What is pelvic floor physical therapy?

This blog post will help you understand what pelvic floor physical therapy is, what to expect, and if it is right for you!

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a highly specialized discipline of physical therapy that addresses conditions of the pelvis including bowel, bladder, or sexual dysfunction, as well as conditions that impact the low back and hips. 

When I ask my patients, “What do you know about pelvic floor physical therapy?”, the answer I usually get is “I know you’re going to tell me to do kegels”.  While kegels may be a part of your plan of care, pelvic floor physical therapy looks at the pelvis as a system, and understands that your pelvic floor muscles do not work alone. In fact, they work together with the diaphragm, abdominal muscles, hips, spine, and glutes in order to support movement and manage pressure. In pelvic floor physical therapy, we evaluate how your pelvic floor muscles are working within the system of your body.

What is the pelvic floor?

The pelvic floor is a group of muscles that sits at the base of your pelvis and acts like a hammock to support your pelvic organs, including the rectum, the bladder, and uterus or the rectum, the bladder, and the prostate, depending on your anatomy. The pelvic floor is responsible for bowel and bladder support, sexual function, pressure management, and deep core support. It helps you to maintain continence, contributes to pleasure during intimacy, and stabilizes you during movement. 

Who can benefit from pelvic floor physical therapy?

The short answer is that anyone with a pelvis can benefit from pelvic floor physical therapy! Most commonly, pelvic floor physical therapy is helpful for conditions such as urinary or fecal incontinence, pelvic pain, pain or difficulty with intimacy, constipation, prolapse, or tailbone pain. A pelvic floor physical therapy plan of care can also help during pregnancy to prepare for birth or postpartum to heal from birth. Pelvic PT can also be helpful for people with low back pain, pelvic pain, or hip pain to return to activities they love like running, dancing, or lifting weights safely and without discomfort or leakage. 

What does pelvic floor physical therapy actually look like?

The first visit usually starts with a conversation to understand what your concerns are, to understand your medical history, and to get a good idea of what your goals are for physical therapy. From there, a physical assessment will take place to understand what your movement patterns are that may be contributing to your symptoms. It may include a strength assessment, some special tests to understand what may be driving your symptoms, and a breathing and posture assessment. Finally, an optional internal assessment may also be a part of your first visit. The internal assessment entails one finger with lubricant inserted vaginally or rectally to help us understand how your pelvic floor muscles are moving, if there is any guarding or muscle tension, what areas may be contributing to pain, how your pelvic floor muscles are coordinating with your brain, and how you are managing pressure.

From there, your physical therapist will create a plan of care based on your concerns, your movement needs, and your goals. The plan of care will include some combination of movement retraining, breathwork, pelvic floor exercises, strength training, and manual therapy. Your plan of care is collaborative, and will always require your ongoing consent and feedback to create and modify your treatment as needed. 

Is the internal assessment required?

The internal assessment is the gold standard to understanding how your pelvic floor muscles are working. An internal assessment can provide valuable information about how your pelvic floor muscles are working, but it is not required for pelvic floor physical therapy. If you consent to the exam, your physical therapist will use the pelvic model to describe what the exam will entail prior to the assessment. During the exam, your therapist will ask you for consent prior to each step, and explain the goal of each piece of the assessment and treatment. 

If you feel uncomfortable with the internal exam, there are absolutely other ways to assess the pelvic floor muscles. We can perform an external assessment by just looking or touching the muscles on the outside, we can instruct you how to perform the internal assessment on your own, or we can come up with some other form of assessment that you feel most comfortable with. Depending on your decision, your physical therapist will inform you of what information we can gather and what information may be missing from the assessment.

What happens after the initial evaluation?

A pelvic floor physical therapy plan of care lasts between 6-8 visits on average. Depending on the complexity of your symptoms and what your goals look like, this may be longer or shorter, and your physical therapist will give you a more accurate plan of care at your initial visit. Follow up visits last 60 minutes and are always 1:1 with a physical therapist. Typically, you will meet at the cadence of once a week, and once your symptoms start to improve and you feel more comfortable with independent management, your frequency will decrease to once every other week or check-ins as needed.

A physical therapy session may consist of manual therapy, movement retraining, functional training, and targeted exercises. Your plan of care and needs will evolve as you progress with the goal of helping you return to activities you love.

If you are experiencing pelvic floor dysfunction, low back pain, hip pain, or are prepping or recovering from birth, an evaluation from a pelvic floor physical therapist can help create a plan for care for you based on your individualized needs and goals so that you can return to activities you love. To learn more about if pelvic floor physical therapy is right for you, schedule a free consultation at this link here.

Written by Dr. Isha Kelkar PT, DPT, MPH