What Is Pelvic Floor Therapy & How Does It Work?

Your pelvic floor is a basket of muscles, fascia, nerves, and connective tissue in your pelvis that holds in all your reproductive organs. When something about them goes awry — they’re too tight, too relaxed, injured giving birth, or weakened over time — it’s known as pelvic floor dysfunction.

Because of how many duties the pelvic floor performs, pelvic floor dysfunction can appear as a wide array of different disorders and symptoms. Some of the most common pelvic floor disorders include:

• Pain
• Incontinence (urinary and fecal)
• Urinary frequency (peeing more often than is typical)
• Chronic constipation
• Pain during penetrative intercourse
• Pelvic organ prolapse (when an internal organ drops below the pelvic floor, which normally supports it, and bulges out of the vaginal opening or anus)

“When people have pelvic floor dysfunction or pelvic floor disorders, what we’re referring to is a bunch of different diagnoses — whether that’s bladder symptoms, bowel symptoms, sexual dysfunction, or pain,” says Meghan Markowski, a board certified physical therapist at Boston’s Brigham and Women’s Hospital who specializes in pelvic floor disorders. “Just like other muscles in our body, like the biceps and the triceps and the hamstrings, we can control these muscles.”

What happens at pelvic floor therapy?

Therapists offer a wide variety of pelvic floor treatments, like manual therapy (basically a specialized internal massage technique to relieve tension). They will teach you exercises and stretches to relax, strengthen, or increase the range of motion in your pelvic floor. Some of them will be familiar yoga poses if you’ve ever taken a class, and others might be totally new. Your regimen may or may not include the infamous Kegels, but if it does, your physical therapist (PT) will instruct you on how to do them properly (people often do them wrong, experts say). Some therapists also offer biofeedback, which can help you learn exactly what your muscles are up to and how to activate and relax them in real time. This usually involves inserting a small sensor into the vagina or rectum and performing a series of exercises, while you watch on a screen which of your muscles are engaged or relaxed.

Depending on your symptoms, PT might also include some lifestyle changes. “A lot of times the treatment is behavioral. It might be suggestions about timing of going to the bathroom, diet and nutrition — certain foods and beverages can irritate the pelvic floor — and then there’s general relaxation,” says Andrea Freeman, a doctor of physical therapy at Sutter Health Alta Bates Summit Medical Center in Oakland, California. Helen Bost Karel, 31, a mom in New Orleans, sought pelvic floor therapy for her vaginismus, and her PT recommended she also start talk therapy. Karel says that after years of sex causing pain, her brain needed some time to learn that intimacy didn’t hurt anymore.

You’ll do treatments in their office and most likely have some homework to do in between visits as well. “There could be a component of exercising, breathing exercises, stretching exercises for the hips and legs, and then just range of motion exercises,” says Freeman.

How long will I need to do therapy?

You might notice your symptoms improving after just a few physical therapy appointments, or PT might be an ongoing part of your health care, just like an annual visit to your primary care doc or OB-GYN. Your therapist will work with you to determine how many appointments you need early on to address your concerns, and you can expect them to become less frequent over time.

“I would say most commonly I see people between six months to a year,” says Laura Meihofer, a pelvic health physical therapist in Rochester, Minnesota. “Generally I start out seeing someone once a week to once every other week for maybe the first four to eight weeks. And then we can kind of push it out from there. I might see them once every other week for maybe another four to eight weeks depending on how things are going. Then I might see them once every three weeks, once a month.”

“Oftentimes, when we see patients, they’ve been experiencing symptoms for months or years, so I tell them six to eight visits is going to scratch the surface. What pace we need to move is really about what works best for their bodies,” says Sara Reardon, a pelvic floor physical therapist and owner of NOLA Pelvic Health. “Sometimes we could be more aggressive; sometimes we just have to take it really slowly.”

Once you reach your goals for therapy, Reardon says you may want to come in for occasional checkups. For example, someone with tailbone pain might feel it flare up after a road trip or a stressful week at work and want to come in for treatment to reset. In an ideal world, according to Reardon, pelvic floor PT would be like going to the dentist — there are routine appointments throughout the year, allowing your therapist to catch potential issues early and keep you feeling your best.

Experts:

Meghan Markowski, PT, DPT, WCS, BCB-PMD, a pelvic health physical therapist at Brigham and Women’s Hospital, in Boston, Massachusetts; board-certified in women’s health physical therapy and biofeedback for pelvic muscle dysfunction.

Andrea Freeman, PT, DPT, PRPC, pelvic floor physical therapist at Sutter Health Alta Bates Summit Medical Center in Oakland, California.

Laura Meihofer, PT, DPT, pelvic health physical therapist in Rochester, Minnesota

Sara Reardon, PT, DPT, WCS, BCB-PMD, board-certified pelvic floor physical therapist and owner of NOLA Pelvic Health in New Orleans, Louisiana