Pelvic floor physical therapy is a potential treatment option for people with pelvic pain or a pelvic floor disorder.
The goal of pelvic floor physical therapy is to help improve function in your abdomen and pelvis. It is open to all people, regardless of age, gender, body type, or physical ability.
Whether it’s a child struggling with bedwetting, an adult dealing with constipation, or a gender-diverse person going through gender-affirming care, pelvic floor physical therapy may be a care option.
“There are a lot of different things we can address when it comes to pelvic floor PT,” says Juliette Lundy, PT, DPT, a physical therapist at UPMC’s outpatient rehabilitation clinic in Squirrel Hill.
What Is the Pelvic Floor?
The pelvic floor is the group of muscles and connective tissues that support the organs of your pelvis.
The pelvic floor is part of your “core.” It works together with other muscles and surrounding tissues — such as abdominal muscles — to keep your pelvic organs in place and functioning correctly.
“A lot of times, people have no idea what your pelvic floor muscles are in the first place,” says Lundy. “They are, in fact, skeletal muscles. You can actively contract and relax them. Male anatomy and female anatomy — we have the exact same pelvic floor muscles. It’s just external genitalia that’s different.”
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What Is Pelvic Floor Physical Therapy?
Many different conditions can cause pelvic floor dysfunction. This can lead to pain, bladder issues, or bowel issues — such as urinary urgency or constipation — and other complications.
Pelvic floor physical therapy can help you learn to strengthen or relax your pelvic floor muscles to increase your abdominal and pelvic function and improve your quality of life.
Many people may be embarrassed to talk about pain or dysfunction in their pelvic region, but they shouldn’t be, says Lundy.
“A lot of people have these issues, but nobody ever talks about it,” says Lundy. “So I think that if we just normalize that in the first place, people wouldn’t be as afraid to come forward and talk about pelvic issues. There are so many different things that we can address if someone has a little bit more awareness in that area.”
What Does Pelvic Floor Physical Therapy Treat?
Pelvic floor physical therapy can treat many different conditions that cause dysfunction in the pelvic floor.
Pelvic floor physical therapy is a common treatment for many different bladder problems, including:
- Urinary incontinence.
- Urinary retention.
- Urinary frequency.
- Urinary urgency.
- Frequent urinary tract infections (UTIs).
Pelvic floor physical therapy can help with various bowel problems, including:
- Irritable bowel syndrome (IBS).
- Fecal incontinence.
- Fecal smearing.
Pelvic floor physical therapy is an option for people with lymphedema, or extra swelling caused by lymph fluid in your body. Conditions that can cause this swelling include:
- Cancer treatments (breast cancer, pelvic, and abdominal cancers, head and neck cancers, etc.)
- Congenital lymphedema.
- Chronic venous insufficiency (CVI) edema.
Pelvic floor physical therapy can help with sex-related pain or dysfunction, including:
- Vaginismus (involuntary contractions of the vagina).
- Dyspareunia (pain during intercourse).
- Vulvodynia (chronic pain in the vulva, the opening of the vagina).
- Anorgasmia (delayed or absent orgasms).
- Dysorgasmia (pain during or after orgasm).
Other conditions that may warrant pelvic floor physical therapy include:
- Peyronie’s Disease.
- Antepartum and postpartum conditions.
- Pelvic pain.
- Diastasis recti (separation of the large abdominal muscles).
- Coccydynia (tailbone pain).
- Chronic hip or back pain along with any of the above issues.
- Pelvic organ prolapse.
- Follow-up from gender-affirming surgical care.
If you are experiencing pelvic floor dysfunction related to any of the above conditions, talk to your doctor to see if you’re a candidate for physical therapy.
What Happens at Pelvic Floor Physical Therapy?
Your first pelvic floor physical therapy session typically will include an assessment. Your therapist will evaluate how your pelvic floor is functioning and determine whether you need to focus on strengthening or relaxing those muscles.
A major part of physical therapy is education. You will learn how the muscles of your pelvic floor work together with surrounding areas to provide proper function. Your therapist also will look to see if you have any habits — such as poor posture — that can be adjusted to improve function.
“I think knowledge is power in this area,” says Lundy. “When you understand why and how certain systems work together, then things start to click.”
Physical therapy sessions also include hands-on exercises designed to help you improve your function. Therapists will tailor your exercise routine to your specific needs. There is one-on-one education, and you will learn specific exercises that can help improve your symptoms.
Lundy says most people will have at least five therapy sessions, which each last for around 45 minutes. The goal of pelvic floor physical therapy is to help improve your function so that you can manage your symptoms in the outside world.
“Whatever their impairment is, patients can learn how to actually stretch certain muscles that need to be stretched, as well as how to activate muscles that need to be working,” says Lundy. “Then, they can also learn how to apply it into a functional motion so they can go to an exercise class and not have to worry about leaking or those types of things.”
Benefits of Pelvic Floor Physical Therapy
Pelvic floor physical therapy aims to improve function in your abdomen and pelvic floor. It can help you manage your symptoms whether you have pain, bladder or bowel issues, or other problems.
Managing those symptoms can help improve your quality of life, says Lundy.
“We answer a lot of questions that go unanswered or unasked,” she says. “By teaching patients so many different strategies to help with their specific impairment, we can bridge the gap and just educate everybody.”
If you have symptoms such as pelvic pain or dysfunction that are affecting your life, talk to your doctor about a referral for pelvic floor physical therapy. Many different doctors — primary care physicians (PCPs), urologists, oncologists, and more — can refer you for care.
The UPMC Rehabilitation Institute offers inpatient, outpatient, and transitional rehabilitation, as well as outpatient physician services so that care is available to meet the needs of our patients at each phase of the recovery process. Renowned physiatrists from the University of Pittsburgh Department of Physical Medicine and Rehabilitation, as well as highly trained physical, occupational, and speech therapists, provide individualized care in 12 inpatient units within acute care hospitals and over 80 outpatient locations close to home and work.