You might have heard of the pelvic floor—the group of muscles and connective tissue that form a hammock-, sling-, or basket-like shape along the bottom of the pelvis—while practicing yoga or Pilates. But until relatively recently, pelvic floor issues remained somewhat unknown.
No matter what your familiarity is with the pelvic floor, it’s more than just a fitness catchphrase. These workhorse muscles hold your internal and reproductive organs Mayo Clinic “Pelvic floor muscles” View Source in place so they can function correctly. When it isn’t functioning as well, you may experience incontinence, constipation, organ prolapse, pelvic pain, erectile issues, and other symptoms.
If you’re experiencing discomfort or a lack of function around your pelvic floor, the first step is to talk to your medical doctor. They can help talk through any symptoms and decide if you should see a pelvic floor physical therapist. Wondering what pelvic floor physical therapy entails? We’ve got the details—from what to expect from your first appointment to what progress you can expect over time.
What Is the Pelvic Floor?
The pelvic floor consists of muscles and connective tissue National Center for Biotechnology Information Bookshelf “Pelvic Floor Dysfunction” View Source that connect to your pelvic bone and support the pelvic organs, including the intestines, bladder, urethra, rectum, and anus. If you have male genitalia, the pelvic floor area includes your prostate, penis and scrotum/testes. If you have female genitalia, the muscles include your uterus, cervix, and vagina.
In addition to protecting and holding your pelvic organs in place, your pelvic floor contracts when you cough or sneeze, aids in the control of passing urine and having bowel movements, and contributes to sexual function Mayo Clinic proceedings “Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction” View Source . Finally, your pelvic floor aids in circulation around the entire pelvic region.
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction (PFD) is a term that’s used to describe a range of symptoms and conditions including incontinence (bladder or bowel control problems), interstitial cystitis, constipation, pelvic organ prolapse, tailbone pain, and pelvic pain. Among those with male genitalia, PFD can also be at play with prostatitis, scrotal and/or testicular pain, pain around ejaculation, and erectile issues.
“You may have a pelvic floor dysfunction that’s manifesting as low back or hip pain,” says Sarah Kaiser of Seattle-based Union Physical Therapy. Kaiser began treating PFD when she noticed an uptick in complex low-back and hip pain among her women patients. “Maybe you’d [previously] seen a physical therapist for back-, hip- or sacroiliac joint-pain, and you just weren’t quite getting to where you wanted to be. That might be an indication to look deeper and assess the function of the pelvic floor.”
Ashley Rawlins, a doctor of physical therapy who practices with Origin PT, describes muscle activity as a spectrum. There can be areas of strength and weakness contributing to pelvic health and/or dysfunction. As the pelvic floor is a relatively nuanced area of the body, physical therapists caution against using any one resource or article to self-diagnose a condition.
The best course of action? Check with your doctor if something feels off. They can help evaluate your experience and come up with a treatment plan that accounts for your health history, including your reproductive and sexual health history, says Serena Fiacco, a doctor of physical therapy who brings a lens of sexual health to her practice, The Pelvic Health Clinic.
Who Experiences Pelvic Floor Dysfunction?
People of all ages and genders have a pelvic floor and can experience pelvic floor dysfunction or discomfort. Studies Scientific Reports “Prevalence of pelvic floor disorders in adult women being seen in a primary care setting and associated risk factors” View Source show that between one in four and one in three U.S. women experience pelvic floor dysfunction; for women 80 and older, the rate may be significantly higher. Pelvic floor dysfunction also affects men, although current rates aren’t well-documented. Research demonstrates that those who have experienced sexual abuse or trauma JAMA “Sexual Abuse and Lifetime Diagnosis of Somatic Disorders” View Source are at a higher risk for developing pelvic floor issues. Individuals who are experiencing gender dysphoria, or who are considering or recovering from gender-affirming surgery may also be interested in seeking out pelvic floor PT.
What Is Pelvic Floor Therapy?
Pelvic floor physical therapy is often the first line of treatment against pelvic floor dysfunction. It’s similar to other forms of PT: With your therapist, you’ll develop a plan to reduce or manage symptoms, address functional limitations, and regain desired movement. Sessions usually involve a combination of hands-on massage or manipulation, plus exercises you practice with your PT and independently at home.
How Do I Find a Pelvic Health Physical Therapist?
Two organizations provide PTs with continuing education in order to specialize in the pelvic floor—the Herman Wallace Institute and the American Physical Therapy Association. Both organizations have directories where you can find a trained pelvic floor physical therapist.
It’s important to find a care provider who asks you questions and listens to your experience with compassion. A specialist or physical therapist should never pressure or force you to discuss experiences of sexual abuse or trauma that you’d prefer not to share.
If you’re experiencing gender dysphoria or undergoing gender-affirming surgery, in particular, consider consulting with your pelvic health provider to find a PT. “You want someone who’s received training and who will individualize your care and respond to your specific needs,” says Rawlins.
What To Expect in Your First Pelvic Floor Therapy Appointment
You can do pelvic floor physical therapy in person or virtually. (Or a combination of both.) During your first session—sometimes called an intake—your physical therapist will ask questions about your health history. Your PT will also likely ask how long your symptoms have persisted, what seems to trigger your symptoms, and anything you want to share about your sexual or reproductive health history.
In a virtual session, your practitioner may prescribe some exercises based on how you describe your symptoms and respond to their questions. You’ll then do the moves together so your PT can see how they work for you. They may modify based on how you feel.
In an in-person session, you will receive an exam, which may include an external and an internal portion. During the external exam, your PT will scan your lumbo-pelvic region, including your hips, low back, and sacroiliac joint to determine if there are muscle imbalances that could be linked to your pelvic floor. Your PT will also examine the skin, tissues, and muscles that support and attach to your pelvis, including your abs, iliopsoas (a hip flexor muscle), and piriformis (a glute muscle that helps you rotate your hips).
During an internal exam, your PT may insert a gloved finger into your vagina (for those with female genitalia) or rectum (for those with male genitalia) to assess tenderness and muscle function. The internal exam may not always be warranted, however. Physical therapists often avoid giving pregnant people an internal exam, for instance, to prevent the spread of illness. Likewise, an internal exam may not be warranted for men, especially if the PT is able to collect enough evidence through external palpation.
Any portion of the exam—external or internal—is optional. And you should expect your PT to explain the assessments they’re making each step along the way. “If it’s feeling too invasive, people always have the right to say ‘No.’” Kaiser says, “A good pelvic floor therapist will respect that.”
What To Wear To Pelvic Floor Therapy
Don’t give it too much thought, according to Rawlins. Any piece of clothing that’s comfortable for you and easy to move around in is golden. Consider something you might wear to a yoga class—stretchy pants, a loose-fitting top, and a supportive (but not restrictive) sports bra if needed. When in doubt ask your PT what they recommend.
Pelvic Floor Therapy Exercises
A good pelvic floor PT will have a “deep pocket of tools, techniques, and approaches to pelvic healthcare,” says Rawlins. “There isn’t a one-size-fits-all approach to pelvic physical therapy.”
Some exercises you might see include:
- Heel slide: To engage the deep muscles in the core and possibly offset low back pain caused by PFD.
- Lie flat on your back on a yoga mat or other comfortable surface. Pull one leg up, keeping your feet on the ground, so your knee is at a 90-degree angle with your torso. As you pull your knee up, you should feel some tension (though not discomfort) in your core. Repeat on the other side.
- Glute bridge: To activate pelvic muscles (in addition to the glutes).
- Lie on your back with your feet on the floor. Contract your ab muscles so your back lies flat on the ground, then gently push your hips up, maintaining a (relatively) straight back and firm core. Hold for a second, then lower yourself back down.
- Bird-dog: To activates the whole core. It’s often recommended for people with incontinence.
- Get on your hands and knees and extend one hand and the opposite leg. (You can also do just the leg or just the hand.) Keep them raised with your abs engaged and spine neutral. Repeat on the other side.
What about kegels MedlinePlus “Kegel exercises - self-care” View Source for PFD? If you’ve read anything about the pelvic floor, you may have heard about this exercise in which you intentionally contract and release your pelvic floor muscles to strengthen the area. And it’s very possible that you’ll see them in a pelvic floor PT session.
However, Kaiser and her colleague Amanda Benson, also of Union Physical Therapy, say you should get a proper analysis of your pelvic floor before incorporating kegels (or any kind of targeted treatment) into your daily routine. Pelvic dysfunction can also be a sign that your muscles are overactive, and strengthening your pelvic area with kegels may exacerbate the issue. Determining what’s going on is a critical first step to effectively treating PFD.
Pelvic Floor Therapy Technology
In addition to traditional exercises and manual therapy, your physical therapist might use two other methods during a PT session: biofeedback and electronic stimulation.
Biofeedback is a broad term that refers to a range of techniques that pelvic floor PTs may use to show patients how they’re activating their pelvic floor muscles. A low-tech version might be using a mirror to observe how the muscles around your vaginal, penile, and/or perineal muscles pull away from the mirror when you contract them.
A more high-tech version of this feedback involves using external or internal sensors to detect your muscle activity when you contract or relax your pelvic floor muscles. The sensors are hooked up to a computer, which uses a screen to display areas of activity.
Research shows that electrical stimulation ScienceDirect “Intravaginal electrical stimulation increases voluntarily pelvic floor muscle contractions in women who are unable to voluntarily contract their pelvic floor muscles: a randomised trial” View Source can help patients to activate and coordinate the movements of their pelvic floor muscles. During electrical stimulation, sometimes called “e-stim,” you may use a chair or other device to help your muscles begin to fire. Several home electrical stimulation devices have been developed in recent years, but Rawlins cautions against investing in these gadgets. Electrical stimulation can be a great way to initiate a PT program, she says, “but it’s not a lifelong way to exercise your muscles.” Instead, rely on the exercises you get from your PT.
What Progress Looks Like in Pelvic Floor Therapy
With time and diligent home practice of your pelvic floor exercises, you should expect to see the same kinds of improvement you’d anticipate from other forms of physical therapy, including the dissipation of symptoms and a return to easier movement.
If you sense something isn’t right, reach out to your care provider sooner rather than later. The earlier you catch a pelvic floor issue, the easier it may be to treat, say Kasier and Benson. But it’s never too late to get the care you need. “There’s always progress that can be made, no matter how far down the line you are,” Kaiser says. Once you meet with your PT, incorporate any home exercises into your daily routine, blocking off time the same way you would to work out or prepare a healthy meal.
Pelvic Floor Physical Therapy and Childbirth
A lot of the current media coverage of pelvic floor dysfunction centers on women and birthing people—and for good reason. Research shows a correlation between pelvic floor dysfunction and vaginal Obstetrics and gynecology clinics of North America “The Epidemiology of Pelvic Floor Disorders and Childbirth: An Update.” View Source and Cesarean Obstetrics and gynecology “Pelvic Floor Disorders 5-10 Years After Vaginal or Cesarean Childbirth” View Source deliveries. But there are things you can do to set yourself up for success if you plan to give birth, says Rawlins.
The perineum is the area of muscle and tissue between your anus and vagina. During childbirth, this area stretches to make room for the baby. About 85% of people BMJ clinical evidence “Perineal care” View Source who have a vaginal birth experience some degree of perineal tearing. Most perineal tears heal within two to three weeks; smaller tears heal on their own but some may require dissolvable stitches.
Perineal massage, in which you manually stretch the bottom tissues of your vaginal opening and perineum, may help reduce injury to the area during labor, although research on the topic is ongoing and currently inconclusive. Most birthing people begin perineal massage around week 34 or 35 of their pregnancy.
Be sure to check with your doctor before performing perineal massage, as it isn’t recommended for people with a low-lying placenta, those experiencing vaginal infection, and others.
Consider Preemptive Pelvic Floor PT
If you’re worried about muscle tone or simply want some exercises to prepare for childbirth, you might consider scheduling a prenatal pelvic floor PT appointment—sometimes called “push prep.” Kaiser and Benson have a handful of patients who see them in the weeks leading up to birth to get feedback on their current levels of strength and learn exercises to help keep them active and mobile throughout pregnancy.
Following birth, you’ll need to wait about six to eight weeks to see a pelvic floor physical therapist. This is the date by which most people are cleared for exercise by their doctor, although many people wait longer before resuming regular activity.
Advocate for Yourself at Your Postpartum Visits
If you’re experiencing symptoms of pelvic floor dysfunction during the postpartum period, even as early as your six-week postpartum visit, let your doctor know. While it’s common for many people to experience PFD after giving birth, it shouldn’t have to go untreated. Don’t be afraid to ask for a prescription for physical therapy, even if your doctor tells you it’s common, for example, to leak urine or to experience discomfort in your pelvic floor area.
What You Need to Do Pelvic Floor PT at Home
If you’ve been told to do pelvic floor exercises at home, you may find it useful to invest in some gear. But don’t worry about buying anything particularly spendy, Rawlins says—luckily, most gear you need for home pelvic floor practice isn’t much different from what you might already have for home workouts.
Consider clearing a space in your home gym and dedicating these items to at-home pelvic floor physical therapy.
- A yoga mat: For all those supine pelvic floor-strengthening moves. We like Lululemon’s Reversible mat.
- Resistance bands: To add some umph to exercises like glute bridges. We like Arena Strength‘s options.
- Light hand weights: For some extra resistance during exercises like bird-dogs. Consider going for an ankle and wrist weight, like CAP’s easily-adjustable option.
- As few as ten years ago, pelvic floor issues remained relatively unknown: “New Public Awareness Campaign Launched to Promote Awareness of Pelvic Floor Disorders and Treatment Options for Women.” Boston Scientific (October 2012).
- These workhorse muscles hold your internal and reproductive organs in place so they can function correctly: “Pelvic Floor Muscles.” Mayo Clinic (2023).
- They also help support and stabilize your hips and core and help you get aroused and orgasm during sex. When they’re healthy, you can squeeze and relax the muscles automatically, as when you flex a muscle to pick up a weight at the gym. Signs you may be suffering from pelvic floor dysfunction include incontinence, constipation, organ prolapse, and/or pelvic pain. In some cases, low-back or hip pain may also be related to pelvic floor dysfunction: Interview with Sarah Kaiser and Amanda Benson of Union Physical Therapy, conducted on January 10, 2023.
- The pelvic floor consists of muscles and connective tissue that connect to your pelvic bone and support the pelvic organs, including the intestines, bladder, urethra, rectum, and anus. If you have male genitalia, the pelvic floor area includes your prostate, penis and scrotum/testes. If you have female genitalia, the muscles include your uterus, cervix, and vagina: “Pelvic Floor Dysfunction.” National Library of Medicine (June 2022).
- In addition to protecting and holding your pelvic organs in place, your pelvic floor contracts when you cough or sneeze, aids in the control of passing urine and having bowel movements: “Pelvic Floor Exercises.” International Urogynecological Association (2011).
- [The pelvic floor] contributes to sexual function: “Recognition and Management of Nonrelaxing Pelvic Floor Dysfunction.”
- Your pelvic floor aids in circulation around the entire pelvic region: “Pelvic Floor 101.” Origin Physical Therapy (2023).
- [Kegels are] an exercise where you intentionally contract and release your pelvic floor muscles in order to strengthen the area: “Kegels Exercises: Self Care.” Medline Plus (January 2021).
- Muscle activity is a spectrum; there can be areas of strength and weakness contributing to pelvic health and/or dysfunction: Interview with Ashley Rawlins of Origin Physical Therapy, conducted on January 31, 2023.
- Check with your doctor if something feels off. They can help evaluate your experience and come up with a plan for treatment that takes into account your health history, including your reproductive and sexual health history: Interview with Serena Fiacco of The Pelvic Health Clinic, conducted on January 30, 2023.
- Studies show that between one in four and one in three U.S. women experience pelvic floor dysfunction; for women 80 and older, the rate may be significantly higher: “Prevalence of Pelvic Floor Disorders in Adult Women Being Seen in a Primary Care Setting and Associated Risk Factors.” Scientific Reports (2022).
- Research suggests that those who have experienced sexual abuse or trauma are at a higher risk for developing pelvic floor issues: “Exacerbation of Symptom Severity of Pelvic Floor Disorders in Women Who Report a History of Sexual Abuse.” The Archives of Surgery (2012).
- Technology your physical therapist may use: Interview with Ashley Rawlins of Origin Physical Therapy, conducted on January 31, 2023.
- Research shows a correlation between pelvic floor dysfunction and vaginal and Cesarean deliveries:
- “The Epidemiology of Pelvic Floor Disorders: An Update.” Obstetrics and Gynecology Clinics of North America (March 2016)
- “Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean Childbirth.” Obstetrics & Gynecology (October 2011).
- About 85% of women who have a vaginal birth experience some degree of perineal tearing: “Perineal Care.” British Medical Journal (April 2011).
- Most perineal tears heal within two to three weeks; smaller tears heal on their own but some may require dissolvable stitches: “Anatomy of Pregnancy and Birth – Perineum and Pelvic Floor.” Pregnancy, Birth and Baby, Australia (October 2020).
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