What is Pelvic Floor Therapy and How Can It Help Me?

Pelvic floor therapy is a non-surgical rehabilitation approach that addresses complaints in the pelvic region. Pelvic floor PT is a specialized form of physical therapy where examination techniques and treatments are specific to pelvic floor functions including bowel and bladder dysfunction, sexual health and pelvic pain. General orthopedic physical therapy and pelvic floor physical therapy could involve patient education, therapeutic exercise, neuromuscular re-education, soft tissue mobilization and joint mobilization. Pelvic floor physical therapy targets treatments to the lumbopelvic girdle to address pelvic floor dysfunctions.

The conditions pelvic floor therapy address:

 Urinary incontinence
 Urinary urgency
 Urinary frequency
 Overactive bladder
 Interstitial cystitis
 Constipation
 Fecal incontinence
 Pelvic pain
 Rectal pain
 Pelvic prolapse
 Pain during intercourse
 Prenatal conditions
 Postpartum conditions
 Diastasis Recti

Pelvic floor issues are diagnosed through the patient’s history and an examination of the lumbopelvic region. This can include an internal and/or external exam of the pelvic floor. During an external exam, the therapist can assess tenderness of the muscles through the skin and assess the pelvic floor’s ability to lengthen and contract. An internal exam assesses the muscles through the vaginal wall. With an internal exam, the therapist can score the patient’s pelvic floor strength and endurance, as well as its ability to relax.

Some techniques and exercises include:
 Soft tissue mobilization and myofascial release to relax pelvic floor muscles
 Joint mobilization to improve range of motion of the pelvis, spine and hips
 Biofeedback to assist with proper recruitment of pelvic floor muscles
 Exercises to strengthen and lengthen the pelvic floor muscles
 Strengthen: pelvic tilts, kegels, squats, deadlifts, bridges, clamshells
 Lengthen: butterfly stretch, pelvic rocks on hands/knees and on ball,
 happy baby, child’s pose
 Local and global core strengthening

Some relaxation techniques include: 
 Bladder training
 Education on diet and lifestyle changes
 Stronger core = less low back pain
 Stronger pelvic floor = no more leaking when you cough or sneeze, helps with
 pressure from organ prolapse
 More relaxed pelvic floor = less discomfort with sex, decreased constipation,
 decreased pelvic pain
 Bladder training = decreased urinary urgency, urinary frequency
 Preparation for labor and birth

Some patients will see improvements immediately whereas most will see them between 4-6 weeks, depending on the prognosis.

I will usually see patients 1x per week for 4 weeks and then decrease to every other week and then to every 3 weeks for a check in. Generally, I’ll see patients for anywhere from 1 visit (1 week) to 6 months.

Interesting Facts:

 1/3 of women will experience pelvic floor dysfunction
 40-50% of post-menopausal women will experience incontinence
 Only about 25% of women living with incontinence seek professional help
 Men can benefit from pelvic floor therapy too!
 Up to 50% of women are unable to correctly contract their pelvic floor
 Correlation has been found between grinding teeth and pelvic floor tightness

Joanna Fisher, PT, DPT, OCS, FAAOMPT has been practicing physical therapy for 7 years. She earned her Bachelor’s degree in Animal Science in 2013 and Doctorate of Physical Therapy in 2016, both from University of Connecticut in Storrs, CT. She became a board certified Orthopedic Clinical Specialist in 2019. She completed her fellowship in Orthopedic Manual Physical Therapy from the Manual Therapy Institute in 2020. She works with all orthopedic conditions and especially enjoys treating equestrians and women suffering from pelvic floor complaints. She served on the House of Delegates for the Connecticut chapter of the APTA and on the Nominating Committee. She is an active member of the APTA and the American Academy of Orthopedic Manual Physical Therapists. You can visit her or make an appointment here: https://forwardmotionpt.net/

Read more about the pelvic floor on Rosewoman.com.

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Medically reviewed by Joanna Fisher, PT, DPT, OCS, FAAOMPT

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Frequently asked

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a non-surgical rehabilitation approach that treats problems in the pelvic region, including pelvic pain, painful intercourse, urinary or fecal incontinence, urgency and frequency, constipation, prolapse, and prenatal or postpartum conditions. A specially trained therapist uses education, therapeutic exercise, neuromuscular re-education, and soft-tissue and joint mobilization to help the pelvic floor muscles both contract and relax properly.

What conditions can pelvic floor therapy help with?

It can address urinary incontinence, urgency and frequency, overactive bladder, interstitial cystitis, constipation, fecal incontinence, pelvic and rectal pain, pelvic organ prolapse, pain during intercourse, and prenatal and postpartum concerns such as diastasis recti. A more relaxed, coordinated pelvic floor often means less pain with sex, less constipation, and less pelvic pain, while a stronger floor reduces leaking with coughing or sneezing.

How long does it take to feel results from pelvic floor therapy?

Some people notice improvements right away, but most see meaningful change within four to six weeks, depending on their condition. A common schedule is weekly visits for about four weeks, then every other week, then a check-in every three weeks. Overall care can range from a single visit to about six months.

Is pelvic pain and pelvic floor dysfunction common?

Yes. Roughly a quarter to a third of women experience a pelvic floor disorder, and 40 to 50 percent of post-menopausal women experience incontinence, yet only about 25 percent of women living with incontinence seek professional help. Up to half of women are unable to correctly contract the pelvic floor on their own, which is one reason guided therapy is so valuable. Men can benefit from pelvic floor therapy too.

References

1. Chronic Pelvic Pain— American College of Obstetricians and Gynecologists (ACOG)
2. Pelvic Health Rehabilitation— Cleveland Clinic
3. Prevalence and Trends of Symptomatic Pelvic Floor Disorders in U.S. Women— NIH / PubMed Central

Keep reading

• A Guide to Painful Sex →
• 1/3 of Women Deal with Urinary Incontinence →
• Switching On the Pelvic Bowl for Alignment, Power and Pleasure →