Pelvic Floor Physical Therapy : Overcoming Dysfunctions

Verified by Michelle Chamberlain, Director of Nursing

Couple Getting Ready For Pelvic Floor Physical Therapy Exercices
Table of Contents

Are you looking to improve your pelvic floor health? Pelvic floor physical therapy may be your guiding light. This specialized form of physical therapy can address a variety of pelvic floor dysfunctions while improving your overall well-being.

In this comprehensive guide, learn about the significance of pelvic floor therapy, the intricacies of pelvic floor dysfunction, and a step-by-step guide to performing exercises at home.

Let’s dive into the subject!

Understanding the Significance of Pelvic Floor Physical Therapy

The pelvic floor, a complex group of muscles and tissues, plays a crucial role in supporting the reproductive, colorectal, and urinary tracts. Pelvic floor dysfunction can lead to an array of health issues, such as urinary incontinence, pelvic pain, and sexual dysfunction.

Pelvic floor physical therapy, or PFPT is ”a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction”(PubMed, National Library of Medecine, 2019). Timely intervention and treatment are essential for successful outcomes, as they help prevent the exacerbation of pelvic floor issues over time.

The Role of Physical Therapy in Pelvic Floor Health

Physical therapists trained in pelvic floor health are experts in assessing and treating pelvic floor dysfunction. They use a combination of internal and external therapy techniques to help patients regain control over their pelvic floor muscles, thereby improving bladder and bowel function.

According to existing research, Pelvic Floor Physical Therapy (PFPT) has the potential to alleviate or completely eradicate symptoms related to urinary incontinence, pelvic organ prolapse (POP), fecal incontinence, pelvic floor dysfunction during and after pregnancy, as well as hypertonic pelvic floor disorders. These disorders can include conditions such as pelvic floor myofascial pain, dyspareunia, vaginismus, and vulvodynia (PubMed, National Library of Medecine, 2019).

An essential aspect of this process is the internal exam of the pelvic floor muscles, which helps the therapist create an effective treatment plan tailored to individual needs. Non-internal assessments may also be used to evaluate those muscles, but they may not provide as precise a measure of muscle strength, tone, or coordination.

Overall, the primary goal of pelvic floor physical therapy is to enhance the function and support of the pelvic floor muscles, ultimately improving patients’ quality of life.

Importance of Timely Intervention and Treatment

Intervening early is crucial for successful outcomes in pelvic floor physical therapy. Conditions such as pregnancy, childbirth, prostate cancer treatment, obesity, and chronic constipation can weaken pelvic floor muscles and lead to dysfunction.

Pelvic floor therapy can help improve urinary leakage, frequency, urgency, pain, difficulty stopping or starting urination, and sexual function. Early intervention is particularly vital during pre-, peri-, and post-menopausal periods when the risk of pelvic floor dysfunction is heightened.

The Intricacies of Pelvic Floor Dysfunction

Pelvic floor dysfunction is a multifaceted condition with varying symptoms and causes. Depending on the type of dysfunction, symptoms may include urinary incontinence, pelvic pain, and sexual dysfunction.

Potential indications may include difficulty with an overactive bladder, pressure in the pelvis, and a sensation of protrusion or pressure in the vagina, bladder, uterus, or rectum. Pelvic floor dysfunction can be classified as either hypotonic (low tone) or hypertonic (high tone) disorders, each with its own unique challenges and treatment approaches.

Causes of Pelvic Floor Dysfunction

Numerous factors can contribute to pelvic floor dysfunction, such as :

  • Childbirth: (Specifically for women) The stress and strain of labor can weaken or damage the pelvic muscles.
  • Prostate Surgery: (Specifically for men) This can sometimes lead to damage or weakening of that region’s muscles.
  • Aging: As the body ages, muscles can lose tone and strength, including the pelvic floor muscles.
  • Chronic Diseases: Certain illnesses or conditions, such as diabetes, obesity, constipation, or chronic respiratory issues leading to persistent coughing, can put pressure on the those specific muscles.
  • Physical Strain: Regularly lifting heavy objects, high-impact exercise, or anything that puts a lot of strain on the abdominal and pelvic muscles can cause these issues.
  • Obesity: Excess weight increases pressure on all body structures, including the pelvic floor muscles.
  • Neurological Disorders: Conditions like Parkinson’s disease, stroke, or spinal cord injury can interfere with nerve signals to the pelvic muscles.
  • Low Tone Disorders: These are characterized by weak pelvic floor muscles, leading to issues like urinary incontinence and bowel dysfunction.
  • High Tone Disorders: These involve excessive tightness of the pelvic floor muscles, causing pain and difficulty with bowel movements or during sexual intercourse.

Now let’s have a look at the symptoms.

Symptoms of Pelvic Floor Dysfunction

The symptoms of pelvic floor dysfunction can vary greatly depending on the type of dysfunction. Women may experience complications such as :

  • Pain or pressure in the vagina or rectum
  • Pain during sexual intercourse
  • Discomfort in the uterus
  • Difficulty in inserting tampons or undergoing gynecological exams
  • Frequent urination or a strong urge to urinate
  • Urinary incontinence or leaking
  • Bowel incontinence or constipation

On the other hand, men may experience these symptoms :

  • Pain or pressure in the rectum
  • Groin or lower back pain
  • Difficulties with ejaculation
  • Erectile dysfunction
  • Frequent urination or a strong urge to urinate
  • Urinary incontinence or leaking
  • Bowel incontinence or constipation

In both men and women, these symptoms may vary in intensity and frequency. It is important to consult with your physician about any symptoms you are experiencing. You should not ignore them. Timely treatment can lead to a decrease in symptoms within a three-month period, provided the patient attends physical therapy sessions regularly and adheres to their treatment plan.

Finding the Right Pelvic Floor Physical Therapist

Choosing the right pelvic floor physical therapist is essential for successful treatment. Look for a therapist who has completed specialized training, possesses the necessary qualifications and credentials, and has experience treating pelvic floor dysfunction.

Equally important is the therapist’s ability to communicate effectively with their patients, as strong communication is crucial for the successful implementation of a treatment plan and for answering any questions the patient may have.

When selecting a pelvic floor physical therapist, consider their credentials, years of experience, appointment duration, ability to establish a personal connection, and sensitivity. The therapist should also provide comprehensive education and recommendations for modifications to behaviors and movements.

The therapist will examine your posture, breathing pattern, strength, and flexibility of your spine, hip, and abdominal muscles during the examination. This assessment will help them decide on the most suitable treatment plan for you.

Establishing effective communication between the therapist and patient is vital for a successful therapeutic relationship. Effective communication allows the patient to feel heard and understood, fostering trust and a strong therapeutic bond. Through communication, the therapist can gain a comprehensive understanding of the patient’s physical and emotional needs, as well as their desired goals for therapy.

Additionally, effective communication creates a secure and reassuring environment for patients to discuss intimate health issues, ensuring they feel at ease throughout the treatment process.

Your First Pelvic Floor Physical Therapy Session

Embarking on your first pelvic floor physical therapy session may feel daunting, but rest assured that the initial session is designed to be comprehensive and informative. The session will involve a thorough assessment to identify the cause of the dysfunction, as well as the formulation of an individualized treatment plan to address your specific needs and goals.

What to Expect in the Initial Session

During the initial session, the physical therapist will review your medical history, symptoms, and complaints, and conduct a physical exam that includes both external and internal components. The therapist will assess for any potential skeletal or muscular issues in the lower back, hips, sacroiliac joint, buttocks, or thighs that may be contributing to pelvic floor dysfunction or pain.

Be prepared to provide detailed notes regarding your symptoms, including any factors that increase or decrease the pain.

Building an Individualized Treatment Plan

Based on the assessment and your unique needs, the physical therapist will develop an individualized treatment plan tailored to your specific requirements. This plan will include exercises like quick flick Kegels, bridge exercises to strengthen the buttocks, and other techniques to target the pelvic floor muscles.

The plan will also address any lifestyle modifications necessary to support your recovery, such as reducing caffeine or alcohol intake, which may be contributing to your pelvic floor issues.

Pelvic Floor Physical Therapy in Home Health Care

For those who cannot access traditional physical therapy, home-based pelvic floor physical therapy can be an effective alternative. The process involves an initial assessment by a physical therapist to determine your needs and goals, followed by the development of a personalized treatment plan that can be executed at home.

With guidance and support from the physical therapist, you can perform exercises and techniques in the comfort of your own home, helping to improve your pelvic floor health and overall well-being.

The Process of Implementing Home-Based Pelvic Floor Physical Therapy

To implement home-based pelvic floor physical therapy, you’ll first undergo an initial consultation with a pelvic floor physical therapist to assess your needs and develop a personalized treatment plan. The therapist will provide instructions and exercises for you to complete at home, such as Kegel exercises and other techniques to strengthen the pelvic floor muscles.

Be sure to follow the recommended frequency for the exercises, as consistency is key to achieving the desired results.

Equipment and Tools Needed for Home-Based Pelvic Floor Physical Therapy

To perform pelvic floor therapy exercises at home, you’ll need access to some essential equipment and tools. Commonly used equipment for home-based pelvic floor therapy includes:

  1. Yoga Mat: Provides cushioning and a non-slip surface for floor exercises.
  2. Exercise Ball: Used for a variety of exercises to improve strength, balance, and coordination.
  3. Resistance Bands: These can provide added resistance to help strengthen the pelvic floor muscles.
  4. Kegel Exercisers: These devices can help ensure that Kegel exercises are done correctly and effectively.
  5. Mirrors: A full-length mirror can help you ensure correct posture and alignment during exercises.
  6. Pilates Equipment: Some individuals may find Pilates-style equipment like magic circles or Pilates balls helpful in their exercise routines.
  7. Support Cushions: Cushions or pillows can help support the body during certain exercises.

These tools can help you effectively target and strengthen your pelvic floor muscles, improving your overall pelvic health and well-being.

Treatment Approaches and Techniques in Pelvic Floor Physical Therapy

Pelvic floor physical therapy incorporates various techniques and approaches to address the unique needs of each individual. These may include manual therapy, electrical stimulation, and biofeedback, all of which can help improve the function and strength of the pelvic floor muscles.

The treatment plan will be tailored to your specific needs, ensuring that you receive the most effective care possible.

Various Techniques in Pelvic Floor Therapy

In pelvic floor therapy, a range of techniques is employed to address different aspects of pelvic floor dysfunction. Here is a table with a few examples of techniques, including their description, what it does and how a physical therapist can help you at home.

TechniqueDescriptionWhat It DoesHow a Physical Therapist Can Help
Manual TherapyThis involves hands-on techniques to manipulate muscles and joints.Facilitates stabilization of the pelvis and increases mobility of skin, muscles, and fascia.The physical therapist uses their training and expertise to safely apply these techniques to improve pelvic function.
Electrical StimulationUses electrical currents to stimulate muscles and nerves.Potentially reduces pain, increases range of motion, and restores function.The physical therapist sets the correct intensity and frequency of electrical stimulation to optimize results and minimize discomfort.
BiofeedbackEmploys sensors to measure and track the body’s physiological reactions.Helps patients become aware of their body’s responses and learn how to manage them.The physical therapist interprets the biofeedback data and guides the patient in making adjustments to their body’s responses.
Kegel ExercisesInvolves the repetitive contraction and relaxation of pelvic floor muscles.Strengthens pelvic floor muscles and improves bladder and bowel control.The physical therapist provides detailed instructions on how to perform these exercises correctly and effectively.
Pelvic Floor Muscle ContractionsRegular contractions of the pelvic floor muscles.Strengthens and harmonizes muscle activity.The physical therapist ensures that the correct muscles are being contracted and helps the patient establish a regular exercise routine.
Pelvic Floor Muscle RelaxationInvolves consciously relaxing the pelvic floor muscles.Relieves tension and tightness in the pelvic floor muscles.The physical therapist guides the patient in effective relaxation techniques and monitors progress.

Tailoring the Therapy to Individual Needs

The key to a successful therapy is customization. By assessing the patient’s pelvic floor muscles through visualization, observation of functions, and an external observation in addition to inserting one or two gloved fingers into the vagina and/or rectum to palpate the pelvic floor muscles from the inside, the therapist can tailor the therapy to individual needs.

This personalized approach ensures that the treatment plan addresses the specific needs of each patient, resulting in optimal outcomes.

Step-by-Step Guide to Pelvic Floor Exercises at Home

Performing pelvic floor exercises at home can be an effective way to maintain and improve pelvic floor health. By following a step-by-step guide tailored to your individual needs, you can target and strengthen your pelvic floor muscles, improving bladder control and overall pelvic health.

Here is step-by-step guide to help you perform pelvic floor exercises at home with ease and confidence :

  1. Preparation: Before you start, make sure you empty your bladder. Find a quiet, comfortable space where you can lie down without interruptions.
  2. Positioning: Lie down on your back with your knees bent and feet flat on the floor. Your arms should be relaxed at your sides.
  3. Identifying Your Pelvic Muscles: Tense the muscles around your anus, vagina, or urethra as if you’re trying to stop the flow of urine. Hold the contraction for 5 seconds, then relax for 5 seconds. This exercise helps familiarize you with your pelvic muscles.
  4. Starting with Kegel Exercises: Contract your pelvic floor muscles, hold the contraction for 5 seconds, then release and relax for another 5 seconds. This exercise is known as a Kegel exercise.
  5. Increasing the Hold Time: Gradually try to increase the time you hold your contraction for up to 10 seconds, while maintaining a 10 second relaxation period after each contraction.
  6. Adding Pelvic Muscles Contractions: These are similar to Kegel exercises. Contract the pelvic muscles, hold the contraction for a few seconds, then release.
  7. Practicing Pelvic Floor Muscle Relaxation: After each contraction, focus on completely relaxing the pelvic floor muscles and let them rest for a few seconds before starting the next contraction.
  8. Increasing Repetitions: Start with 5 repetitions of each exercise twice a day, then gradually increase to 10 repetitions.
  9. Maintaining Consistency: Aim to perform these exercises every day, and make them part of your daily routine, such as when you’re taking a shower or during commercial breaks on TV.
  10. Monitoring Progress: Keep track of your progress. You should start to notice improvements in bladder control and overall pelvic floor strength in a few weeks to a few months.
  11. Checking in with a Pelvic Floor Physical Therapist: If you’re unsure whether you’re performing the exercises correctly, or if you’re not noticing any improvements after a few months, it may be helpful to consult with your physical therapist.

Remember, everyone’s body is different, and results can vary. It’s important to be patient with your body and give yourself time to see improvements.

Progress and Results: What to Expect from Pelvic Floor Physical Therapy

The progress and results from pelvic floor therapy will depend on the severity of your condition, your commitment to the treatment plan, and your individual needs. After 4 to 6 weeks of regular therapy, you may start to notice some improvement, with significant changes potentially taking up to 3 months to manifest.

The number of treatments required will vary based on the condition being addressed, but typically 12 or more sessions are necessary for complete or near-complete resolution of symptoms, such as painful urination, constipation, back pain, pelvic muscle spasms, pelvic pressure, and pelvic pain.

Self-Care Practices to Support The Therapy

In addition to professional pelvic floor physical therapy, incorporating self-care practices into your daily routine can support your recovery and maintain your progress. Here’s a list of self-care practices that can support pelvic floor physical therapy both physically and psychologically:

Physical Self-Care Practices:

  1. Regular Exercise: Incorporate a routine of gentle exercises such as yoga or pilates that can help strengthen the pelvic floor muscles.
  2. Healthy Diet: A balanced diet can improve overall health and support healing. Specific to pelvic health, a diet high in fiber can help prevent constipation, which can strain the pelvic floor.
  3. Stay Hydrated: Proper hydration is essential for bladder and bowel health, both of which can impact the pelvic floor.
  4. Follow the Therapy Plan: Regularly perform the exercises assigned by your therapist. Consistency is key in physical therapy.
  5. Proper Posture: Maintaining good posture can help prevent unnecessary strain on the pelvic floor.
  6. Regular Rest: Ensure you are getting enough sleep. Proper rest can help the body heal and recover.

Psychological Self-Care Practices:

  1. Mindfulness and Meditation: These practices can help manage stress and anxiety, which can physically manifest as tension in the pelvic floor.
  2. Deep Breathing Exercises: Similar to mindfulness, deep breathing can help reduce stress and encourage relaxation, including in the pelvic muscles.
  3. Positive Affirmations: Maintaining a positive mindset can aid in the recovery process. Positive affirmations can help change the way you perceive your physical condition.
  4. Seek Support: Joining a support group or seeking help from a mental health professional can provide emotional comfort and practical advice.
  5. Set Realistic Goals: Setting achievable goals for your recovery can provide a sense of control and purpose, enhancing your motivation.
  6. Practice Patience: Healing takes time. Be patient with your body and the pace of your recovery.

These self-care practices are intended to complement your physical therapy, not replace it. By taking an active role in your recovery, you can enhance your overall physical and mental health and quality of life.

Potential Challenges and Solutions in Home-Based Pelvic Floor Physical Therapy

While home-based therapy offers many benefits, it can also present some challenges. Here is a table outlining potential challenges and corresponding solutions in home-based pelvic floor physical therapy:

Potential ChallengesSolutions
Lack of motivation to complete exercisesEncourage motivation through setting achievable goals and tracking progress.
Difficulty performing exercises without supervisionConsider online sessions with a physical therapist for guidance. Educate and train yourself and family caregivers on correct exercise techniques.
Lack of access to necessary equipmentInvest in basic home therapy equipment. Many exercises can also be done using items commonly found at home.
Creating a secure and comfortable environment for exerciseDedicate a specific area for exercises that is free from hazards and interruptions. Make it as comfortable as possible.
Balancing patient autonomy and riskFoster independence while ensuring safety measures are in place. Regularly communicate with healthcare providers about any concerns or changes.
Enhancing caregiver communication and handoffsKeep clear lines of communication open between all parties involved. Consider using a shared notebook or digital platform for updates and instructions.
Limited mobility or transportation issues make it difficult to consistently attend in-person therapy sessionsOpt for in-home physical therapy, where the therapist can come to the patient’s home, eliminating the need for regular transportation to a clinic.

When to Seek Additional Help

If you notice any changes in your bathroom habits or experience bothersome symptoms in your pelvis, such as constipation, straining to defecate, urine or stool leakage, or a frequent need to urinate, it is advisable to seek additional help.

Consult your primary care doctor or gynecologist, or see a continence professional to determine the cause of the problem. Professional guidance can help ensure that any infection or condition related to your gastrointestinal, urinary, or reproductive organs is properly evaluated and treated.

Embracing the Benefits of Pelvic Floor Physical Therapy

Pelvic floor therapy can have a profound impact on your overall health and well-being. By addressing pelvic floor dysfunction and improving muscle tone, elasticity, and strength, you can experience benefits such as :

  1. Improved Bladder and Bowel Control: Strengthening the pelvic floor muscles can help manage urinary and fecal incontinence.
  2. Pain Reduction: Therapy can help reduce discomfort associated with conditions like pelvic floor dysfunction, interstitial cystitis, or endometriosis.
  3. Improved Sexual Function: For both men and women, a healthy pelvic floor can enhance sexual function and pleasure, and can help manage conditions like erectile dysfunction in men and pain during sex in women.
  4. Better Recovery from Surgery or Childbirth: Therapy can aid in the recovery process after surgeries like prostatectomy in men or after childbirth in women, helping to strengthen and regain control of the pelvic floor muscles.
  5. Increased Body Awareness: Therapy often involves education about the pelvic floor and its function, which can increase a patient’s awareness of this part of the body and how it influences overall health.
  6. Improved Quality of Life: By managing symptoms and improving pelvic health, patients can often enjoy a better overall quality of life.
  7. Prevention of Future Issues: Regular pelvic floor physical therapy can help prevent future issues related to pelvic health, particularly as one ages.

With consistent effort and dedication to your treatment plan, you can embrace the benefits and enjoy a healthier, happier life.

Considering Potential Risks and Precautions of Pelvic Floor Therapy

As with any form of therapy, it is important to consider potential risks and precautions when undergoing pelvic floor physical therapy. Some potential risks include discomfort or pain during therapy, or a potential worsening of symptoms if the therapy is not done correctly. Precautions may include avoiding certain exercises if you have certain medical conditions and not overdoing Kegel exercises.

Additionally, it is important to consider contraindications to internal pelvic floor assessment and treatment, such as active infection, active rectal bleeding, and radiation injury less than 6-12 weeks old.

By being mindful of these potential risks and precautions, you can ensure a safe and effective treatment experience.


In conclusion, pelvic floor physical therapy is an effective and specialized form of therapy that can address a variety of pelvic floor dysfunctions and improve overall well-being.

By understanding the intricacies of pelvic floor dysfunction, finding the right therapist, and following a personalized treatment plan, you can experience the benefits of pelvic floor therapy and enjoy a healthier, more comfortable life.

So, take the first step toward better pelvic health and embrace the benefits of pelvic floor physical therapy!

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