The pelvic floor is a powerhouse group of muscles and connective tissues that support many of your everyday activities. But pelvic dysfunction or pain can disturb these functions. Fortunately, pelvic floor therapy may offer some relief.
Your pelvic floor muscles and tissue are attached to the bones at the bottom of your pelvis, per the University of Washington School of Medicine. Our pelvic floor does many jobs, including:
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- Maintaining continence (bladder and bowel control)
- Stabilizing and supporting the lower body
- Supporting sexual sensation
In people assigned female at birth, the pelvic floor holds the bladder in the front, the uterus at the top and the vagina and rectum in the back, according to Loma Linda University Health. In people assigned male at birth, the pelvic floor supports the bladder, bowel, urethra and rectum.
But pelvic floor problems can mess with all of these functions. Here, a pelvic floor physical therapist explains the signs of pelvic floor dysfunction, why you might need pelvic floor therapy, what to expect from this treatment and how to tell if it's right for you.
What Is Pelvic Floor Therapy?
Pelvic floor therapy is exactly what it sounds like: physical therapy for your pelvic area.
"Pelvic floor physical therapy is the conservative first line of treatment for most types of pelvic floor dysfunction," Tina Christie, PT, CCE, senior physical therapist, certified childbirth educator and women's health program manager for Athletico, tells LIVESTRONG.com.
During pelvic floor therapy, a physical therapist who specializes in pelvic floor health will evaluate your strength and mobility (especially in your core and lower body) and prescribe exercises or treatment that can help with your specific type of pelvic floor dysfunction.
But is pelvic floor therapy right for you? In short, if you're experiencing symptoms that negatively affect your quality of life, therapy may be worthwhile, Christie says.
What Is Pelvic Floor Dysfunction, Exactly?
Pelvic floor problems happen when you're unable to adequately relax and coordinate your pelvic muscles to urinate or have a bowel movement, according to the Cleveland Clinic. It's usually diagnosed after a doctor assesses your medical history and performs a physical evaluation, which may include an intrarectal (inside the rectum) or vaginal exam.
Causes of pelvic floor dysfunction can include:
- Traumatic pelvic injuries
- Overuse of pelvic muscles
- Having overweight
- Pelvic surgery
Here are some of the most common types of pelvic floor dysfunction, according to Christie:
- Stress urinary incontinence: You lose urine when exercising, coughing, sneezing, laughing or during any type of activity.
- Urge urinary incontinence or overactive bladder: You frequently go to the bathroom (every 15 to 60 minutes) and have a great amount of urgency, but then do not produce a large amount of urine due to the frequency.
- Pelvic pain: You have pain in the groin, lower abdominal region, hips or perineal/pelvic region with sitting, activity or sexual activity.
- Pelvic organ prolapse: The organs within the pelvis — including the bladder, bowel and uterus — may descend into lower positions and cause all types of pelvic floor dysfunction.
- Fecal incontinence: You have an inability to control bowel movements.
- Peripartum or postpartum pelvic floor problems: You may experience pelvic floor issues in the period before, during and after giving birth.
If you notice any of these issues or you're experiencing other problems with bowel movements, bladder control or pelvic pain, that may be indicative of pelvic floor dysfunction.
Signs of Good Pelvic Function
Understanding normal pelvic functioning can also help you gauge if you're having pelvic floor problems, Christie says. Here are some indicators of good pelvic health:
- Normal bladder emptying should occur six to eight times in a 24-hour period, or every 2 to 4 hours during the day and zero to one times at night
- Bowel movements vary, but one bowel movement per day without needing to push or strain is typical
- No urinary leakage
- No amount of pelvic pain, including during sexual activity
What to Expect From Pelvic Floor Physical Therapy
Therapy is different for everyone based on your unique health concerns. But in general, here's what you can expect throughout pelvic floor treatment:
Before Your First Appointment
Most regions of the U.S. have physical therapists that can help with pelvic floor dysfunction. The quickest way to find one is with an Internet search, Christie says. Once you land on a promising therapist, you're typically able to complete a free assessment without a referral.
If you'd rather get a recommendation for who to see, you can also ask your doctor to refer you directly to a pelvic floor specialist.
Your First Appointment
Much like any other initial physical therapy appointment, your first time seeing a pelvic floor specialist will include a thorough evaluation. The evaluation will last about an hour and include questions about your fluid intake, diet and sexual activity, per the University of Utah Health.
"This will include a comprehensive history intake of the current symptoms, orthopedic injuries, past surgeries and birth history, if applicable," Christie says.
You'll also be evaluated on your movement and gait patterns, as well as the strength and mobility in your core and lower body. That's because common areas of dysfunction include the hips and mid-back, Christie says.
Your initial evaluation may also include a pelvic floor muscle assessment, in which you consent to an external/internal vaginal and/or rectal exam.
"During the exam, we would evaluate if the pelvic floor muscles can contract and lengthen, test for any areas of pain or restrictions and guide an individual on how to use their breath to enhance pelvic floor movement," Christie says.
Although it may feel embarrassing to discuss pelvic floor issues, the more open and honest you are about your symptoms, the better your treatment will be, per the Cleveland Clinic.
Your physical therapist will then create a treatment plan tailored to your individual needs. "A plan of care would include education on the current diagnosis or dysfunction and manual therapy, which can include myofascial release, trigger point release and many other types," Christie says.
During myofascial and trigger point release therapy, your physical therapist will focus on massaging stiff pelvic floor myofascial tissue (the membranes that wrap around your muscles) using their hands or special tools. This massage therapy may help loosen restricted movement and lead to a reduction in pain, per the Mayo Clinic.
You'll also be prescribed specific pelvic floor exercises during your time in therapy. The most well known are kegel exercises, or strengthening drills that typically involve squeezing and releasing your pelvic floor muscles, per the University of California San Francisco Health (although these aren't right for every pelvic floor issue).
"Exercise prescriptions address the individual's needs and goals," Christie says. "Exercises may include mobility and stretching for the hips and lower girdle, down-training to allow for flexibility in muscles that may be tight, core and lower-girdle strengthening and a comprehensive home exercise program."
Per the University of Utah Health, other pelvic floor treatment techniques may include:
- Diaphragmatic or belly breathing techniques
- The use of biofeedback sensors with a low electrical current, which is used as a visual cue to either contract or relax the correct muscles
Although the length of your treatment may vary, one visit per week for eight weeks is a common timeline, per Loma Linda University Health.
The results of pelvic floor therapy depend on your unique concerns, as well as your goals and how well you stick to your treatment plan, per the University of Utah Health.
Successful pelvic floor physical therapy, though, should help strengthen the muscles that may have been weakened or relax overactive, too-tight muscles. Either way, the therapy should ultimately provide relief from any symptoms that affected your quality of life.
- Loma Linda University Health: "Could Pelvic Floor Physical Therapy Help You?"
- UCSF Health: "Pelvic Muscle Exercises"
- UW School of Medicine: "What Is Your Pelvic Floor and Why Should You Care?"
- Mayo Clinic: "Myofascial release therapy: Can it relieve back pain?"
- University of Utah Health: "Pelvic Floor Physical Therapy"
- Cleveland Clinic: "Pelvic Floor Dysfunction"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.