Is It Time to Add Pelvic Floor Physical Therapy to Your Healthcare Routine?

Should you exercise your pelvic floor? If so, how do you exercise your pelvic floor? By the way, what is your pelvic floor?

When people talk about exercising the "pelvic floor," they're usually referring to the pelvic floor muscles, which are located at the base of the pelvis, and protect the pelvic organs like the vagina, cervix, uterus, bladder, urethra, and rectum.

The pelvic organs have several essential purposes, so protecting them is a big job. Pelvic muscles facilitate sphincter function, so people don't involuntarily relieve themselves. They assist in orgasm function, aid in postural support, and help pump lymphatic blood.

When the pelvic floor muscles aren't functioning correctly, people may experience symptoms like painful sex, prolapse (when an organ or tissue "drops" or moves out of place), urinary incontinence, or constipation. This can trigger secondary issues like shame, embarrassment, and anxiety.

As uncomfortable or disruptive as these symptoms can be, the good news is that they can be treated. Pelvic floor physical therapy (PT) is one intervention practitioners use to alleviate peoples' discomfort.

"If you're in pain, if you feel like you have no control over your bladder, if you're having excruciating sex, or if you have a prolapse, it can be very isolating," Janelle Howell, DPT, WCS, a pelvic floor physical therapist known as the "Vagina Rehab Doctor" on Instagram, told Verywell. "Pelvic physical therapy can give you that quality of life back where you understand your body better, you feel better, and you have a grip on what to do going forward."

Pelvic floor issues can be more common in older adults, as women and people with vaginas undergo hormonal changes with age that can lead to vaginal dryness or thin tissues.

"Estrogen is what tells our tissues to stay thick and nourished with blood flow, as well as ready for sex," Howell said. "As we get older, estrogen is just not as robust as it was when it was younger."

With time, commitment, and targeted treatment, people of all ages can use pelvic floor physical therapy to lubricate tissues, strengthen muscles, and restore their pelvic floor function, Howell said.

What Causes Pelvic Floor Problems?

Pelvic floor dysfunction tends to occur as people age, during pregnancy, or in tandem with life events like the postpartum period and menopause, which can lower a person's hormone levels.

People who are pregnant are especially prone to pelvic floor problems, Heather Jeffcoat, DPT, a pelvic floor physical therapist and founder of Femina Physical Therapy, told Verywell. The weight of a pregnant person's uterus can pressure and strain the pelvic floor muscles. Vaginal childbirth can also stretch or weaken the muscles.

"[The risk of] pelvic floor dysfunction is increased in anybody that is pregnant, but people might not necessarily know that they have a problem," Jeffcoat added. "They might normalize things [or think] they will get better after delivering—which is not necessarily true."

How Do You Know If You Need Pelvic Floor PT?

Unlike muscles like the glutes and abs, the pelvic floor muscles aren't easy to see. As a result, Howell said that not everyone who needs help may notice the signs.

"We don't see the pelvic floor because it's in a private area, so we assume that many of the issues that we experienced—privately or intimately—cannot be helped, but they can," she said. "These issues are happening from the young to the old; it's just happening more when you're older."

Symptoms of pelvic floor dysfunction may include:

• Urinary or stool leakage or incontinence
• Constipation
• Pain in the pelvis region
• Back pain
• Painful urination
• Painful sex

If left untreated, these problems can worsen over time.

Jeffcoat recommends that women and people with vaginas schedule at least three pelvic floor physical therapy appointments during pregnancy, at least one during the postpartum period, and at least one at the onset of menopause.

"Pelvic PT should be a part of general wellness visits to catch dysfunction early and help set [people] up better for the rest of their lives," Jeffcoat said.

What Happens During Pelvic Floor PT?

At their first pelvic floor PT appointment, a person will meet with a specialist to discuss symptoms and undergo two physical exams.

The first is an internal pelvic floor muscle exam, so you should be prepared to disrobe from the waist down and to be touched internally. Practitioners will not touch or require you to disrobe without consent, however, and anyone has a right to refuse examination.

The other exam is conducted pants-on and evaluates posture, mobility, and overall core strength.

Once the initial exams and evaluation are complete, the practitioner will likely go over pelvic floor exercises and provide a plan for treating the issue. Recommended exercises will vary based on symptoms but tend to focus on relaxing, stretching, and/or strengthening muscles.

Relaxing Muscles

To relax the pelvic floor muscles, a practitioner may have you work on your breathing. For a pregnant person, this means preparing to time breaths with contractions. For a person experiencing constipation, breathwork can help them relax and reduce strain.

Stretching Muscles

Stretching the pelvic floor can help relieve tightness, assisting in more comfortable sex. A practitioner may help you stretch your pelvic floor by using more invasive interventions, like intervaginal massages or a vaginal dilator. This type of PT can help loosen tight muscles or gently coax dislocated organs into place.

Strengthening Muscles

After the pelvic floor is loose and relaxed, the focus of pelvic floor work typically switches to strengthening. Strength work may target abdominal muscles or the pelvic floor muscles themselves via Kegels. Though many people have heard of Kegels, experts caution against treating them as a foolproof cure for all pelvic floor issues.

In fact, Jeffcoat said not every person needs to practice Kegels, and those who do should work on them after completing breathwork and other techniques first. People who experience pain and tightness during sex should initially avoid Kegels, as they can increase unwanted tension to the pelvic floor.

“The emphasis shouldn’t always be on contracting those muscles because if they get short and tight, that is also dysfunctional—they aren’t able to do their job,” Jeffcoat said. “You have to also learn how to relax and lengthen them.”