Pelvic Floor Physical Therapy. The Ultimate Guide to What It Is, Who It Can Help, and Why You May Need It.

Pelvic floor physical therapy is gaining more popularity in recent years. With the emergence of new pelvic health biomedical technology, social media influence, and push for women’s health advocacy, pelvic floor physical therapy is becoming a household name. But what exactly is pelvic floor physical therapy, and who specifically would benefit from it? Let’s break it all down.

What is pelvic floor physical therapy?

Pelvic floor physical therapy is specialized physical therapy that is performed by a physical therapist that focuses on the muscles that sit in the bottom of the pelvis (called the pelvic floor). See below.

Bird’s eye view of the pelvic floor muscles (female anatomy)

Similar to how physical therapists can help patients overcome common musculoskeletal injuries and pain, pelvic floor physical therapists help patients overcome various pelvic health conditions.

Pelvic floor physical therapy utilizes the same techniques as regular physical therapy including manual therapy including joint and soft tissue mobilizations, therapeutic exercises, modalities, gait and postural retraining, as well as lifestyle and habit modifications to help patients overcome symptoms of pelvic floor dysfunction (listed below).

What do they do in pelvic floor physical therapy?

Pelvic floor physical therapy typically consists of internal and external treatment. Since the pelvic floor muscles sit on the bottom on the pelvis, the best way to assess and treat these muscles is via an intravaginal and/or intrarectal examination.

With internal pelvic floor therapy, the therapist will take a single gloved finger and insert it either vaginally or rectally and assess the pelvic floor muscles for areas of tightness, tenderness, and weakness.

Internal pelvic therapy is an important aspect to pelvic floor physical therapy, as is external pelvic therapy.

External pelvic floor therapy addresses the muscles that attach to the outside of the pelvis, or those that can be accessed without an internal examination. These muscles include the hip muscles, back muscles, core muscles, and essentially every other muscle except the pelvic floor!

What types of symptoms do they treat in pelvic floor physical therapy?

Pelvic floor physical therapy focuses on anything that affects bowel, bladder, sexual function, or pain around the pelvis. Common diagnoses include:

• Prolapse: Prolapse is a shifting of the pelvic organs, often the result of pregnancy, extreme coughing, or excessive heavy lifting. For more information on prolapse, click here.

• Diastasis Recti: Diastasis recti is a separation of the abdominal muscles in an area called the linea alba. Diastasis recti occurs in 100% of women at the end of pregnancy and the gold standard of care is core exercise with the assistance of real-time ultrasound. For more information on diastasis recti, click here.

• Urinary Leakage: Urinary leakage is the involuntary loss of urine control. Often this happens during coughing, sneezing, laughing, jumping, and squatting. Despite what society says, urine leakage is never normal and any amount of leakage should be addressed. For more information on urinary leakage, click here.

• Constipation: Constipation is defined as having fewer than 3 bowel movements per week, however you can go every day and still be constipated. Tightness in the pelvic floor can lead to, and contribute to, constipation. For more information on constipation, click here.

• Painful intercourse: Painful intercourse typically occurs due to tightness in the pelvic floor muscles. For more information on painful intercourse, click here.

• Vulvodynia: Vulvodynia means pain in the vulvar region. Vulvodynia can be caused by hormonal changes, pelvic floor muscle tension, nerve irritation, and even lower back dysfunction. which puts pressure on the nerves as they exit the spine.

• Vaginismus: Vaginismus is a reflexive tightening of the pelvic floor muscles, typically with any attempt at vaginal penetration. For more information on vaginismus, click here.

• Pelvic pain conditions like endometriosis or interstitial cystitis: Often referred to as the evil twins, endometriosis and interstitial cystitis can occur in isolation, or together. In both situations, abdominal wall tension, and pelvic floor tension can play a role in symptoms.

• Low back, hip, tailbone and pelvic girdle pain: Since the pelvic floor muscles attach to the lowest portion of the spine, low back pain, hip pain and pelvic girdle pain can be the result of dysfunction in the pelvic floor muscles. For more information on tailbone pain, click here.

• Pregnancy related pain and symptoms: The body goes through a lot of changes during pregnancy! The postural changes, hormonal changes, and relaxation of the ligaments in the pelvis put increased demands on the internal and external pelvic muscles. For more information about prenatal physical therapy, click here.

• Postpartum related pain and symptoms: Pelvic floor therapists specialize in helping women recover from pregnancy and helping them safely get back to the activities they love. Pelvic floor PTs also help patients recover from childbirth, whether via vaginal or Cesarean birth. For more information on postpartum recovery, click here.

• Perimenopausal concerns: Hormonal changes during perimenopause can cause pelvic floor symptoms to creep up, or intensify. Often women in the peri and postmenopausal time period struggle with painful intercourse, urinary leakage and pelvic pain due to decreased muscle tone and decreased lubrication to the pelvic floor muscles. For more information on perimenopausal concerns, click here.

What to expect at my first session of pelvic floor physical therapy?

Your first session of pelvic floor physical therapy will consist of a lot of talking! You therapist will want to know all about your symptoms, including how long you’ve had them, if anything specific brought them on, and more specifically what brings on (and doesn’t bring on) your symptoms.

After you discuss a thorough history of your symptoms, your pelvic floor therapist will likely proceed with a physical examination.

Your therapist will suggest that they look at how you move during functional movements such as bending, squatting, and walking, as well as look more specifically at other joints such as how your hips, lower back, and bones of the pelvis move.

With your permission, your therapist will then proceed with an internal examination to assess the strength, tension, and tenderness of the pelvic floor muscles.

After the physical assessment, your therapist will discuss their findings, and recommend an appropriate treatment which may include manual therapy, exercises, and lifestyle modifications to help you meet your goals.

For more information about what to expect at pelvic floor therapy, click here.

Do I need to have an internal examination?

An internal examination is always consented by the patient. If you are uncomfortable with an internal assessment and treatment, you can always discuss this with your therapist and choose to forgo internal assessment and treatment.

Bear in mind though, because of how the pelvic floor muscles sit and where they are located, doing an internal exam is the most comprehensive way to assess the pelvic floor muscles.

Can I go to pelvic floor physical therapy if I am on my period?

You can absolutely have pelvic floor physical therapy on your period, even if your treatment consists of internal pelvic floor work. Menstrual fluid does not affect the therapist’s ability to perform internal work.

Often, your symptoms could be affected by your menstrual cycle and therefore having your period may help your pelvic floor therapist find areas of tension or tightness that they normally wouldn’t find if you weren’t on your period.

Of course, if you are uncomfortable with having a pelvic floor assessment on your period, your pelvic floor therapist can forgo the internal assessment and treatment and instead focus on other areas such as your back, hips, and core which may be contributing to your symptoms.

Is pelvic floor physical therapy-covered by insurance?

Sometimes! But bear in mind that many pelvic floor physical therapists choose to not contract with insurance companies.

Without getting into the specifics, insurance company restrictions cause most traditional physical therapists treat multiple patients all at once and most in-network physical therapists only get about 15 minutes of one-on-one time with their patients.

With pelvic floor physical therapy however, it is a challenge to see multiple patients all at once and one-on-one treatment needs to be longer than 15 minutes.

In addition, the pelvic floor is extremely complicated. Insurance companies only want the pelvic floor therapist to treat the pelvic floor. However, many times symptoms in the pelvic floor can be the result of dysfunction elsewhere. This includes hip issues, back issues, and even foot issues. If we only stick to treating the pelvic floor, but that isn’t why your symptoms are there, your issues wont be resolved.

Finding the why is an important part of preventing the symptoms from coming back. Since insurance companies also don’t cover comprehensive treatment, wellness or prevention services, or goals that they don’t deem functional (they don’t consider pain free intercourse, or ability to workout without pain or leakage to be functional goals).

Therefore, because of the time needed with patients, complexity of the pelvic floor, and ensuring we are addressing the goals of the patient, many pelvic floor PTs opt to be out of network with insurance.

For more information about out of network physical therapy, click here.

What should I wear to pelvic floor PT?

Since your therapist will be assessing how you move, wearing something comfortable is appropriate.

We also recommend wearing a shirt that you can roll up to expose the abdomen and lower back.

Something we would avoid wearing to pelvic floor PT is a jumper or romper!

How can I find a pelvic floor PT near me?
Vivid is located in Newtown, Bucks County, PA. We serve Yardley, New Hope, Richboro, and Doylestown PA communities, as well as communities in Mercer County, NJ. If you are not local to our area, please click here to find someone near you!