Your Pelvic Floor and You: Answers to Common Questions About Pelvic Floor Physical Therapy

Reviewed and contributions made by Kari (Ziemba) Melby, MPT, Senior Director of Women's Health

If you think of the pelvis as the home to major organs like the bladder, vagina, uterus (or prostate in men), and rectum, then the pelvic floor muscles are considered the home’s foundation. Everyone has a pelvic floor made up of pelvic and lower abdominal organs, nerves, veins, and an interwoven network of muscles, ligaments, and connective tissue. 

This “network” is known as the pelvic floor, which forms a sling-like hammock or bowl in the lower part of the pelvis. It helps support and stabilize organs and aid in bladder, bowel, and sexual function. It also works in coordination with the deep abdominal muscles for core stability and strength.

Pelvic floor physical therapy is a branch of physical therapy. It involves everything that affects your abdominal and pelvic areas, including all the muscles, bones, ligaments, and fascia. 

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What is pelvic floor dysfunction and how common is it?

Pelvic floor dysfunction occurs when the pelvic floor muscles are unable to relax or work together the way they should. If these muscles can’t relax or work in a coordinated manner, one may experience several symptoms. Constipation, pain during sexual activity, and/or difficulty controlling your bowels or urine may be a sign that pelvic floor therapy might be right for you.

Many patients feel embarrassed by their symptoms, but they shouldn’t be! Approximately one in four women will suffer from a pelvic floor disorder in their lifetime. Right now, one-third of all women and more than 50 percent of women over the age of 55 are affected by a pelvic floor disorder.

What causes pelvic floor dysfunction?

Pelvic floor muscle changes can be caused by several factors. Such factors include pregnancy, childbirth, trauma to the pelvis, and pelvic surgeries. Other reasons may involve obesity, muscle straining because of pushing too hard to have a bowel movement, or from using the restroom too often.

Pregnancy and childbirth are main causes for women in developing a pelvic floor disorder. But men can also develop this condition. Additionally, surgery or radiation can cause nerve or tissue damage, which can also lead to a pelvic floor disorder. Other causes include a history of lifting or moving heavy objects as well as hereditary conditions. 

How do you know if you need pelvic floor physical therapy?

Pelvic floor physical therapy seeks to relieve the symptoms of pelvic floor dysfunction. It also aims to make the pelvic muscles work the way they should. This type of physical therapy may be right for you if you experience one or more of the following symptoms: 

• Frequently needing to use the bathroom
• Constipation or a straining pain during bowel movements
• Leaking urine (incontinence) or stool
• Painful urination
• Feeling ongoing pain in your pelvic region, genitals, or rectum (with or without a bowel movement)
• Feeling pressure or heaviness in your pelvic region
• Difficulty fully emptying your bladder or bowel
• Feeling pain in your lower back or hips with no other cause 

What should I expect at my first appointment?

First Assessment

When you begin pelvic floor therapy, a physical therapist will learn more about your concerns by having a detailed conversation with you. You will discuss your medical history, symptoms, difficulties with activity completion and lifestyle. Your physical therapist will then check alignment and muscle function in your trunk, pelvis and hips. They will assess your core muscles to gauge how strong they are and how well they work together. 

This assessment typically includes checking the control, strength, mobility, and endurance of core support and pelvic muscles. Your PT will also test these muscles in different activities and positions. It will help your physical therapist create a treatment plan to help you improve, so you can get back to your daily routine and start feeling better.

Secondary Assessment

For concerns involving bowel, bladder, sexual function or core weakness, an internal pelvic floor muscle assessment is needed. However, this evaluation may not be completed at your first session. Your physical therapist will recommend how often you should be seen based on their findings during your first visit and your doctor’s recommendations.

How do you do pelvic floor therapy?

Pelvic floor physical therapy is designed to improve muscle tone and strength. Our Women’s Health Specialists will take the time to determine what treatment is right for you. They will also be your guide throughout treatment. A list of our treatment options include:

• Patient, dietary and behavioral education
• External and internal soft tissue mobilization 
• Appropriate strengthening exercises and muscle awareness activities
• Biofeedback, electrical stimulation and transcutaneous electrical nerve stimulation (TENS)
• Hot and cold therapy
• Home exercise program
• Vaginal dilator program

Visit our Women’s Health Care Services page for full list of our treatment options. You can also learn more about scheduling your first appointment. 

How long does pelvic floor therapy take to work?

Some patients begin to see the benefits of pelvic floor physical therapy within three to four weeks. For others, it may take a few months. It is important to create muscle awareness and perform the strength exercises correctly. Regular check-ins with your physical therapist will ensure you’re doing them properly. 

In addition to body awareness and/or exercises, you can improve the function and reduce symptoms of pelvic floor dysfunction through lifestyle choices. Patients may improve symptoms by eating more fruit and vegetables, by drinking more water and by losing weight. They can also talk to their doctor for concerns that may increase pressure on the pelvic floor organs or muscles, such as chronic cough.

Can pelvic floor therapy benefit me? 

Absolutely! Our physical therapists can help ease the pain (and sometimes embarrassment) that accompanies this condition. They have the skills and tools available to help you live a fuller, more care-free life. 

Let us be a part of your health journey! Visit our website to learn more about ATI’s Women’s Health Physical Therapy and to find a women’s health specialist near you.