So you’re tired of peeing a little bit when you jog or sneeze. Who wouldn’t be?! You have multiple options to help you get from “time to do something about this” to “yes, sweet relief!” but if you’re looking for a solution that will tackle those errant tinkles, teach you a lot about your body, and maybe address a few other issues along the way, consider pelvic floor physical therapy.
Pelvic floor PT might sound like something that’s only for pregnancy or postpartum discomfort. In reality, it’s a growing specialty of physical therapy that can benefit patients of all ages. Everyone has a pelvic floor, after all: that’s the network of muscle and connective tissue that holds our pelvic organs in place. It’s also an integral part of the core, helping to stabilize the pelvis and spine along with the other muscles and tissues in your torso. Given its complexity, there’s a lot that can go awry in the pelvic floor, and dysfunction is common and increases with age, especially during the menopause transition.
What is pelvic floor physical therapy?
Sometimes called pelvic floor physiotherapy or pelvic floor rehabilitation, pelvic floor therapy focuses on the muscles and tissues between the pubic bone and tailbone in the pelvis. They make a sort of cradle to support organs like the bladder, urethra, rectum, uterus, and prostate. They’re key players in digestive, urinary, and sexual function, so when they’re not working optimally, we notice. Just like any other muscle, pelvic floor muscles can be overly weak, or prone to spasm or tightness with difficulty relaxing. Both issues can lead to all sorts of discomfort and dysfunction: urinary or stool incontinence, painful penetrative sex, organ prolapse, constipation, even sciatica, hip pain, or lower back pain.
And that’s where your pelvic floor physical therapist comes in. They specialize in assessing the muscles of the pelvic floor, diagnosing the cause of pain or dysfunction, helping patients set goals for improvement, and using therapeutic techniques like manual therapy or exercises to get the pelvic floor back to optimal function.
Who should go to pelvic floor physical therapy?
Anyone who needs it, really! Many blame pelvic floor issues on pregnancy, childbirth, or menopause, but disorders can also stem from injury, such as a bad fall on your tailbone, or arise after a lifetime of seemingly harmless bathroom habits, like holding it too long when you’ve gotta go, or “hovering” over public toilet seats (pelvic health experts are begging you: stop doing that!). Issues with the pelvic floor might feel a little awkward to talk about, but they are common, treatable, and nothing to be ashamed of.
Signs you should see a pelvic floor PT in menopause
The menopause transition is an ideal time to see a pelvic floor PT, as the genitals and pelvic floor tend to need extra TLC to manage the effects of hormonal changes. Your doctor or a PT can advise you about when and why you might need pelvic floor therapy, but here are some of the most common issues for which you might seek care:
- Pelvic organ prolapse
- Genitourinary syndrome of menopause
- Incontinence or urinary urgency
- Constipation
- Pain with intercourse
The good news is, pelvic floor PTs are accustomed to treating menopause-related concerns and understand how pelvic floor dysfunction fits in with all the other changes your body goes through during this time.
If you’re unfamiliar with it, physical therapy for your most sensitive bits might sound intimidating (especially if pain is what’s driving you to get help). We asked Dr. Kerry Boysen, DPT and owner of Restore Physical Therapy, for the lowdown on what to expect from pelvic floor physical therapy to make the whole thing a little less daunting.
What to expect from a pelvic floor PT appointment
Intake and first appointment: Before your first appointment, you’ll fill out some intake paperwork to get your physical therapist up to speed about your medical history and your reasons for seeking PT. At your appointment, you’ll have a chance to explain your concerns and goals in more detail.
Appointment length: Appointment length varies by practice, but for pelvic floor PT, expect your first visit to last about an hour to 75 minutes to allow for a thorough intake. Follow-up visits, if you need them, can last 45 minutes to an hour based on your treatment plan.
Privacy: Your privacy is a priority! Your appointment will take place in a private room, one-on-one with the physical therapist.
How does a pelvic floor PT exam work?
The phrase “pelvic exam” conjures thoughts of breezy medical gowns (socks on or off? We never can decide), cold crinkly exam table paper, and a speculum that’s colder still, but Kerry assures us that a pelvic floor PT exam isn’t much like an in-person visit to your OBGYN.
“The physical exam for pelvic floor PT is different than a gynecological exam in a couple of ways” she says. “The PT does not use stirrups and a speculum, and the PT is evaluating the function of your pelvic floor and musculoskeletal structures, not your pelvic organs.”
Even though you’re there for your pelvic floor, Kerry says, you’ll probably get a head-to-toe sizing up as your therapist gets to know you—PTs look at the whole body as part of the musculoskeletal assessment to see what’s going on with your hips, spine, pelvis, and extremities. It’s all connected, and patients are often surprised to learn that even things like gastrointestinal complaints or deep buttock pain can sometimes be related to pelvic floor dysfunction.
Is there an internal exam for pelvic floor PT? How does that work?
“Physical therapy is typically ‘hands-on’ care,” Kerry explains. “However, if you are not comfortable having an exam, you certainly can choose not to proceed. There does not have to be an internal vaginal or rectal exam on the first visit. No exam is ever done without your written and verbal consent. Building trust and rapport with your physical therapist is critical for optimal outcomes.”
In addition to an internal exam, some treatment plans may include manual therapy to help improve muscle tone and ease tissue restrictions to help with pain. Some of these manual techniques may be done internally (gently, gloved, and with consent, of course) but external techniques can be helpful too, if indicated. Pelvic floor physical therapists often have specialized training in trauma-informed care, so are thoughtful about informing patients about what to expect from hands-on treatment and seeking consent. You should never feel unsafe or uncomfortable with the sort of physical contact involved in your appointments. If you’re nervous about this, don’t be afraid to ask questions when you book your appointment.
Is pelvic floor physical therapy different before and after menopause?
Kerry says her exams aren’t tailored to her patients’ age—the assessment is the same whether they’re in their twenties or mid-fifties—but she adjusts her talking points and patient education based on their life stages and related concerns. Younger and pre-menopausal patients may come in with questions about endometriosis, childbearing, or postpartum pain, while patients in or approaching menopause may need information about conditions like genitourinary syndrome of menopause or pelvic organ prolapse.
But, she says, many pelvic issues and the benefits of pelvic floor PT are age-agnostic, so that doesn’t change how she approaches her exams. “Women at all ages and stages can have bladder and bowel issues. With all exams I am looking at vulvovaginal tissue health and pelvic floor muscle function. I want to know how women are addressing their bone health and heart health. I ask about nutrition and refer out for specific needs.”
What should you wear for pelvic floor physical therapy?
Kerry says you can wear anything you want to your PT appointment, but she always recommends comfortable clothes you can move in. For the pelvic floor exam portion of your appointment, she says, “you will be asked to undress from the waist down (your socks can stay on!) and you will use a sheet or gown to cover your lower half.”
How long do you have to do pelvic floor PT?
It depends on your individual treatment plan and why you’re in physical therapy. Some patients only need a few sessions to meet their goals and start feeling better; others may need to go for a few weeks or even months to address persistent pain or a complex diagnosis. Your PT probably won’t be able to tell you up front how many visits you’ll need for relief, since this is highly variable based on each patient’s symptoms, goals, and progress, but they should be able to help you understand your treatment plan and set expectations for your course of physical therapy.
Are there exercises for pelvic floor physical therapy? How do you know you’re improving?
Just as in PT for sports injuries or surgery recovery, pelvic floor PT treatment plans can include exercises to address your symptoms (and no, it’s not always Kegels!). One patient may need to focus on strengthening the muscles in their pelvic floor, while others may have to practice relaxing those muscles instead, do exercises to improve mobility, or even learn new breathing techniques—seriously! Most exercises you’re prescribed are meant to be done at home, and in the clinic, you may receive manual therapy (hands-on techniques to release tense muscles, trigger points, or “stuck” connective tissues) if it’s part of your treatment plan.
As for how to know if physical therapy is working, Kerry says, look to your symptoms. “The goal of physical therapy is to optimize function, so your response to PT should result in improved function. For example, you will start to see an improved tolerance to penetrative intercourse or leak less urine when working out.”
Remember that most pelvic floor disorders don’t start overnight, so improvement won’t happen overnight either, but gradual, steady progress should feel encouraging. Here are a few things to look for:
- Less pain
- Improved capacity to do the things you want to do
- Fewer symptoms or less bothersome symptoms
- Better bodily awareness (e.g. you can tell when you’re clenching your pelvic floor muscles now, when before it was a subconscious habit)
Sticking to your treatment plan will help you reach your goals, so do prioritize any at-home exercises and follow-up sessions your physical therapist recommends.
Do you need a referral for pelvic floor therapy? How do pelvic floor physical therapists and physicians work together?
Physical therapy is direct access in all 50 states, which means you can see a PT without a doctor’s referral (though some states have rules about the conditions or treatments that qualify for direct access and some insurance plans may require referrals, so it’s always a good idea to double-check for your situation). Kerry notes that while patients don’t need a referral to see her for physical therapy, many people first hear about pelvic floor PT from their physician. That relationship between PTs and doctors can work both ways; Kerry sometimes refers her patients to specialists if they need prescriptions for hormones or other medications, require a surgical consult, or if she spots any red flags that need evaluation by a healthcare provider in another field.
How to find a pelvic floor physical therapist
Kerry says that most pelvic floor PTs establish a background in orthopedic physical therapy and then specialize in pelvic floor PT, so they’ll have a robust foundation in other musculoskeletal issues too. Pelvic floor specialists may have years of continuing education in pelvic floor health and therapeutic techniques, and some may seek certifications in subspecialties like pregnancy and postpartum pelvic PT.
If you’re looking for a physical therapist with specific training and credentialing in pelvic floor therapy, Kerry recommends the APTA Pelvic Health PT Locator Tool, or PelvicRehab.com.
Finally, feeling comfortable and safe with your pelvic floor PT is a must, Kerry says. Getting a recommendation from your doctor or a friend can be helpful, but the important thing is that you click with your physical therapist; you should trust them, feel at ease asking questions, and have confidence in your treatment plan.