Pelvic Floor Physical Therapy

Why see a pelvic floor therapist?

There are many pelvic floor conditions that can be managed and healed without surgery using the conservative treatment of pelvic floor physical therapy. A physical therapist (PT) who is trained as a pelvic floor therapist may help you better understand your symptoms and design a personalized program to help alleviate your pelvic discomfort or pain through retraining and strengthening your muscles and improving the way your body moves and functions. 

What to expect during the first appointment

Your first appointment will include a careful interview and discussion about your experience, including an account of symptoms, as well as medical history and lifestyle. The therapist will then perform a physical examination to identify the causes of your pelvic discomfort and/or pain—for example: joint issues, muscle tightness or weakness, or nerve involvement. The exam may include:

• Postural observation

• Pelvic bone alignment screening

• Soft tissue assessment

• Visual inspection of the tissues

• Reflex testing

• Sensation testing

• Internal assessment of pelvic floor muscles

• Internal examination helps a PT get a full sense of the strength, flexibility, and coordination of your pelvic floor muscles, ligaments and fascia. For women, this will be through the vagina (though not with a speculum like a standard pelvic exam). For men and some women, the exam is done rectally.  In some cases an internal exam is not necessary or possible, such as when your condition involves pain during penetration.

• If you are on your period or not comfortable doing this part during your first visit, the internal exam can wait until the second appointment. Pelvic floor therapists are trained to be sensitive to any pain or discomfort that arises and can modify the examination and treatment as needed. Be sure to speak up and know that you are in control–nothing should happen without your full consent.

How pelvic floor physical therapy can help

Based on the examination results, your physical therapist will design an individualized treatment program to meet your specific needs and goals. Your physical therapist may:

• Show you how to identify the appropriate muscles, such as the pelvic floor, deep abdominals, and diaphragm.

• Teach you appropriate exercises—exercises to stretch and strengthen the affected muscles and retrain them, so they work together normally and in a coordinated manner.

• Educate you on how to use these muscles correctly for activities like proper posture, exercise, getting up from a chair, or squatting to pick up a child or pick something up from the floor.

• Teach you techniques to improve blood flow and tissue function in the pelvic area.

• Review bladder and bowel habits and give recommendation on ways to improve your control of the bladder and bowel. 

• Guide you through an exercise/maintenance program for you perform at home to help you manage your symptoms and keep your body functioning the way it should.

Biofeedback for the pelvic floor muscles

This location does provide biofeedback for the pelvic floor muscles. Depending on your symptoms and level of discomfort, your physical therapist may decide to use biofeedback to help make you aware of how your pelvic floor muscles work, and how you can control them better. During biofeedback, small electrodes are attached to the area to measure your muscle activity as it display on a monitor for you to see. These sensors do not do anything to you; they read the electrical activity in your muscles so that you and your therapist can see your pelvic floor muscles at work on a monitor. Your therapist will guide you through the appropriate exercises needed to improve your muscles activity and function. Being able to visually see the activity of your pelvic floor muscles will help you to understand and learn to change those readings as needed. 

Your PT should be able to give you an approximate timeline for therapy, though rehabilitation and healing is not always predictable. We recommend collaborating with your therapist to set specific treatment goals, such as having comfortable sex, alleviating back pain, managing incontinence, etc. Again, pelvic floor therapists are trained to be sensitive to how personal and intimate these topics and this part of your body can be. Your therapist will explain along the way what they are noticing and how physical therapy can help. 

Integrated, holistic approach to health and wellness

Pelvic floor issues are rarely isolated—it is common for symptoms to emerge together or for on problem to cause a cascading effect. Some conditions treated by a pelvic rehabilitation therapist include:

• Bladder and bowel issues

• Incontinence

• Prolapse

• Painful sex or an inability to have penetrative sex

• Vaginismus

• Vulvodynia (pain of vulva) and genital skin conditions

• Musculoskeletal aches and pains (involving the back, hips, SI joint, groin, abdomen and sometimes limbs)

• Pregnancy & postpartum recovery

• Constipation/IBS

You might need to seek care from multiple specialists to address complicate pelvic issues. Sometimes putting together an integrated treatment plan including a PT/OT, other specialists, and complementary medicine services such massage, yoga, bodywork, and nutritional guidance is the best approach. Your primary care provider or OB/GYN may be able to help you with this.