Pelvic floor physical therapists specialize in the muscles, nerves and connective tissues that live between your legs, also known as the pelvic floor. They gain their expertise through a series of post-graduate continuing education classes, certifications, and training. Their training allows them to perform both internal and external pelvic exams, and broadens their knowledge of conditions which affect the pelvic floor. Sometimes, people who specialize in modalities like biofeedback or dilator therapy, advertise themselves as pelvic floor therapists, but don’t have any hands on experience treating the sensitive and often reactive muscles of the pelvic floor. If you are seeking pelvic floor physical therapy, it is important to enquire about the experience and level of training your potential physical therapist has had in this specialty.
The contents of this website are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.

The “prescription plan” for tight and weak muscles is different than loose and weak. I recommend going to a Pelvic Floor Physical Therapist (do a google search) or Doctor specializing in Pelvic Floor issues (Most OB/GYNs are NOT knowledgeable of this issue) to get a proper diagnosis. Otherwise, you might do the wrong thing for your condition and make it worse.
My pelvic floor dysfunction has the opposite effect in terms of peeing. My bladder will not fully empty when I pee although I’ll wait and wait until a little more will come out, then I’ll go lie down because I have some burning sensation and discomfort. At that time, lying down, I will experience of flood of urine. my urologist wants to test me by filling my bladder up but that is counterintuitive to me so I’m not sure if I should have that test?

It is essential that we, as pelvic floor physical therapists, also include other assessments when we are examining our patients for the very first time. We employ the tried and true physical therapy exam practices to determine if there is an underlying condition elsewhere in your body, such as a strength deficit or alignment issue that could be affecting your pelvic floor. It’s wild to think of it, but something as seemingly unrelated as a flat foot or a hip injury can be enough to set off pelvic and abdominal pain!
The therapist may do manual therapy or massage both externally and internally to stabilize your pelvis before using other kinds of treatment. Manual therapy takes time and patience, and may require one to three sessions per week, depending on the technique used and your response to treatment. You may feel worse initially. However, many patients see improvement after six to eight weeks.
Pelvic floor dysfunction can be diagnosed by history and physical exam, though it is more accurately graded by imaging. Historically, fluoroscopy with defecography and cystography were used, though modern imaging allows the usage of MRI to complement and sometimes replace fluoroscopic assessment of the disorder, allowing for less radiation exposure and increased patient comfort, though an enema is required the evening before the procedure. Instead of contrast, ultrasound gel is used during the procedure with MRI. Both methods assess the pelvic floor at rest and maximum strain using coronal and sagittal views. When grading individual organ prolapse, the rectum, bladder and uterus are individually assessed, with prolapse of the rectum referred to as a rectocele, bladder prolapse through the anterior vaginal wall a cystocele, and small bowel an enterocele.[10]
Biofeedback uses electrodes placed on your body (on the perineum and/or the area around the anus) or probes inserted in the vagina or rectum to sense the degree of tenseness in your pelvic floor muscles. Results displayed on a computer or other device provide cues to help you learn to relax those muscles. Usually, patients feel relief after six to eight weeks of therapy. You may be able to buy or rent a unit to use at home.
There are various procedures used to address prolapse. Cystoceles are treated with a surgical procedure known as a Burch colposuspension, with the goal of suspending the prolapsed urethra so that the urethrovesical junction and proximal urethra are replaced in the pelvic cavity. Uteroceles are treated with hysterectomy and uterosacral suspension. With enteroceles, the prolapsed small bowel is elevated into the pelvis cavity and the rectovaginal fascia is reapproximated. Rectoceles, in which the anterior wall of the rectum protrudes into the posterior wall of the vagina, require posterior colporrhaphy.[6]
Pelvic floor dysfunction is very different than pelvic organ prolapse. Pelvic organ prolapse happens when the muscles holding a woman’s pelvic organs (uterus, rectum and bladder) in place loosen and become too stretched out. Pelvic organ prolapse can cause the organs to protrude (stick out) of the vagina or rectum and may require women to push them back inside.
The contents of this website are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.
The contents of this website are for informational purposes only and are not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you have regarding a medical condition, and before undertaking any diet, dietary supplement, exercise, or other health program.
Stop sucking in your gut. Sucking in your gut does not create core strength and can actually increase downward pressure on your pelvic floor. This creates a strain on the connective tissue in your abdomen by displacing your abdominal viscera. Many people hold in their bellies without knowing it. If you do this, try to consciously relax your belly while sitting, lying down, or in a cat/cow position on your hands and knees while taking deep, relaxing breaths. And pretend you are a dog or cat with your tail out—not tucked under you. Do this several times per day.
Develop your core. You can develop your core muscles (between your pubic bone and lower rib cage) by doing the following: Take in a deep breath while keeping your shoulders down and pulling your abdomen toward the back of your spine. Notice how this feels like engaging a corset. Hold for the count of 10—keeping all those corset muscles pulled in. Aim for doing this 10-20 times per day. This will pull up and strengthen your abdominals and take pressure off your pelvis. This is not the same as sucking in your gut unconsciously. This is consciously developing your core strength.  Esther Gokhale of the Gokhale Method teaches this as part of ideal posture: Sit with a towel folded lengthwise under your sitz bones. This will automatically tilt your pelvic bowl forward so that your pubic bone is where it should be—under your pelvic contents. Think of your pelvis as a bowl—you want it tilted so water spills out the front. When you sit, make sure your tailbone is out behind you.
If an internal examination is too uncomfortable for you, your doctor or physical therapist may use externally placed electrodes, placed on the perineum (area between the vagina and rectum in women/testicles and rectum in men) and/or sacrum (a triangular bone at the base of your spine) to measure whether you are able to effectively contract and relax your pelvic floor muscles.
Once patients with pelvic floor constipation have these basic tools, they can begin retraining the pelvic floor muscles with biofeedback. Based on the principle of operant conditioning, biofeedback provides auditory and visual feedback to help retrain the pelvic floor and relax the anal sphincter. Biofeedback training is the treatment of choice for medically refractory pelvic floor constipation, with some studies showing improvement in more than 70 percent of patients. Patients also learn to identify internal sensations associated with relaxation and long-term skills and exercises for use at home.

By definition, postpartum pelvic floor dysfunction only affects women who have given birth, though pregnancy rather than birth or birth method is thought to be the cause. A study of 184 first-time mothers who delivered by Caesarean section and 100 who delivered vaginally found that there was no significant difference in the prevalence of symptoms 10 months following delivery, suggesting that pregnancy is the cause of incontinence for many women irrespective of their mode of delivery. The study also suggested that the changes which occur to the properties of collagen and other connective tissues during pregnancy may affect pelvic floor function.[7]


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What sets pelvic floor physical therapists apart is their in depth understanding of the muscles and surrounding structures of the pelvic floor, beyond what was taught in physical therapy graduate school. What that means for a patient who is seeking the help of a pelvic floor physical therapist, is that his or her pelvic floor issues will be examined and treated comprehensively with both internal and external treatment, provide them with lifestyle modifications to help remove any triggers, and receive specific exercises and treatment to help prevent the reoccurrence of pain once he or she has been successfully treated.
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