If you leak pee, find sex painful, are pregnant, or have given birth, your pelvic floor could probably use some help.
The pelvic floor consists of hammock-like muscles that sit at the base of your pelvis and support important organs, like your bladder, your bowels (or your large intestine), and internal reproductive organs. Both men and women have pelvic floors.
Pelvic floor muscles are similar to other muscles in the body in that they can be weak, stretched out, strong, or tight, notes Mayo Clinic. If the pelvic floor muscles are too weak or tense to function well, you may have issues urinating, defecating, or having sex comfortably, according to an article.
To fix these issues, you can get your pelvic floor muscles in shape with pelvic floor therapy.
Find out what pelvic floor therapy is, what conditions it treats, and how to get started.
What Is Pelvic Floor Therapy?
“Pelvic floor physical therapy is a specialty within orthopedics, and it addresses any issues that arise related to underactive or overactive pelvic floor muscles,” says Riva Preil, DPT, a doctor of physical therapy in New York City who specializes in pelvic floor therapy.
Pelvic floor physical therapists are licensed physical therapists who have completed additional coursework and hands-on training in pelvic health assessment and treatment techniques. Many organizations offer pelvic health certifications, including the American Physical Therapy Association and the Academy of Pelvic Health Physical Therapy.
To begin pelvic floor therapy, you’ll consult with a pelvic floor physical therapist in a private, one-on-one setting to review your medical history, symptoms, and goals. The physical therapist will conduct a physical exam to determine whether your pelvic floor muscles are too loose or too tight. “The gold standard for assessing these muscles includes, with consent, an internal vaginal or rectal assessment,” says Carly Gossard, DPT, a pelvic floor therapist in Montvale, New Jersey.
After the consultation, the physical therapist will create an individualized plan to address your issues. They may recommend exercises, stretches, manual therapy (hands-on massage), biofeedback therapy (a mind-body technique used to control body functions like heart rate and muscle responses), or electrical stimulation (the use of a low-grade electrical current to stimulate muscle contractions) to strengthen or relax your pelvic floor muscles, per the Mayo Clinic.
For example, if you experience pelvic pain after childbirth, your treatment plan may include exercises to strengthen the abdominals, back extensors (spine muscles that support and straighten your spine), and pelvic floor muscles, according to clinical guidelines published in the Journal of Women’s & Pelvic Health Physical Therapy. Depending on your pain level during exercise, your physical therapist may recommend a pelvic belt (a rigid belt that wraps around the belly to support the pelvis) to reduce discomfort.
One common misconception about pelvic floor therapy is that it’s the same as doing Kegel exercises. Kegel exercises, which involve repeatedly tightening and relaxing the pelvic floor muscles to strengthen them, can be done at home. But Kegel exercises are typically only one component of a larger treatment plan. Moreover, they can’t solve every pelvic disorder, and they may worsen symptoms if done incorrectly, Mayo Clinic notes. So, only perform Kegels if your physical therapist recommends them.
Physical therapy is a marathon, not a sprint, so it may take several weeks before you notice improvements. How long ultimately depends on the individual and the severity of their symptoms. “Some people may notice improvements within a few weeks of starting therapy, while others may require several months of consistent therapy to see significant changes,” says Kari Hough, DPT, who practices physical therapy in Ellicott City, Maryland.
The frequency of sessions depends on the needs of the patient, she adds, noting that she typically sees patients once per week for up to 10 weeks.
Potential Health Benefits of Pelvic Floor Therapy — and Conditions It Treats
“Anyone with a pelvis could benefit from pelvic floor physical therapy,” says Heather Jeffcoat, DPT, a pelvic floor therapist in Los Angeles and the president of the Academy of Pelvic Health Physical Therapy. Still, certain people should seek pelvic floor therapy sooner rather than later. Here are the potential health benefits of pelvic floor therapy.
Better Pregnancy, Labor, and Recovery
An estimated 24 percent of U.S. women are affected by pelvic dysfunction, and vaginal childbirth is one of the main risk factors, per past research.
Your pelvic floor muscles are at work throughout your pregnancy. They support the weight of a growing baby and help you push during childbirth, which stretches and strains these muscles. After pregnancy and delivery, the pelvic floor muscles can weaken, increasing your risk for urinary and fecal incontinence and pelvic organ prolapse (a condition where one or more pelvic organs sag), per research.
Performing pelvic floor muscle exercises during pregnancy can prevent pelvic floor disorders before and after childbirth, according to a randomized controlled trial. Pelvic floor physical therapy also prepares the pelvic floor muscles for childbirth, Dr. Hough says.
Improved Urinary and Fecal Incontinence
The pelvic floor muscles support the bladder and bowels. When that support is lacking, you may experience unwanted urine or fecal leakage (known as urinary incontinence and fecal incontinence) when sneezing, coughing, or laughing. Pelvic floor therapy, and Kegel exercises in particular, may help.
The authors of a review of 15 studies found that up to 62 percent of patients with urinary incontinence cured or significantly reduced their symptoms with pelvic floor therapy.
Meanwhile, pelvic floor rehabilitation for fecal incontinence has a reported success rate of up to 80 percent, per past research.
Boosted Sexual Function
As the pelvic floor muscles provide support for the prostate (a small organ that creates semen fluids) and vagina, dysfunction can have a negative impact on sexual function.
Many women experience pelvic pain, which can make intercourse a source of pain instead of pleasure. This condition, known as dyspareunia, can be significantly improved with pelvic floor rehabilitation, according to a randomized controlled clinical trial.
In addition to reducing pain from intercourse, pelvic floor therapy may increase sexual pleasure. “Pelvic floor muscles need length and strength to get blood flow to this area and to have strong orgasms,” Dr. Gossard explains. “Many clients report improved sexual pleasure with pelvic floor therapy.”
In men, pelvic floor therapy has been shown to improve premature ejaculation and erectile dysfunction, or difficulty getting and keeping an erection, per a review of 37 studies.
Reduced Pelvic Pain
Chronic pelvic pain affects up to 32 percent of women, per estimates from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. This condition can affect a woman’s quality of life, even causing her to miss work. Moreover, chronic pelvic pain is a difficult condition to treat, research notes, because it can be challenging to pinpoint the cause of the pain and identify the appropriate treatment.
That said, pelvic floor therapy may provide relief. When combined with other treatments, attending a weekly pelvic floor physical therapy session for six weeks improved pain levels in 186 women with chronic pelvic pain, according to a study.
How to Get Started With Pelvic Floor Therapy
Seeking pelvic floor therapy can be intimidating, but choosing the right therapist and knowing what to expect can help calm your nerves.
Don’t Wait to Seek Help
Choosing to see a pelvic floor therapy professional is the first step. “The best outcomes happen with early intervention,” Hough says, encouraging people not to wait to seek help.
If you have pelvic pain, pain during intercourse, trouble urinating or releasing a bowel movement, urine or fecal leakage, or you can’t get or maintain an erection during sex, pelvic floor therapy could be a good fit for you.
Know What to Expect
As a type of physical therapy, pelvic floor therapy involves seeing a licensed physical therapist. While there are some exercises and stretches you can do at home, such as Kegel exercises, pelvic floor therapy isn’t something you can do exclusively at home — you’ll need to be examined and assessed by a professional.
The therapist will ask you questions about your medical history and symptoms. They may also use their hands to check for spasms, knots, or weakness in your pelvic floor muscles, per Cleveland Clinic.
To assess your pelvic floor muscles, your physical therapist may also need to perform a rectal or vaginal exam with your agreement. “Your participation in this exam is always at your consent, and does provide valuable information to your provider,” Dr. Jeffcoat says.
Choose a Physical Therapist You Feel Comfortable With
You will likely see your physical therapist on a weekly basis for several weeks or months, so it’s important that you feel comfortable around him or her. Don’t be afraid to cut ties if the therapist isn’t a good fit.
