Image used with permission from Pelvic Guru®, LLC as a member of the Global Pelvic Health Alliance Membership (GPHAM)

The pelvic floor muscles serve a variety of functions including:

• Support of the abdominal contents, reproductive organs, bladder & rectum
• Sphincter control around the urethra to keep urine in, when needed, and anus to keep gas and stool in, when needed
• Urge suppression through the pelvic floor and bladder connection to decrease the need to go to the bathroom more frequently (did you know going to the bathroom every 3-4 hours is the norm? Unless you are pregnant or over 65, if you go more frequently you should see a pelvic therapist!)
• Sexual appreciation through strong and well coordinated muscles as this is necessary for achieving orgasm (muscles that are too tight or won’t relax may impact your ability to orgasm)
• Stabilization along with the abdominal muscles and in coordination with the diaphragm during things like coughing, laughing, sneezing, running, jumping, lifting heavy objects, and just moving our body around day to day

  What kind of symptoms or diagnoses do you treat in pelvic floor therapy?

The short answer: we treat anything related to pee, poop, sex, pain, pregnancy, postpartum, and gender affirming care. 

The long answer: 

Urinary Issues

• Urine leakage
• Urgency/frequency to urinate
• ‘Just in case’ voiding
• Urinary retention/difficulty emptying your bladder
• UTI-like symptoms

Bowel Issues

• Constipation
• Diarrhea
• Pain while voiding bowel
• Abdominal pain due to bowels
• Difficulty or straining to go

Sexual Issues

• Pain during intimacy (including superficial/deep penetration)
• Incomplete or inability to orgasm
• Decreased sensation during intimacy
• Pain or difficulty with erection/ejaculation
• Premature ejaculation

Pain Symptoms

• Genital pain (including vaginal opening, deeper inside of the vagina, along the shaft and into tip of the penis or testicles)
• Abdominal pain
• Pelvic girdle pain
• Pain resulting from endometriosis, adenomyosis, PCOS, interstitial cystitis, and more
• Low back and hip pain
• Pelvic heaviness or prolapse

Prenatal & Postnatal Issues

• Leakage during and after pregnancy
• Pubic symphysis or sacroiliac (SI) joint pain
• Round ligament pain
• Diastasis Recti management during pregnancy & recovery after delivery
• Low back or upper back pain
• Labor & delivery preparation including breathing techniques, positioning, and perineal massage
• Scar tissue resulting from perineal tearing or delivery via cesarean section
• Postnatal pelvic floor assessment
• Return to exercise or return to running postpartum

Gender Affirming Care

• Presurgical consultation for vaginoplasty
• Postsurgical care after gender affirming top or bottom surgery including scar tissue massage, pain management, range of motion and strengthening
• Support with dilator protocol post-vaginoplasty

For a comprehensive list of diagnoses we treat please check out the Conditions We Treat.

  Who can benefit from pelvic floor PT?

EVERYONE! We know most people assume that pelvic floor therapy is just for those who have had babies. While that isn’t incorrect, it’s also not the full picture. Everyone has a pelvic floor which means everyone can experience issues. We frequently treat people of all genders for a variety of symptoms (as can be seen above). Pelvic floor issues don’t just happen to people who have had babies. We have young patients experiencing pelvic pain, we have patients who never had babies have prolapse, we have penis-owners have urinary leakage and many more presentations just like this that may not fit the mold of what one might think of with pelvic floor therapy. 

When should I see a pelvic therapist?

This depends on if we are taking a proactive or a reactive approach. For those that like to be proactive, we suggest establishing care with a pelvic floor provider who can perform a comprehensive exam to determine if you have any pelvic floor dysfunction related to tightness, weakness, or discoordination. Think of it like your yearly physical, just for your pelvic floor.

If you are taking a reactive approach, then if you are experiencing any of the symptoms we mentioned above, it is time to get to a pelvic health therapist. Some of the most common things we see patients for that they think is normal but in fact is an issue include going to the bathroom more than every 3-4 hours; leakage of any kind, at any time, whether you’ve had a baby or not; any kind of pain; UTI-like symptoms that may actually be due to a tight pelvic floor; and constipation, including if you feel like you don’t fully empty when you have a bowel movement. Keep in mind, this is not an all inclusive list but it’s a start. 

Do I need a referral to see a pelvic floor pt?

Nope! The good news is that physical therapy now has direct access in all 50 states, DC, and the US Virgin Islands. ‘Direct access’ means you can go to a physical therapist without a referral from your doctor. Each state has their own rules around how long direct access lasts before needing a signature from a physician, so be sure to look up the rules in your state. In Maryland, we have unrestricted access meaning your care won’t be cut short if you don’t have a physician to sign off on your plan of care. 

Why is this important? Because you no longer have to wait to see your provider, ask for a referral, hope you don’t get dismissed, and then schedule an evaluation with a pelvic floor therapist. Instead, you can schedule your pelvic floor evaluation as soon as you want! It is as easy as 

1. Look up a pelvic floor therapist
2. Call or fill out an inquiry form
3. Schedule an appointment

What training is involved in becoming a pelvic floor therapist?

You may not have noticed, but most of the time throughout this blog post we have used the terms “pelvic floor therapist” and “pelvic health therapist.” This is because both physical therapists (PTs) and occupational therapists (OTs) can be pelvic floor providers. So even though you may see pelvic health PT or pelvic floor physical therapy more commonly used, rest assured that OTs can treat the pelvic floor and they are really good at it! 

Unfortunately, we don’t learn a lot about the pelvic floor in PT school. In my case, we had a very short lecture but that was enough to peak my interest. So after graduating from PT school and passing boards, there is extra training through continuing education courses to specialize in pelvic floor therapy. These courses typically include didactic and hands-on learning. Unlike medical school, we are not provided models for classes like this which means we are both the patient and the therapist - learning all of the manual techniques needed to treat the pelvic floor with our own body and that of our lab partner. There are a variety of courses that can be taken, but at the minimum providers will take around three foundational pelvic floor courses to start treating the pelvic floor which cover urinary issues, bowel issues, and pelvic pain. Additional courses should be taken to learn about pregnancy and postpartum, gender inclusive care, pediatric pelvic therapy, and more complex pain conditions. 

If you want to hear more about the training that goes into becoming a pelvic floor therapist give this podcast episode a listen!

Now the important thing to highlight here is what sets apart a pelvic health physical therapist from a general physical therapist: internal pelvic floor assessment. While a patient may decide not to consent to an internal assessment, it is important that the therapist has the ability to perform an internal examination and treatment as this provides different information about the pelvic floor muscles and their function. 

How do I find a pelvic floor therapist?

Like many things, one of the best ways to find a pelvic floor therapist that you can trust is through word of mouth. Ask trusted friends, post in a neighborhood Facebook group, or give Google a shot & take a look at their reviews! 

Another great option is to check out these resources for finding a pelvic provider near you: 

• Pelvic Rehab Directory by Herman & Wallace
• Pelvic Global Directory
• Pelvic PT Rising Provider Map

If you are located near Baltimore Maryland, we’d love to help you here at Pelvic Pride.

What should I expect at the pelvic floor evaluation?

While each clinic is different, at Pelvic Pride we allot 75 minutes for your evaluation. During this time we want you to share your story and explain your symptoms, tell us about any providers you have seen and share any testing that has been completed already. (Be sure to fill out any intake paperwork ahead of time and put down as much information as you feel comfortable sharing as this will help make sure you don’t forget anything.) 

As you go, your provider should ask questions to gather more information and start to better understand your symptoms and their possible causes. Once this portion of the evaluation is done, you will move into the hands-on assessment. This may include assessing the range of motion, flexibility, strength and/or soft tissue restrictions of various areas from head to toe (depending on what brings you to therapy). This may also include a hands-on pelvic internal examination. 

Doing an internal examination will give your provider more information about your pelvic floor muscles including if they are tight, weak, coordinated, or struggle to relax. It is important to note that while an internal assessment is helpful, it is never required and your enthusiastic consent should be gained by your provider prior to performing an internal exam. If you wish to defer the internal assessment, there are plenty of other options that your provider should offer you instead. 

Once the assessments have been completed, your provider should review their findings and guide you in some treatment options which may include things you can do at home before your next appointment. 

What about at the follow-up visits?

Again, we feel like time is so important, therefore we offer full 60-minute follow up appointments, one-on-one with your provider. At Pelvic Pride we don’t change providers unless it is requested or we discuss how that may be helpful (for instance Dr. Joy does dry needling and Dr. Marlena may incorporate that into your plan of care at some point by having Dr. Joy join one of your therapy sessions, with consent of course). 

Keep in mind that it may take a few visits to complete all of the evaluative assessments needed, therefore your first few sessions may be a mix of assessment and treatment. Once your provider has finished their evaluation testing, your sessions should focus on treatments that address the root causes of your symptoms. This may include stretches, breathing exercises, strengthening, muscle relaxation and downtraining, soft tissue mobilization, and hands-on internal pelvic floor work. 

If you want to learn more check out our blog post on The 3 Treatment Methods of Pelvic Therapy.

Is pelvic floor therapy awkward?

While some patients may feel awkward at first, we do our best to make it as un-awkward as possible! Keep in mind that as pelvic floor providers we are very used to seeing vulvas, vaginas, penises, testicles, and anuses. We have seen it all from completely waxed, to neatly trimmed, to au natural and we welcome your body exactly as it is! Every pelvic region is different and we want you to feel comfortable showing up in yours. On top of that, we are the experts in helping to treat these areas so we are very knowledgeable about what is normal and what needs to be addressed. All that to say, there is no need to apologize for any part of your body (I promise we don’t care if you don’t shave!). You also don’t need to apologize if you’d like to take things slow and work up to the more hands-on or internal examination. 

Can’t I just do kegels?

Sure, but it likely won’t fix your issues! Many of our patients report they have no idea if they are doing them right anyway. And the thing with kegels is knowing if you need to do them and then if you are doing them correctly. Oftentimes patients have tight pelvic floor muscles so doing kegels will just feed into that tightness - doing the opposite of what your body needs. 

Trust me, there is definitely a time to strengthen. But when we strengthen your pelvic floor we prefer to do this with functional movements instead of just kegel exercises. Even if you started with a tight pelvic floor, once your muscles are relaxed/lengthened, it is important to work on coordination/strength. To do this, your pelvic therapist will likely combine pelvic floor muscle engagement with other strengthening exercises such as bridges, squats, lunges, core engagement exercises or even heavier lifting movements. This will serve you well as you interact with your environment and perform daily activities to help prevent leakage or pelvic pressure/heaviness symptoms. 

What about those shorts or that chair that does kegels for you?

So the issue with these devices is that they can also feed into pelvic floor tension/tightness and result in pelvic pain. Functionally we rely on a maximal contraction of the pelvic floor to provide the support we need when living life (think laughing, jumping, coughing, sneezing, lifting, exercising, running, etc). Things like the kegel chair or the shorts create artificial contractions (and in the case of the kegel chair they boast “supramax contractions”) and while that isn’t the worst thing, it is not the most ideal either. Helping the body reconnect the muscles and the brain through things like electrical stimulation is handy, however it does require appropriate assessment beforehand to ensure the devices will not make the symptoms worse. Our society has become a fan of the quick fix and unfortunately the pelvic floor doesn’t respond to quick fixes :)

What kind of results can I expect at pelvic floor therapy?

While each patient is different, things we typically see with our patients include:

• Elimination of leakage
• Improved bowel habits
• Decreased pelvic pain and tightness
• Minimized or elimination of pelvic heaviness or prolapse symptoms
• Elimination of painful sex
• Preparation for labor & delivery to prevent stalls and minimize risk of tearing
• Improved connection to your body after c-section delivery as well as improved mobility and decreased pain in your abdominal scar tissue
• Improved strength and coordination of abdominals after diastasis recti

Can you dry needle the pelvic floor?

Yes, you sure can! Dry needling to the pelvic floor can be an effective way to treat those stubborn trigger points or get to deeper pelvic floor muscles (we’re looking at you Obturator Internus). It’s important that your provider is certified in dry needling as there are a lot of important structures in the pelvis that they need to be mindful of as they perform dry needling in this area. 

Never heard of dry needling or curious to learn more? Check out our Dry Needling FAQs blog post.

What if my physician doesn’t think PT will help?

Oof… this question will get us up on a soap box real quick! The greatest thing about physical (or occupational) therapy is that it is non-invasive. We work on restoring functional movements and finding the root causes as we help you navigate your rehab. We are a lower stakes treatment option compared to putting medication in your body via a pill and/or injection or surgical intervention. We also help to quarterback your care by connecting you to different providers who bring their expertise to your treatment plan. 

The second half to this answer brings us back to our point above about direct access. You do not need your provider to write you a referral for therapy at this time. (Keep in mind some insurances may require a referral for reimbursement of services). This means you get to make the decision for yourself to see a pelvic floor therapist if you feel that may be the best treatment for your symptoms. 

Can I use my insurance?

Insurance companies do not look at pelvic floor therapy as a different type of therapy than standard physical/occupational therapy. So, if you have coverage for those services then yes, insurance will pay for pelvic floor therapy, BUT…

There are big limitations placed on physical/occupational therapy by the insurance companies in the form of visits limits (your plan will dictate how many sessions they cover), denial for certain diagnoses (they feel PT/OT is ‘experimental’ treatment for certain diagnoses which is honestly BS), and the decision to discontinue coverage for PT/OT if they determine it is no longer medically necessary. 

At Pelvic Pride we often see patients who have chronic pelvic floor issues that started 10+ years ago. These patients will not make significant change within 6-8 visits and oftentimes require ongoing therapy to help manage their chronic symptoms, which insurance does not like. Insurance also doesn’t tend to pay for wellness care so for those that choose to see a pelvic floor therapist for proactive treatment, insurance won’t always pay. 

I noticed a lot of pelvic therapists are out of network, why is that?

While looking for pelvic floor providers, it will not be uncommon to find that many are considered ‘out-of-network’ meaning they do not have a relationship with insurance companies. This means the patient will pay for their sessions at time-of-service and can submit receipts to insurance for reimbursement. This is the model we offer at Pelvic Pride as we feel it allows the provider to work with the patient and determine the best plan of care for their symptoms, without the limitations we previously discussed from insurance companies. This also prevents the issue of a surprise bill at any point in your care (this typically occurs when the insurance stops paying or the visit limit is reached however the therapy clinic does not realize this until the patient has been seen past those limits, then the cost is put onto the patient). At Pelvic Pride, you will know up front what the cost is each time and you will never get a big bill at the end. 

Do you want to dive into this a little deeper? Read our blog for more on Why Choose A Fee-For-Service Physical Therapist. 

How do I know if I need pelvic PT?

Excellent question! Luckily we have a quick screening tool for that. Read through the 10 questions and keep in mind, if you say ‘yes’ to 3 or more questions, it is likely you have pelvic floor dysfunction and would benefit from seeing a pelvic health therapist. 

Dr. Joy

@pelvicpride