What is Pelvic Floor Therapy?

As a physical therapist and someone who has been working with patients with pelvic health conditions for awhile, I feel like I am surrounded by so much information on social media about pelvic health all the time (I guess that is how the algorithm works!). The pelvic floor, pelvic floor therapy, pelvic health therapy – they are all buzz words right now. Sometimes it is hard for me to remember that there are still so many folks out there who have no idea what we do in pelvic floor therapy.

Just this week, I saw a post in a Facebook group where an expecting mom was asking about perineal massage for pregnancy and a few women suggested pelvic floor therapy, and others asked what pelvic floor PT is. It made me realize that there are still so many people who don’t realize we can help them! In this post, I’m going to cover what the pelvic floor is, what pelvic floor (or pelvic health) therapy is, and what to expect when you see a pelvic floor therapist.

What is the pelvic floor?

The pelvic floor is a group of muscles (and ligaments and tendons) that sit in the bottom of your pelvis. These structures have attachments to the ilium (sides of the pelvis), sacrum (tail bone), and femur (hip/thigh bone). The pelvic floor muscles also have fascial connections to the lower back and abdomen, and fascial and neural connections to the neck and jaw.

The pelvic floor muscles have a few very important roles in our body. They are involved in bladder function, bowel function, and sexual function. They also work to support our pelvic organs. During activities the pelvis and pelvic floor muscles absorb and translate forces in our body, so they play a large role in physical activities and can sometimes be a culprit in hip, back, and SI joint pain. The pelvic floor muscles make up 1/3 of our “core”, and coordinate with our diaphragm and abdominal muscles.

The pelvic floor muscles are kind of like a trampoline. We want them to be resting at a nice baseline tension to support our body. They need to be able to lengthen and lift during breathing, movement, and exercise as needed to support us.

The three main issues I find in patient’s pelvic floor muscles are that they are holding tension and unable to lengthen well, that they are resting in a more lengthened state and are “offline” or not lifting well, or that they are not coordinated properly with breath and core engagement.

What is pelvic floor therapy? 

Pelvic floor therapy is a specialty of physical and occupational therapy. Both PT’s and OT’s can specialize in pelvic floor therapy, taking additional continuing education coursework after they graduate. You may also hear pelvic floor therapy referred to as pelvic health therapy. I like the term pelvic health therapy because it is really more representative of what we do (pelvic health is about way more than just the pelvic floor muscles), however I often choose to use the term pelvic floor because I feel like that is the more commonly used terminology among patients.

Many therapists (like myself) work in outpatient orthopedics for several years prior to specializing, while others will specialize right out of school. It is important for pelvic floor therapists to have a good understanding of orthopedics and biomechanics, since the pelvic floor has to work in tandem with the rest of your body, and treating pelvic floor conditions often involves addressing a lot of things outside of your pelvis. 

What should I expect in a pelvic floor therapy appointment? 

Here is a list of things you can expect during a pelvic floor therapy appointment.

1) A full discussion of your history and symptoms. Your therapist will have a long list of questions to ask you about your symptoms, medical history, bowel function, bladder function, sexual function, and more. One of the most important things you will discuss with your therapist is what your goals are for therapy.

2) Movement assessment. If you have ever been to physical therapy, you probably remember your therapist checking your strength and range of motion. This should happen in pelvic floor therapy, too! In my assessments I check several functional movements (like squatting, hinging, step ups, gait, and more), core and lower extremity strength, range of motion, posture, and anything else specific to the patient that comes up during our discussion. 

3) Internal pelvic floor muscle assessment. This is where pelvic floor therapy is different than orthopedic physical therapy. An internal pelvic floor muscle assessment can provide your therapist with valuable knowledge about how your pelvic floor is functioning. This is done by placing one gloved finger into the vaginal canal or rectum. The muscles are assessed at rest, with breathing, and with abdominal engagement. An assessment for pelvic organ prolapse can also be completed.

The internal pelvic floor muscle assessment can feel intimidating for patients, so your therapist should be thoroughly explaining the process and answering all of your questions both before and during the assessment. They should also be obtaining consent throughout.

I often do not get to the internal muscle assessment during the evaluation due to time (there is just so much to cover that first day!), but if I feel it would be valuable I will recommend we do the assessment at the second visit. If you feel you could benefit from pelvic floor therapy but do not want to do an internal assessment, please speak with a therapist near you about this. The internal assessment is NOT required, but does provide your therapist with valuable information to develop the best plan of care for you.

4) Discuss a plan. You have a life outside of pelvic floor therapy, and it is important that your therapeutic plan works well with your lifestyle. Your therapist should be making a recommendation based on their findings, then the two of you should work together to determine a plan.

What can pelvic floor therapy help with?

There are SO many things pelvic floor therapy can help with. For a full list of diagnoses we treat, visit our pelvic health page.

A few signs that you may benefit from seeing a pelvic floor therapist include the following.

1)    You experience urinary incontinence (leaking), hesitancy, urgency, or difficulty completely emptying

2)    You experience back, hip, or SI joint pain

3)    You have had trauma or stress to your pelvic floor or abdomen (this includes falls onto your tailbone or buttock, vaginal birth, etc)

4)    You experience pain with insertion (such as tampons) or during pelvic exams

5)    You experience bowel issues such as constipation, incomplete voiding, straining or pain, difficulty initiating a bowel movement, or loss of control of gas or feces

6)    You experience painful sex/intimacy or difficulty/inability to orgasm

7)    You have experienced pelvic or abdominal surgery (including a c-section)

8)    You have a feeling of increased pelvic pressure, a sensation of pelvic organs slipping down or falling out, or have been diagnosed with pelvic organ prolapse

If you are interested in learning more, reach out here to set up your free 15 minute phone consult or schedule your 1:1 evaluation with me!

Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS