Pelvic Floor Disorder Treatment

If you have pelvic floor dysfunction, you may have symptoms like urinary or bowel incontinence, pain, pressure, or problems with sex. One of the first treatments your gynecologist or urogynecologist may suggest is pelvic floor physical therapy (PT). This special kind of PT helps people with pelvic floor muscles that aren't working properly.

What Is Pelvic Floor Therapy?

Pelvic floor physical therapy (PT) helps treat pelvic floor disorders. It is individualized therapy that can help you learn to strengthen or relax your pelvic floor muscles, depending on your symptoms and concerns.

These issues can affect people of all ages and aren't just a normal part of aging.

Like traditional PT, pelvic floor PT is about helping you function better. The area you’ll be working on includes your pelvic area and may also include your abdomen, lower back, and hips.

Pelvic floor PT can include different types of therapy, such as:

• Exercises and stretches that the therapist teaches you.
• Manual work, where the therapist performs an internal exam.
• Biofeedback, where you learn how to engage your pelvic muscles.

Pelvic floor physical therapists have specialized training. Your therapist will work with you one-on-one to ensure you’re comfortable with therapy. They will also determine which type of therapy is best for you.

To receive pelvic floor PT services, you'll need a referral, which your gynecologist, urogynecologist, or primary care doctor can give you.

UPMC offers pelvic floor PT in multiple locations throughout Pennsylvania.

What causes pelvic floor dysfunction?

Pelvic floor dysfunction happens when your pelvic floor muscles aren't working right. The muscles can be too weak or too tight.

There are different causes of pelvic floor dysfunction. Pregnancy and childbirth are a common cause, and we have a special program specifically for postpartum pelvic floor healing.

Sometimes, people have pelvic floor dysfunction without a specific reason. As you get older, you’re more at risk for pelvic floor disorders, but that doesn’t automatically mean you’ll have pelvic floor problems as you age. Genetics and lifestyle also play a role.

People often feel embarrassed to talk about pelvic floor disorder symptoms, which involve peeing, pooping, sex, and private areas of the body. Know that pelvic floor physical therapists are experts at having these conversations and helping you feel comfortable.

Can men have pelvic floor problems?

Yes, men can have pelvic floor issues. People born as males, or those without female reproductive organs, can have pelvic floor problems, along with anyone with female reproductive organs.

Why Would I Need Pelvic Floor Therapy?

You might need pelvic floor PT if you have:

• Feeling of heaviness in your vagina and/or a bulge where your vagina opens.
• Pain during sex.
• Pelvic pain.
• Problems with urine leaking when you don't want it to.
• Problems with pooping or where you can’t reach the toilet in time.
• Sacroiliac pain, which is pain in the lowest part of your back, often radiating to your butt.
• Severe diastasis recti, or the separation of the two sides of your abdomen, causing a bulge.
• Trouble keeping tampons in.

Can my gynecologist treat pelvic floor dysfunction?

Your gynecologist is a good place to start if you’re having problems you think are related to your pelvic floor muscles.

Gynecologists treat pelvic pain, especially when it’s related to conditions like endometriosis. But if it’s pelvic floor dysfunction, they'll often refer you for pelvic floor PT. Pelvic floor physical therapists work closely with gynecologists and urogynecologists.

What happens if pelvic floor dysfunction goes untreated?

Some pelvic floor dysfunction is more severe than others, but it generally doesn’t improve on its own.

When you are suffering, it can be hard for you to know exactly what’s causing your symptoms. That's why you should speak to your gynecologist or see a urogynecologist.

What Are the Risks and Complications of Pelvic Floor PT?

Some people struggle to feel comfortable with the exercises during pelvic floor PT. But you always get to decide if you want to proceed. Open dialogue with your therapist during PT sessions is important.

If you’ve experienced sexual trauma in the past, mention it to your pelvic floor physical therapist. They understand these concerns and deal with them often.

What Should I Expect from Pelvic Floor Physical Therapy?

It’s natural to have questions about what happens at pelvic floor PT; many people we see are nervous when they arrive.

Everything we do, we explain. And we always make sure we have your consent before any treatment.

The first session

During your first pelvic floor PT session, you’ll talk to your therapist in a private treatment room.

They’ll take a complete medical history and spend time learning about your issues. They’ll ask questions to try to see how your pelvic floor is functioning. And they’ll ask you about your goals and what you hope to get from therapy.

Your therapist will explain the nerves, muscles, and tissues of the pelvic floor. Understanding what the pelvic floor does and how everything works together can be empowering.

They’ll perform a physical exam to check the muscles around your pelvis, including your lower back, abdominals, and piriformis, to look for tender spots or tightness.

Your therapist may ask to do an internal exam at the first visit to assess your pelvic floor. During the internal exam, they’ll insert one or two gloved fingers into your vagina or rectum. This helps them determine how tight or weak your pelvic floor muscles are and how much control you have over these muscles.

You can decide if you want to proceed with this part of the exam.

What to know:

• Not all first visits require an internal exam.
• If you don’t want to do an internal exam on your first visit, we will still find a way to help you.
• If you've had sexual trauma in the past, let your therapist know. They will work with you to make you comfortable.
• If, at any point during the exam, you want the therapist to stop, they will. You're in charge.

After assessing your pelvic floor, your therapist will work with you to make a plan. You'll be given exercises to do at home and a recommendation for how often you should come to pelvic floor PT.

How many pelvic floor PT sessions will I need?

Most people need four to six PT sessions, each lasting around 45 minutes. The number of sessions will depend on your problem and its severity.

Doing your exercises at home (which your therapist will explain) can help you be more successful with your PT.

What are some of the therapies in pelvic floor PT?

There are many techniques we can use during therapy to help improve pelvic floor function. Remember, everything is optional, and you don’t have to do any internal work. The type of techniques will also depend on the therapist and your symptoms.

Therapy techniques can include:

• Manual therapy — Your therapist may do both external and internal work to help you relax tight pelvic floor muscles. They may have you do contraction and release exercises, inserting gloved fingers in your vagina. They may also do vaginal massage or apply pressure to trigger points in the pelvic area.
• Electrical nerve stimulation — This uses a low-grade (safe) electrical current to stimulate muscle contraction and strengthen muscles. It requires inserting a small device into your vagina.
• Weighted cones — With a weighted cone in your vagina, you contract pelvic muscles to hold the cone in place.
• Ultrasound — This device delivers a kind of healing heat to the muscles and tissues of your pelvic floor. It can help reduce inflammation and pain.
• Biofeedback — This method uses a small device in your vagina or rectum. It senses pressure and helps you learn when to contract or relax your pelvic floor muscles.

What pelvic floor exercises will I do?

Your physical therapist will likely lead you through exercises for you to do at home.

Exercises may focus on squeezing or relaxing the pelvic floor muscles. You may be asked to do them at various intervals and speeds.

They may also suggest a series of core strengthening exercises, such as hip lifts and planks. They’ll make sure you understand how to do each exercise and what muscles each targets.

You may also receive recommended posture exercises and stretches. Again, they'll make sure you understand how to do each move and why you’re doing it.

What are the benefits of pelvic floor physical therapy?

Pelvic floor physical therapy can help decrease pain and improve bladder and bowel problems, pelvic organ prolapse, and other issues. When you improve symptoms, you can improve your quality of life. You can get back to doing things you enjoy without worry.

There’s also an educational component. Most people don’t understand how the pelvic floor works or its importance. When you do pelvic floor PT, you learn to identify the muscles and see how they all work together.

What’s the success rate of pelvic floor therapy?

Pelvic floor PT is a great first-line treatment for many conditions that cause pain and urinary problems. Some people may need additional treatments, including devices, medicine, and surgery.

Various studies have examined how pelvic floor therapy can help improve symptoms and quality of life.

A recent review study assessed several years’ worth of studies. The authors found that pelvic floor physical therapy can improve quality of life for people with pelvic floor

By UPMC Editorial Staff. Last reviewed on 2024-09-05 by Lauren Elizabeth Giugale, MD.