What is pelvic health physical therapy?

Pelvic health PT treats the muscles and connective tissue within your pelvis (in other words, the muscles that help you pee, poop, and support sexual function). These muscles can have dysfunction as a result of pregnancy and childbirth, trauma, injury, recurrent infection, surgery, hip pain, or even prolonged periods of stress.

 Dysfunction in the pelvic floor can show up as:

• incontinence (leaking)

• urinary frequency 

• pelvic pain (for example, putting in a tampon causing discomfort)

• chronic low back pain that hasn’t responded to other treatment

Issues like these are common, not normal! Leaking urine is something that many patients manage for a long time (often decades) without realizing that there is help. Some folks have been struggling with pelvic pain for as long as they can remember without knowing that relief is possible.

Physical therapy for pelvic health looks very similar to regular physical therapy – you learn movements to decrease symptoms and prevent future issues. Sometimes treatment may involve the use of an internal pelvic floor muscle assessment, which your PT can discuss with you.

Pelvic health PT encompasses much more than what can be covered here. See our FAQs or contact us with any questions.

What are some common things that come from pelvic floor dysfunction?

Urinary or bowel incontinence – leakage, whether urinary or bowel, is not normal and can indicate issues with coordination, endurance, tension, or strength of the pelvic floor.

Constipation —  defined as passing less than three bowel movements a week or difficulty passing stool (straining, pushing, or pain).

Urgency/frequency of urine or bowel – if you find yourself often going every hour, needing to go again and again, difficulty emptying your bladder or bowel, or leakage with a sudden urge to go to the restroom.

Pelvic pain – pain in the pubic bone, or around your saddle can arise from pelvic floor dysfunction. 

Sexual dysfunction — if you’ve had issues with arousal, sexual activity, inserting tampons, OB-GYN exams, or with sexual activity, the muscles of the pelvic floor may be having difficulty relaxing. Penile/ testicular, vaginal, rectal, or lower abdominal pain can be confusing and frightening, and too often pain with sexual activity is treated as normal. If any of the above are happening, please make sure to bring them up to your therapist. 

Low back or tailbone pain — the pelvic floor is a group of muscles that help to support the trunk and hips, so if these muscles are struggling to coordinate, it can contribute to low back pain. Often, training the pelvic floor goes hand in hand with training back and core.

Pelvic pressure, instability, or feeling like your organs are slipping out — this may be due to instability of the structures that help support your pelvic floor.

How can pelvic health PT fix my pelvic floor problems?

For some folks, improving strength and coordination of their pelvic floor can get rid of symptoms. For others, improving pelvic floor awareness and mobility may be key. And for some, it may be a matter of improving hip, back, and core function.

What happens at my first pelvic health PT visit?

Much like with “traditional” physical therapy, the first visit is all about getting to know you and the symptoms that bother you. We’ll discuss your medical history and your goals for physical therapy so that we can figure out how to best help you.

We may decide to do an internal pelvic floor muscle exam. Your therapist, using lubrication and gloves, will assess the muscles either vaginally or rectally. This is to understand how your pelvic floor is working. We may go forward with an internal exam on the first day, or it may be something we visit later in your care.

It’s common to be nervous at your first visit, and we want you to understand that you are in control. If you have any concerns, we want to hear them. If an internal muscle exam makes you uncomfortable or anxious, we want to know. We can discuss expectations, language, and ways to keep you comfortable and prepared. Ultimately, it may be that we decide together to hold off on an internal exam, and that’s okay. You’re here to improve your life, and we’re here to provide you with as many tools as we can to help you on that journey.

What should I wear?

While the words “pelvic floor” often bring to mind issues with bladder, bowel, and sexual function, it’s important to understand that the pelvic floor does not work alone - it’s part of a complex system! Because of this, wear something that’s easy to move around in, as we’ll likely want to take a look at some basic movements to tie the big picture together. Shorts or leggings, a t-shirt, and sneakers are a good bet.

So what comes next?

After we get your story and finish your exam, we’ll come up with a plan together. Your therapist will explain what they’ve found in the exam and how it relates to your problems, and describe what they think is the best course of action in terms of home exercises, what future visits will look like, and when you should start noticing positive changes. You’ll have time to ask questions and figure out what’s going to work best for you. Your therapist is on your team! Be as honest and open as possible about your current situation and your ability to carry out your treatment plan so that we can help you succeed!