What Is Pelvic Floor Therapy

Your treatment may consist of the following:

What Is Pelvic Floor Therapy?

Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

Laura Campedelli, PT, DPT, is a physical therapist currently working in New York at Morgan Stanley Children’s Hospital, an affiliate of New York Presbyterian.

Table of Contents
Table of Contents

Pelvic floor therapy involves physical methods of strengthening and/or relaxing the muscles of the pelvic floor to help improve core stability and control over urination, bowel movements, and sexual function.

Pelvic floor physical therapy uses a variety of different methods to:

Increase pelvic floor muscle control
Improve awareness of contraction and relaxation patterns
Decrease pain and symptoms of pelvic floor dysfunction

Pelvic floor muscle tone can change due to childbirth, the aging process, or stress. This may result in the muscles becoming too stretched and loose, weakened, or too tight and restricted. Both decreased and increased muscle tone can lead to pelvic floor dysfunction.

Research supports pelvic floor therapy as a minimally invasive treatment option that should be used as a first-line method for treating various types of pelvic floor dysfunction, including issues such as pelvic organ prolapse, urinary or fecal incontinence, and painful intercourse.

This article covers what to expect with pelvic floor therapy, as well as potential benefits. It also explains how to prepare for a pelvic floor therapy session.

Pelvic Floor Therapy: What to Expect

On the day of your pelvic floor therapy evaluation, you will be brought into a private treatment room. Your physical therapist will go over your medical history, symptoms, and complaints.

They will also perform a physical exam, which will consist of an external and internal component:

During the external exam, your physical therapist will assess your lumbar spine, sacroiliac joints, and muscles that surround or attach to the pelvis—including the rectus abdominis, iliopsoas, and piriformis—to check for pain, tightness, or tenderness.
During the internal exam, your physical therapist will assess your pelvic floor muscles for tone, elasticity, pain, and tenderness. They may insert one or two gloved fingers into your vagina and/or rectum to palpate the pelvic floor muscles from the inside. A lubricant is often used to help ease the discomfort.
Your physical therapist will also examine your ability to perform voluntary contraction and relaxation of your pelvic floor muscles, as well as movement of your pelvic floor with your breathing patterns.

After your physical therapist has completed the examinations and made a clinical assessment about the possible causes of your symptoms, you will be scheduled for follow-up sessions. Each session will take place in a private treatment room.

Pelvic Floor Therapy Cost

Out of pocket, pelvic floor therapy can cost around $150 to over $300 per session.

Pelvic Floor Therapy Exercises and Treatment Techniques

Your treatment may consist of the following:

Exercises to relax or contract the muscles of your pelvic floor, such as Kegels
Manual therapy, often performed internally by your physical therapist, to relax the pelvic floor muscles and relieve trigger points
Biofeedback, with the use of a sensor pressure probe that is inserted into your vagina or rectum, to sense the strength of contractions of the pelvic floor muscles to help you be aware of when you are contracting or relaxing these muscles
Electrical stimulation to help elicit pelvic floor muscle activation
Pelvic floor therapy devices like vaginal dilators, which are cylindrical objects of varying widths that are inserted into the vagina to gently stretch the pelvic floor muscles and allow them to relax with insertion
Weighted cones, which can be inserted into the vagina or rectum, and used during contraction exercises to provide increased resistance

Who Does It

Pelvic floor therapy involves specialized treatment from a physical therapist who is specifically certified in treating pelvic floor disorders.

A physical therapist will either obtain a Certificate of Achievement in Pelvic Physical Therapy (CAPP) or more extensive training and specialization as a Women’s Health Clinical Specialist (WCS) to evaluate and treat all diagnoses related to women’s health.

What Does Pelvic Floor Therapy Do?

Pelvic floor physical therapy is used to treat all types of disorders classified as pelvic floor dysfunction. Pelvic floor dysfunction can be subdivided into hypotonic, or low tone, and hypertonic, or high tone, disorders.

Muscle tone refers to the amount of resting tension in a muscle when it is not contracted. Too little or too much tone in the pelvic floor muscles can cause different forms of pelvic floor dysfunction.

Low Tone Disorders

When a muscle has low tone, the muscle is more relaxed and looser than normal, making it difficult to actively contract.

When the pelvic floor muscles are weak due to low tone and you have difficulty actively contracting them, your core cannot be adequately supported and your control over your bladder and bowel movements may be affected.

Low tone pelvic floor disorders that can be helped by pelvic floor therapy include:

Pelvic organ prolapse: Abnormal descent of the pelvic organs, including the uterus, vagina, bladder, or rectum, from their normal positioning
Stress incontinence: Involuntary leaking of urine during activities that increase intra-abdominal pressure, including coughing, sneezing, laughing, squatting, and heavy lifting
Overactive bladder: A condition characterized by urinary urgency, frequency, and urge incontinence when your bladder involuntarily contracts
Anal incontinence: Involuntary leaking of gas, fluid, or stool from the rectum

High Tone Disorders

When a muscle has high tone, the muscle is tighter and more restricted than normal. This can often cause pain when you try to relax or stretch the muscle.

When the pelvic floor muscles are excessively tight due to high tone, you may experience pelvic pain, muscle spasms, as well as pain and difficulty with insertion during intercourse or during a gynecological exam.

High tone pelvic floor disorders for which pelvic floor therapy may be recommended include:

Pelvic floor myofascial pain: Chronic pain that results from tightened pelvic floor muscles
Vaginismus: Uncontrolled, involuntary spasm of the muscles surrounding the vagina that occurs with penetration
Dyspareunia : Pain during sexual intercourse from vaginal penetration
Vulvodynia: Pain and discomfort in the vulva, often referred from tight and dysfunctional pelvic floor muscles

How to Prepare

To prepare for pelvic floor therapy, you should arrive dressed in comfortable clothes that allow you to move your legs freely without restricting your movement. Your exam includes an internal component, so make sure your groin and genital area is clean before your appointment.

It is helpful to come prepared with a list of questions or concerns you want to ask your physical therapist during your exam and evaluation. Give yourself extra time to arrive at the physical therapy facility to fill out initial paperwork before your first visit.

You should bring the following with you to your first appointment:

Form of identification, such as a driver’s license or passport
Health insurance card
List of any medications you are taking
Prescription from a referring physician, if needed

When Do You Need Pelvic Floor Therapy?

Pelvic floor therapy is appropriate for those with low tone or high tone forms of pelvic floor dysfunction and related pelvic floor muscle pain.

Pain in the pelvic region may not always be related to pelvic floor muscle dysfunction, however. The following symptoms may be signs of a more serious condition:

Burning sensation during urination
Heavy bleeding during menstruation
Severe menstrual cramping
Irregular periods
Blood in urine or stool
Abnormal vaginal discharge
Fever
Chills
Nausea and vomiting

Make sure to contact your primary care physician or gynecologist if you have been experiencing any of these symptoms. You may have an infection or another condition related to your gastrointestinal, urinary, or reproductive organs that requires further medical treatment.

Summary

Pelvic floor therapy is a treatment option for pelvic floor dysfunction, whether the pelvic muscles are too tight or too weak. It can help with problems with urination, sexual intercourse, and more.

The initial assessment for this type of physical therapy includes an internal exam. Check with your healthcare provider to make sure this is an appropriate treatment for you.

A Word From Verywell

Symptoms of pelvic floor dysfunction tend to get worse over time and can have a significant impact on your quality of life. Starting pelvic floor physical therapy as early as possible can help alleviate pain and other symptoms to help you regain control over your life.

If you have been experiencing chronic pain for more than three months or problems with urination, bowel movements, or sexual intercourse, contact your healthcare provider to see if additional testing is needed to determine if there is a more serious issue underlying your pelvic symptoms.

Frequently Asked Questions

How soon do I start pelvic floor physical therapy?

Pelvic floor physical therapy should be initiated as soon as you start to notice symptoms that interfere with your daily functioning, including control over your urge to urinate and comfort during sexual intercourse.

How long does it take for pelvic floor therapy to help?

On average, it can take between six to 12 visits for pelvic floor therapy to help. However, this varies depending on the individual and the condition being treated.

Can I do pelvic floor therapy at home?

Yes. Pelvic floor therapy can be done in your home with your physical therapist present, or you can do therapist-provided exercises on your own. You may need some equipment to complete some of the moves.

Should you do pelvic floor physical therapy when in extreme pain?

If you’re in severe pain, pelvic floor therapy may not be appropriate until you have further testing done to determine if there is a more serious problem present.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485-493. doi:10.1097/GCO.0000000000000584
University of Washington. FAQ for pelvic health pt.

By Kristen Gasnick, PT, DPT
Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

What Is Pelvic Floor Therapy? Here’s How to Tell if It’s Right for You

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.

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
Pregnancy
Overuse of pelvic muscles
Having overweight
Aging
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.

Tip

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.

Throughout Treatment

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

Tip

Although the length of your treatment may vary, one visit per week for eight weeks is a common timeline, per Loma Linda University Health.

After Treatment

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.

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What Is Pelvic Floor Therapy

What Is Pelvic Floor Therapy?