What is Pelvic Floor PT and When Do You Need It?
Want to get the scoop on pelvic floor health, but feel too sheepish to ask? Let’s normalize talking about it!
We asked two of our favorite Pelvic Floor Physical Therapists to give us the “down low” (no pun intended!) on how to keep our bodies healthy and in shape—both inside and out!
Our bodies go through so much during pregnancy, labor, birth, and postpartum. Something that’s not talked about often enough is pelvic floor health. It’s so common for women to have pelvic floor issues and not know how to address them or get help. Here’s where to start!
What’s the Pelvic Floor Again?
The muscles of your pelvic floor sit like a bowl at the bottom of your pelvis—they are a significant part of your deep core muscles and are responsible for lifting and supporting all your internal organs. They play a really important role in urinating, pooping, and intimacy.
During pregnancy, pelvic floor muscles help lift and hold the baby, and then during labor, they need to properly release to allow the baby to pass through.
What is Pelvic Floor Physical Therapy (PT)?
Pelvic floor physical therapy is a type of physical therapy that specifically targets the muscles of your pelvic floor.
It may involve exercises that strengthen or relax the muscles of the pelvic floor. Your goals may be any of the following:
Improve overall pelvic floor muscle control
Increase muscle pattern awareness (when the pelvic floor is contracted or relaxed)
Decrease pain, pelvic floor injuries or dysfunction
Improve functions like urination, core stability, digestion and more
Pelvic floor PT can help you better support your body through the process of ongoing physical therapy. While it is most common for women to seek this out during healing and recovery from childbirth, it can be very beneficial to start pelvic floor PT while pregnant.
“A common misconception is that pelvic floor physical therapy is only about doing Kegel exercises. While learning to coordinate your pelvic floor muscles is important, there is much more nuance to pelvic floor health than just contracting them for exercises like Kegels. Pelvic floor therapy is about optimizing how your body functions from a holistic perspective and taking into consideration the many influences that are placed on the pelvic floor muscles in order to make long lasting change.” —Dr. Jenn Gelfand, Pelvic Floor Specialist, Owner of Root To Rise Physical Therapy & Pelvic Health
Reasons to See a Pelvic Floor Therapist
There are so many good reasons to add physical therapy to your postpartum or prenatal experience. This list has a few common reasons, but by no means exhaustive. If you want to see a pelvic floor PT, do it! You don’t need a reason on this list. In fact, you would benefit from pelvic floor PT if you are pregnant or postpartum even if you are feeling great.
Incontinence. While it is very common, it is never normal to leak stool or urine.
Constipation. If you are straining to poop, it could be a pelvic floor issue.
Pelvic pain. If you're having any lower back or pelvic pain.
Intimacy discomfort. A pelvic floor that is too tight can result in pain during sex.
Prolapse. Pelvic floor prolapse is a common childbirth injury. This is when the uterus, bladder, or rectum can drop causing pelvic pressure or heaviness as well as bladder and bowel issues
If you have any curiosity about the health of your pelvic floor muscles, book an appointment for an assessment.
What to Expect During Pelvic Floor PT
First your therapist will ask about your symptoms. Come prepared with specific examples of what brought you to pelvic floor PT.
“It’s always helpful to bring specific goals to PT so they can customize your treatment plan for you. If you have incontinence, maybe your goal is to run after your toddler without peeing your pants! Maybe your goal is to sneeze or laugh really hard with your friends without having to worry about leaking. Perhaps your goal is to be able to be intimate with your partner without pain. You and your therapist will work together to ensure you reach your specific goals” —Dr. Jenn Gelfand, Pelvic Floor Specialist, Owner of Root To Rise Physical Therapy & Pelvic Health
Your practitioner will want to know about your medical history, including your pregnancy, birth and delivery.
A physical exam and assessment will likely take up most of your initial appointment. Be very clear with your therapist if you prefer to have an internal and external exam, or just external.
They will then help execute a plan for recovery to meet any goals you set together. This may include postural and movement pattern training, breathing and connecting to your pelvic floor muscles, manual therapy (usually internal), stretching and relaxation strategies, and any other complimentary core strengthening exercises to help support your pelvic floor health and function.
How to Choose a Pelvic Floor PT
Choosing a practitioner may feel daunting. Use the same methods you want to find a primary care provider, a mental health therapist, or a life coach. You want to work with someone who is qualified, caring, and who you get along with. Pelvic floor PT can be very intimate, and you need to feel 100% comfortable with your provider.
Some considerations before making an appointment:
Poll your friends for a referral and ask hard questions about their experience.
Map out how close the office is to you. If you’re recently postpartum you may want something very convenient and close.
Visit the office or give them a call to get a vibe check. Quality pelvic floor PT will provide 1:1 sessions entirely with your therapist, they will take the time to listen to your specific needs and goals, and will have an approach that considers your whole body and not just isolated to your pelvic floor.
Check if your insurance covers it, either in full or partial. Often your provider and/or clinic can help you navigate this process.
Pelvic Floor Physical Therapy FAQs
Does it hurt?
The only time you may have some discomfort in a pelvic floor PT is during the evaluation process if you’ve come in to address pelvic pain. This is only to assess what is causing the pain and to accurately treat your symptoms and point the treatment plan in the right direction for optimal healing.
“Treatment should never hurt! If something does cause pain during your evaluation or treatment session, it is important to communicate that to your provider so adjustments can be made. The goal is always to have you leave feeling better than when you walked in. ” —Dr. Brooke Fleurent, Pelvic Floor Specialist, Cape Integrative Health
Do I have to be naked?
Some pelvic floor PT sessions may include an internal evaluation or treatment. Yes, this means your practitioner will need to manually assess your pelvic floor muscles, or the areas nearby.
This is entirely up to you and your comfort level. If you choose to have any internal assessment done, typically people will only undress from the waist down. Most therapists will use draping to make sure that modesty is ensured.
Remember, everything is always up to the patient. You should be 100% comfortable with everything done in the treatment session.
Is it like going to the OBGYN?
If you do choose to do internal work, you might have to be undressed from the waist down. It may feel like your OBGYN, but less invasive.
“Having your pelvic floor examined internally completely depends on you - your symptoms, and your comfort level. While internal assessment allows for the most accurate evaluation of the pelvic floor muscles, it is not always necessary to begin treatment. Discuss with your provider your options and what might benefit you best. Your comfort level should always be top priority.” — Dr. Brooke Fleurent, Pelvic Floor Specialist, Cape Integrative Health
Because the muscles of the pelvic floor cannot be seen from the outside of your body, most women will likely benefit from internal work. If this doesn’t sound good or suitable to you, that’s entirely okay too. Pelvic floor PT can be done without any internal manual work.