Pelvic Floor Physical Therapy: How it works to relieve pelvic pain
The health and wellness of your pelvis has huge impact on mental health and self-confidence. Pelvic floor physical therapy can improve your pelvis and pelvic floor.
·October 16th, 2021
Like other forms of physical therapy, pelvic floor physical therapy or pelvic floor PT treats muscles and tendons to repair damage and increase strength and mobility–specifically, within your pelvic floor
Your pelvic floor muscles may be hard to detect, but they perform the important role of supporting many of your digestive and reproductive organs
Pelvic floor PT benefits a range of conditions, including incontinence, chronic constipation, pain with sex or menstruation, pelvic organ prolapse, and postpartum
There are different modalities of pelvic floor PT, including exercises (potentially including biofeedback devices), soft tissue mobilization, and some types of massage
Pelvic floor physical therapy is exactly what it sounds like: PT for your PF. Like PT for an injury to a muscle or joint like your knee or hamstring, pelvic floor PT has similar goals—to repair damage, increase strength and coordination, and leave you stronger and more mobile than when you started.
The only difference is that pelvic floor physical therapy (or PFPT) treats the group of muscles and tendons that support your reproductive organs, and because those muscles are internal, pelvic floor PT works a little differently than orthopedic PT.
In many countries around the world, pelvic floor PT is the standard of care for people as they recover from giving birth. In the U.S., however, it is treated as more of a complementary or specialty service, which is unfortunate, because many people of all genders can benefit from a one-time consult or ongoing work with a pelvic floor specialist.
What exactly is your pelvic floor, and what does it do for you?
If you think of your core as a canister, your pelvic floor is the bottom of the can. It’s a group of muscles and tendons that stretch from your tailbone to your pubic bone, like a hammock that supports your bladder, bowels, and (if you have them) your uterus and vagina.
The pelvic floor affects many areas of function for the body, from general movement to urinary and fecal continence to sexual function. Because we can’t see our pelvic floors from the outsides of our bodies, it can be difficult to know whether they are strong and coordinated—that’s where a trained and specialized physical therapist comes in.
Signs you might benefit from pelvic floor physical therapy
You’ve had a baby. Sustaining a pregnancy and giving birth (whether vaginally or by Cesarean birth) is extremely taxing on your pelvic floor, and even if you’re years postpartum, issues can linger. It’s never too late to reach out for help with your PF.
Chronic constipation and/or hemorrhoids. While these are often digestive issues, there can be a pelvic floor element, too, and a trained PT can help figure out what’s what.
Heaviness in your pelvic region or a sense of fatigue in your vagina. If you do a lot of heavy lifting or have given birth, you may be suffering from pelvic organ prolapse, which can be treated by a PFPT
Painful sex. This isn’t something that you have to live with. Having a frank and honest conversation with a PT can start you down the road to enjoying sex—again or for the first time.
For men, premature ejaculation or inability to orgasm through intercourse. Targeted work on your PF can help you experience more agency in your sexual life.
Because many of the issues that can benefit from pelvic floor physical therapy are very personal, they can feel private or embarrassing. Furthermore, some of these issues are often assumed to be normal or not worth addressing because they are common.
Talking about sexual dysfunction or incontinence isn’t easy, but a good pelvic floor PT will have a great bedside manner and will help you feel comfortable sharing all of your symptoms.
Other issues that can be treated or addressed by a pelvic floor PT include non-specified pelvic pain, back pain, hip pain, diastasis recti (a separation of your abdominal wall that is common after pregnancy), endometriosis, and dysmenorrhea (painful menstruation).
What happens when you go to your appointment?
Your first session with a pelvic floor physical therapist will be a combination of interview and examination. Your provider will want to know all about your symptoms, in detail, and will make careful notes so they can track your progress. They will also examine you physically.
Typically, this will include an external exam during which they will ask you to perform movements that may include walking, squatting, raising and lowering your legs, and/or engaging your abdominal muscles (depending on your presenting symptoms).
Your PT will also most likely examine your genitals. If you have a vagina, your PT may examine you internally, using their fingers to assess your pelvic floor. Some PTs will also use insertable biofeedback devices and vaginal dilators as appropriate.
What your provider can do for you?
Some of the therapeutic modalities you might encounter include biofeedback, joint and soft tissue mobilization, scar tissue mobilization (particularly for Cesarean birth), pelvic floor massage, dry needling, breathwork, and strength and conditioning exercises.
Because there is a huge range of conditions and treatments that fall within the scope of practice of a pelvic PT, the treatment protocols they may recommend are similarly varied.
Depending on what’s going on, those pelvic floor exercises may or may not include Kegels (internal exercises in which you squeeze your pelvic floor up and in, as if you were shutting off a stream of urine), as well as core and lower body strength-building movements. Your PT will show you how to do everything they prescribe for you and will help you learn to tune into your pelvic floor as you’re going through your daily activities.
Here’s to happy, healthy PFs!
As the literal floor of your organs, your pelvic floor is highly important. Its health and wellness affect your menstrual health, your sex life, your digestion, your athletic capabilities, and can have a huge impact (positive or negative) on your mental health and self-confidence.
Finding a pelvic health practitioner who can guide you through restorative work for this vital part of yourself is a wonderful act of self-care, whether you are postpartum, noticing your body change with age, or simply wanting to keep every part of yourself in tip-top shape.
If you think you may need pelvic floor PT, the right provider can help you build a personalized plan to support your wellbeing. Connect with a credentialed expert who serves your area here.