Beyond Anatomy: How Socioeconomic Context Shapes Pelvic Floor Physical Therapy
Written by Yuhang "Doris" Cai, PT, DPT
As an early-career physical therapist practicing at an outpatient orthopedic-pelvic floor clinic in the Bay Area, California, I have the opportunity to serve diverse populations with varying socioeconomic backgrounds. Pelvic floor physical therapy (PFPT) focuses on assessing and treating conditions related to urinary, bowel, and sexual function.
From my clinical experience, I have learned that pelvic floor symptoms are influenced by more than anatomy; they are also shaped by psychosocial and contextual factors, including socioeconomic circumstances. Understanding a patient’s socioeconomic context is essential in PFPT because it shapes symptom patterns, functional limitations, and treatment priorities. Clinicians who ask probing questions and adapt care to these contexts can significantly improve outcomes.
Understanding Symptoms in Context
A female patient was referred for pelvic pain and urinary leakage. The referral noted incomplete bladder emptying and recommended a specific voiding schedule. During evaluation, I asked when and in what situations she experienced leakage. She explained that she was busy caring for her mother post-stroke, and her leakage and back pain were most pronounced during lifting.
I observed her lifting technique and noted that she pulled her mother’s shoulders straight up. I also asked about pelvic pressure, heaviness, or bulge sensation, and she endorsed a feeling of “something coming out,” particularly during lifting.
Screening Beyond the Referral
Although the referral did not mention prolapse, a condition in which pelvic organs bulge into the vaginal canal, I screened for it based on her symptom of incomplete emptying and the repetitive stress of improper lifting. I identified a grade 2 prolapse and educated her on the importance of following up with her medical team for a definitive diagnosis if desired.
Screening for prolapse despite the absence of a referral diagnosis highlights the value of considering patients’ broader daily responsibilities and potential contributing factors beyond what is documented in referral notes.
Teaching Functional Strategies
I then taught strategies to lift and breathe properly, minimizing strain on the low back and pelvic floor. Specifically, I instructed her to keep her mother close to her body and use the log roll technique, which involves bending the person’s knees, rolling the whole body to the side, swinging the person’s legs down, and simultaneously lifting at the shoulders.
I emphasized exhaling during exertion, especially when rolling her mother or assisting her to sit up, because breath-holding increases intra-abdominal pressure, which can strain the pelvic floor and potentially worsen prolapse. Proper lifting and breathing techniques reduce musculoskeletal strain and protect pelvic floor integrity.
Positive Outcomes and Real-World Constraints
At her next visit, the patient reported no back pain during lifting and consistently remembered to exhale during exertion. She used only liners rather than pads, which were nearly dry, and was able to hold urine for 2.5 hours compared with one hour previously.
I encouraged her to continue PFPT to further improve her back pain, pelvic pain, incontinence, and prolapse symptoms. However, she was only able to attend PFPT once a month due to caregiving responsibilities, highlighting the real-world constraints faced by many patients with significant caregiving roles. Understanding these constraints allowed me to prioritize functional strategies she could apply independently, demonstrating the importance of patient-centered care tailored to individual circumstances.
Key Takeaways for Clinicians
This case illustrates the importance of asking about the timing, specificity, and context of pelvic floor symptoms, particularly for patients with complex daily responsibilities. It also demonstrates the value of tailoring interventions to real-life demands and patient-specific roles.
Caregivers cannot avoid lifting tasks, so PFPT should focus on strategies that minimize symptoms and prevent worsening conditions, in addition to pelvic floor muscle training. Integrating functional assessments into evaluation allows clinicians to identify improper body mechanics and target treatment accordingly.
The Role of Socioeconomic Context
Ultimately, this experience underscores how understanding socioeconomic factors can guide PFPT assessment and treatment. By asking context-specific questions, observing functional tasks, and considering patients’ responsibilities and resources, clinicians can personalize care, improve outcomes, and empower patients to manage pelvic floor symptoms in the context of their daily lives.
As PFPT continues to evolve, prioritizing individualized care that accounts for social context will be essential in addressing the multifactorial nature of pelvic floor dysfunctions and achieving meaningful, lasting results.
About the Author
Yuhang "Doris" Cai, PT, DPT
Yuhang Cai earned her Bachelor’s degree in Psychobiology with a minor in Food Studies from the University of California, Los Angeles, and her Doctor of Physical Therapy from the University of Southern California. She is passionate about pelvic health for all genders and is an active member of the Academy of Pelvic Health Physical Therapy. As the California State Representative for the Academy, Yuhang has organized webinars, distributed quarterly newsletters, and fostered community engagement to advance pelvic health knowledge. She currently practices at an outpatient orthopedic-pelvic floor clinic in the Bay Area, California, serving diverse populations across ethnic, cultural, and socioeconomic backgrounds.
