, you may benefit from biofeedback, which uses a computer system to visualize what your muscles are doing via electrical sensors connected to your body. Since some pelvic floor muscles are deep inside your body, you may benefit from using certain tools to stimulate or massage them by inserting these tools into your vagina or rectum. “We can’t get to them another way except by doing intravaginal or intrarectal work,” Pikula explains. Whatever exercises your program includes, you’ll probably be asked to do them every day, for a maximum of 15 minutes. You’ll probably be given no more than three or four exercises to do, since any more can be difficult to remember or focus on, says Pikula. RELATED: The Best Exercises for Stronger Abs and a Stronger Core
How Long Does Pelvic Floor Physical Therapy Last?
How often you see your pelvic floor physical therapist will depend on type and severity of your problems. Pikula typically sees patients once a week to once a month. For pain-related concerns, “I tend to see [patients] more frequently, at least initially, until we build them a good program for home,” says Pikula. “Then the goal is to slowly decrease the frequency of visits as we work toward an independent program.” For concerns related to muscle weakness or coordination, she notes, “I’ll see [patients] every couple of weeks, because of the time it takes to get these muscles stronger” between visits. Seeing significant improvement in muscle strength may take six to eight weeks of consistent exercises, says Pikula. You can expect to stop seeing your therapist once you’ve met your goals, or when you’ve reached the maximum benefit from your program. “Unfortunately, we may not be able to meet their goals,” says Pikula. “But if they’ve made improvement and they’re comfortable with their home program, sometimes that’s when we finish seeing patients.” Typically, Pikula says that treating pain-related concerns involves 8 to 12 visits, while urinary or bowel control concerns involve 6 to 8 visits. But people with more severe MS may need more visits, she notes. Another factor is your health insurance plan, which may cover only a set number of visits. If you have the financial resources, you may choose to see your therapist longer than your plan’s policy allows, but it’s important to let your therapist know as soon as possible what limits are set by your plan.
Finding a Pelvic Floor Physical Therapist
Even if you’re convinced you could benefit from seeing one, it’s not necessarily easy to find a pelvic floor physical therapist. “Unfortunately, there are not a ton of us,” says Pikula. If you’re looking for a pelvic floor physical therapist in the United States, you can refer to the American Physical Therapy Association (APTA), which has a PT Locator tool to help you find a specialist in your area. You can also ask your neurologist or primary care doctor for a referral. Telehealth can help connect you with a specialist for pelvic floor PT, per the APTA, but the benefits of your visit are likely to be limited without a physical examination.
A Final Word on Whether Pelvic Floor Physical Therapy Is Right for You
If you have the ability to see a therapist but aren’t sure if it’s what you need or want, Pikula recommends considering how your problems affect you, and how much time and energy you’re willing to devote to improving them. “I think sometimes it comes down to worth and value,” says Pikula. “How much does the patient value what we’re giving them, and how much does it affect the quality of their life?”
