Should You See a Pelvic Floor Therapist?
This little-known powerhouse of medical intervention can help people with urinary incontinence, bowel dysfunction, or pelvic pain.
Choosing an OB/GYN is hard enough. So, the thought of finding a second provider with whom you’re comfortable sharing your intimate sexual health details? That’s not the most enticing prospect. But for people who deal with pelvic pain, urinary incontinence, or pain during sex, a pelvic floor therapist can be a life-changing addition to your medical team.
You’re not alone if you’ve never heard of this—a physical therapist who works with the pelvic area? Yep! Pelvic floor therapy is an official specialty that can be obtained by physical therapists or occupational therapists for the treatment of pelvic pain or pelvic dysfunction. It is used to help people with a variety of conditions, from endometriosis to urinary incontinence or bowel incontinence caused by chronic illness.
“The great thing about physical therapy is that it is conservative and safe, so it is usually a good option for most people,” says Rachel Gelman, DPT, INTIMINA’s pelvic floor health specialist and owner of Pelvic Wellness & Physical Therapy in San Francisco. “Anyone who is experiencing urinary, bowel, or sexual dysfunction may benefit from working with a pelvic floor therapist.” If this is you, it might be worth reaching out to find a pro you can trust.
What Is a Pelvic Floor Therapist?
A pelvic floor therapist is pretty much exactly what the title sounds like: a physical or occupational therapist who specializes in the pelvic floor. “They can be physical therapists or occupational therapists who have done advanced training in pelvic floor physical therapy,” says Paul Tulikangas, M.D., associate professor at the University of Connecticut School of Medicine in Farmington, CT, and division director or urogynecology and pelvic surgery at the Hartford Hospital.
“Pelvic floor” is an odd term (um, is my pelvis built like a room in a house?), but it’s a pretty accurate description. “The pelvic floor is a bowl of muscles inside the pelvis that supports the pelvic organs: bladder, colon, and prostate or uterus,” Gelman explains. These muscles sit along the base of your abdominal area right in the middle of your pelvic bone. They stretch across your core like a hammock or sling to keep your organs securely in place, and they control your ability to hold in or push waste out of your body.
Like any other muscle group, your pelvic floor muscles can become weakened due to an injury, prior trauma, or chronic stress. Pelvic dysfunction occurs when your muscles don’t contract like they’re supposed to, which can cause a variety of problems in your abdominal area. For instance, if you’re unable to squeeze these muscles at will, you may have some form of urinary or bowl incontinence. Or, if they’re tight and unable to relax, this results in pelvic pain conditions like vulvodynia. “Most pelvic floor PTs will treat a combination of lower urinary tract dysfunction, bowel dysfunction, sexual dysfunction, and chronic pain disorders,” Dr. Tulikangas says. And depending on the individual, the therapy techniques may be quite different.
Who Can Benefit From Pelvic Floor Therapy?
This therapy is expansive and can help people with a variety of different reproductive and sexual health issues, including:
Chronic abdominal pain
Pain with sex
Postpartum pelvic dysfunction
How Does Pelvic Floor Therapy Work?
The pelvic floor muscles are connected to several different organs in your body, and the treatment method varies based on the condition. “Pelvic floor PT is available for all these conditions, but it is different” depending on the patient’s needs, Dr. Tulikangas notes. Let’s break this into two major categories:
Urinary or bowel incontinence. At least 25 million people are currently living with urinary incontinence, according to the National Association for Continence—and yet only one in 12 people seek help for it. This is nothing to be ashamed of, and you shouldn’t feel like you have to keep it to yourself. Incontinence can be caused by past injury or surgery, trauma from childbirth, aging, or a chronic condition like IBD or MS. And in most cases, pelvic floor therapy can help.
To treat incontinence, your pelvic floor PT will start by introducing you to Kegel exercises. This is when you tighten the area around your urinary tract (think of that feeling of “holding it in” when you have to urinate) for a few seconds at a time, then relax. Kegel exercises can be incorporated into your day like any other exercise routine, and they focus specifically on your pelvic floor. “A common regimen would be to do 10 contractions and try to hold the contraction for up to 10 seconds,” Dr. Tulikangas says. “Do 10 squeezes three times a day over a four- or five-month period.” Research has consistently shown that this can work to “retrain” your pelvic floor muscles to expand and contract at your will. Think of this like strength training for your pelvic floor.
If home training doesn’t cut it for you, your pelvic floor therapist may want to try something called biofeedback. They’ll insert a probe into your vagina or anus to get a closer look at your muscle contractions and figure out what is going on. They may use electrical stimulation to help your muscles learn to contract in the right way.
Pelvic pain disorders. “Most pelvic floor therapists are also trained to treat myofascial pain syndromes and pelvic pain for women,” Dr. Tulikangas says. “These different pelvic pain syndromes can be related to endometriosis, vulvodynia, prior sexual trauma, bladder pain disorders, or rectal pain disorders.” Pelvic pain belongs in a separate category from incontinence because Kegel exercises aren’t necessarily the right approach. In this case, your muscles need to learn how to relax rather than contract.
Biofeedback can be helpful here as well as manual therapy, where the pelvic floor therapist will use massage and stretching techniques on your muscles. If the area is super tight and penetration during sex is an issue, your provider may suggest the use of vaginal dilators. These are tube-shaped devices that can be inserted into the vagina, gradually increasing in size as the muscles learn to stretch.
These techniques may sound invasive and a bit intimidating, but with the right provider and treatment, pelvic floor therapy can be hugely impactful in reducing your pain and discomfort. “That bond between the pelvic floor physical therapist and the patient is critical for success,” Dr. Tulikangas says. “It’s an intimate exam, and that bond [a patient has] with their therapist really does improve their compliance with the program. I think it improves results, too.”
How Do You Find a Pelvic Floor Therapist?
The first person to ask is your primary care doctor or OB/GYN. “Most providers are familiar with pelvic floor therapists,” Dr. Tulikangas says, and they can supply an initial referral. If you’d rather search for a provider yourself, you can try websites like Pelvic Rehab or the Academy of Pelvic Health Physical Therapy, both of which contain search tools to find a provider near you.
Pelvic floor therapy isn’t the perfect approach for everyone, but if you’re curious, it might be worth an initial visit to learn more. “Many pelvic floor PTs offer consultations to determine if a patient is appropriate for pelvic floor PT,” Gelman says. She also suggests talking to your provider to rule out the possibility of an active infection or anything that would require immediate medical care. What’s important to know here is that you do not have to suffer from things like painful sex or incontinence on your own. There is help for you out there, you just need to take that initial step and ask for it.
- Pelvic Floor Therapy: International Society for Sexual Medicine. (n.d.) “What is pelvic floor physical therapy?” issm.info/sexual-health-qa/what-is-pelvic-floor-physical-therapy/
- Urinary Incontinence: National Association for Continence. (n.d.) “Incontinence Conditions From A-Z.” nafc.org/conditions-overview
- Kegel Exercises for Incontinence: StatPearls. (2020.) “Kegel Exercises.” ncbi.nlm.nih.gov/books/NBK555898/
- Kegel Exercise How-To: MedlinePlus. (n.d.) “Kegel exercises—self-care.” medlineplus.gov/ency/patientinstructions/000141.htm