What is the pelvic floor?
Your pelvic floor is made up of muscles and connective tissues. It is shaped like a bowl and supports your pelvic organs. These organs include your bladder, your bowels and rectum, and your uterus and/or vagina. If the pelvic floor isn’t working well, then you may have issues with:
- pelvic pain
- leaking of urine or stool
- pelvic or vaginal prolapse
- a number of other issues we call pelvic floor disorders
What is pelvic floor physical therapy?
Pelvic floor physical therapy (PFPT) is a type of treatment for people with certain kinds of pelvic floor disorders. It involves one-on-one treatment with a trained pelvic floor physical therapist. The therapist assesses your pelvic floor and designs a treatment plan for you. This treatment plan may involve:
- external work– pressure and massage of the hips, buttocks, perineum, vulva
- internal work– manipulation of muscles and connective tissue of the pelvic floor through the vagina or rectum
- biofeedback and electrical stimulation
What about Kegel exercises? Aren’t those pelvic floor exercises? Why do I need to go see a pelvic floor physical therapist if I know how to do Kegels?
Kegel exercises are only one kind of pelvic floor exercise. It may not be the best type of exercise depending on what kind of pelvic floor disorder you have. Also, Kegel exercises can actually be very difficult to perform correctly. Some people may think they know how to perform a Kegel exercise, but in fact, they are performing the exercise incorrectly and may be making their pelvic floor problem worse. That said, if you are pretty sure that you’re doing your Kegels correctly, then it is a good place to start, especially after you have a baby. In addition, some common yoga exercises can help strengthen pelvic muscles.
Your pelvic floor physical therapist will evaluate your overall pelvic health and determine what kind of pelvic floor exercises best meet your needs. Your therapist will teach you how to perform the right kind of pelvic floor exercises the right way. Some people may learn how to do strengthening exercises such as Kegel exercises, while others will learn how to do relaxing exercises.
What kind of conditions can be treated with pelvic floor physical therapy?
There are a number of different kinds of pelvic floor disorders that can be treated with pelvic floor physical therapy. These disorders include:
- leaking of urine
- leaking of stool
- overactive bladder
- pelvic organ prolapse
- pelvic pain
- pain with sex
- sexual dysfunction
How does PFPT work to help treat my pelvic floor disorder?
Depending on what kind of pelvic floor issue you have, your pelvic floor physical therapist will create a personalized plan to treat your condition.
If you have issues with leaking urine when you laugh, sneeze or cough, your physical therapist may help you learn to activate your pelvic floor muscles to hold your bladder when you’re doing those activities. If you have issues with leaking urine when you feel a desire to go to the bathroom, your therapist may help you learn to activate your pelvic floor muscles to hold your bladder when you’re having a strong urge.
If pain is your primary issue, your pelvic floor physical therapist may diagnose you with myofascial pain syndrome. This pain syndrome is caused by tight and tender pelvic floor muscles. You may also have trigger points which are areas in your pelvic floor muscles which when pressed cause pain. This pain syndrome can be related to other pain syndromes such as painful bladder syndrome, pain with sex and other pain disorders related to pelvic organs. Your therapist will focus on relaxing your tight pelvic floor muscles and treating the trigger points that can cause flare-ups in your pain.
What are common symptoms of myofascial pelvic floor disorder?
You might have pain in the pelvis. You may also experience pain in your vagina, vulva, rectum, or bladder, which may or may not be caused by sex. You may notice pain in other areas such as hips, back, buttocks, or abdomen. You may also notice burning, dull aching, or a heaviness in your pelvis. Other symptoms include urinary frequency and urgency and issues with constipation.
How did I get myofascial pelvic floor disorder?
We do not know why some people develop myofascial pelvic floor disorders. Some people who had tears at the time of childbirth may develop myofascial pain. Some may have had pain due to other conditions that led to pelvic floor dysfunction. Some people have issues with vulvovaginal processes such as thinning of the vaginal tissue from menopause and develop pain because of this, leading to myofascial pain. If you have an underlying cause of your pain, be sure to mention this to your medical provider and therapist.
What conditions are not treated by pelvic floor physical therapy?
Pelvic floor physical therapy can be very helpful for people who have symptoms due to a weak or tight/painful pelvic floor. However, conditions not related to a weak or tight/painful pelvic floor cannot be treated with PT. Some of those conditions include:
- pain of the vulva or vagina due to infection or skin changes
- pain or incontinence due to bladder infections
- pain or incontinence due to inflammatory conditions of the bowel
- leaking due to a fistula or diverticulum
Please see your medical provider to determine if you have a condition that needs to be addressed separately from PT.
What can I expect during my course of pelvic floor physical therapy?
You will likely undergo a course of therapy that lasts 10 to 12 weeks. Each week you will meet with your therapist for 1-hour sessions. During this course, you will be given exercises to perform at home. At the end of this treatment course, your therapist will assess your progress and determine whether or not you should continue with another course of therapy or if you can be discharged from in-person treatment and just continue with home therapy. If you have a history of trauma or abuse, please let your medical provider and physical therapist know. They will work with you to make sure you are comfortable with the planned therapy course and to make any adjustments needed in order to meet your treatment goals.
When happens after pelvic floor physical therapy?
You should continue with your home exercises as instructed by your pelvic floor physical therapist. You should also follow up with the medical provider who referred you to the therapist to make sure there are no additional treatments you should pursue.
Take Home Points
- Pelvic floor physical therapy can be a very helpful treatment for women with certain pelvic floor disorders.
- Myofascial pelvic floor dysfunction is caused by tight and tender pelvic muscles and can be helped by pelvic floor physical therapy.
- Pelvic Floor Muscles in Women, from the Continence Foundation of Australia: https://www.continence.org.au/who-it-affects/women/female-pelvic-floor
- Pelvic Floor Exercises, A Guide for Women: https://www.yourpelvicfloor.org/media/Pelvic_Floor_Exercises_RV2-1.pdf
- Voices for PFD, Pelvic Floor Muscle Strengthening: https://www.voicesforpfd.org/assets/2/6/Kegel_Exercises.pdf
Emi Bretschneider, MD
Assistant Professor, Department of OB-GYN,
Urogynecology & Reconstructive Pelvic Surgery,
Northwestern Medicine, Chicago, IL, USA
No conflicts of interest to report.