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What is pelvic health physical therapy and what does it look like?

A woman receiving care, exploring Pelvic Health Physical Therapy.

The pelvic floor is a group of skeletal muscles that are like a hammock at the bottom of the pelvis. All people, regardless of sex or gender, have pelvic floor muscles. These muscles are like any other muscle group (like the biceps) that can be trained, strengthened, and coordinated. These muscles have a few different functions:

  • Support abdominal organs

    • If there is weakness in the pelvic floor or a change in the support system of pelvic organs (bladder, rectum, uterus), the organs might start to move down into the vaginal tissues. This is called prolapse. Clients often report feelings of heaviness in the vagina or like a tampon is falling out.
  • Sexual function

    • The pelvic floor needs to relax for pain-free insertion. If there is pain with insertion or deep thrusting, there could be pelvic floor dysfunction, such as muscle tension. 
    • These muscles also play a role in orgasm. If there is pain or tissue restriction, it can lead to painful sex and difficulty achieving orgasm. 
  • Maintain urinary and fecal continence

    • A functional pelvic floor helps us not poop or pee ourselves during activities such as hikes with the family, playing soccer with the kids, when laughing with friends, and when squatting and lifting. 

If you are experiencing any of these changes, a Pelvic Health PT can assist in the diagnosis and treatment of these conditions and more.

Weakness, discoordination, pain, tension, scar tissue, or surgery can affect the function of the pelvic floor and can lead to some of the conditions listed above.

A Pelvic Health Physical Therapist is someone who trained as a general PT, but who also took extensive postgraduate training specializing in pelvic floor evaluation, diagnosis, treatment, and condition management. 

Pelvic Health PT evaluations and assessments are performed in a private room one-on-one with your therapist. You have the option to bring a second person to stay in the room with you for comfort.

A Pelvic Health PT evaluation is similar to a typical PT evaluation in that it always starts with the client telling us their story. What is going on, how long has it been happening, when did it start, how bad is it, how is it impacting your life, and what are your goals for treatment? We then assess the general musculoskeletal system as needed in relation to what the client is describing. There are a couple of options for specific evaluation of the pelvic floor itself: internal or external assessment.

The internal assessment involves the PT inserting a gloved finger into the vagina or anus where we can actually feel the muscles. This allows us to assess the strength, power, endurance, and coordination of the pelvic floor muscles. You always have the right to decline an internal assessment.

The external assessment can be done with clothes on or clothes off. With clothes on, the PT can externally feel the pelvic floor muscles. We cannot assess as well as with the internal examination, but this still provides valuable information for creating a treatment plan. The clothes-off version is similar to the clothes-on version but allows the PT to visually assess tissue quality, and visualize muscle activation and coordination. As with the internal examination, you always have the right to decline an external assessment.

If you are uncomfortable with internal or external assessment options, your PT might walk you through a self-assessment and will likely ask more self-report questions in order to assess your pelvic floor function and needs. You and your comfort level set the pace of your evaluation and treatment.

After the evaluation has taken place your therapist will review their findings and outline a basic treatment plan. They will then develop a personalized program with exercises and interventions specific to your needs and goals. 

If you have ever been diagnosed with or suspect you might have any of the following conditions, reach out to a pelvic health PT for further evaluation:

  • Dyspareunia (pain with sex)
  • Vaginismus 
  • Vulvodynia 
  • Urinary leakage
  • Urinary frequency
  • Stress incontinence
  • Fecal incontinence
  • Pelvic organ prolapse
  • Pelvic heaviness
  • Post-prostatectomy
  • Interstitial cystitis
  • Difficulty fully emptying bladder/bowel
  • Difficulty starting urination
  • Constipation
  • Pelvic pain
  • Tailbone pain
  • Pelvic nerve injuries
  • Endometriosis
  • Injury during labor and delivery
  • Pain in low back, groin, or hips that has not responded to other treatment

About the Doctor

Karen Timm-Lenning

Dr. Karen’s mission is to provide education, treatment, and support for your unique musculoskeletal and pelvic floor needs. Whether you’re considering pregnancy, currently pregnant, immediately postpartum, or in the continued postpartum years, she’s here to equip you with the tools to address your body changes, optimize your function, and enable you to lead a strong and unrestricted life.