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!
Thank you Dr. Northrup for sharing great information about pelvic floor dysfunction. I am a physical therapist and board-certified women’s clinical specialist. I’ve been practicing pelvic physical therapy since 1999. Over the years I have realized that we as women to not have basic information to take care of our bodies and never discuss the ‘secret’ pelvic area. I have such a passion for bringing this information forward that I wrote a book Pelvic Zone Coach, Every Wonan’s Guide To Pelvic Health and Sexual Vitality (available on Amazon).
Pelvic floor dysfunction may include any of a group of clinical conditions that includes urinary incontinence, fecal incontinence, pelvic organ prolapse, sensory and emptying abnormalities of the lower urinary tract, defecatory dysfunction, sexual dysfunction and several chronic pain syndromes, including vulvodynia in women and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men. The three most common and definable conditions encountered clinically are urinary incontinence, anal incontinence and pelvic organ prolapse.
Mechanistically, the causes of pelvic floor dysfunction are two-fold: widening of the pelvic floor hiatus and descent of pelvic floor below the pubococcygeal line, with specific organ prolapse graded relative to the hiatus.[2] Associations include obesity, menopause, pregnancy and childbirth.[5] Some women may be more likely to developing pelvic floor dysfunction because of an inherited deficiency in their collagen type. Some women may have congenitally weak connective tissue and fascia and are therefore at risk of stress urinary incontinence and pelvic organ prolapse.[6]

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.


Help….I had a preventive hysterectomy seven months ago because of a horrible maternal family history of ovarian and uterine cancer. At 53, I had just started into menopause with skipping periods, but hadn’t gone a year. Now, I have had constant pelvic pain….it’s hard to walk sometimes, hard to stand for more than 30-40 minutes and a cystocopy showed that my bladder was inflamed. All these practitioners are telling me I have IC, but I have no frequency, no urgency or burning. When I finally went to a uro/gyn, during the exam she told me several of my pelvic muscles were tight and I the only pain I had was when touched near my bladder. I think this may be a pelvic floor dysfunction along with a hormonal imbalance, but no one listens and just keeps prescribing Uribel and other bladder drugs and now they want to do instillations. Am I completely off base that this is a wrong diagnosis? Any insights would be helpful.
Use vaginal weights. Weightlifting strengthens your muscles. You gain the same effect when you use vaginal weights. Inserting cone-shaped weights into your vagina helps to train your pelvic floor muscles. You simply contract your pelvic floor muscles to keep the weight in place. You can find vaginal weights, such as Yoni Eggs, or Lelo balls, online. I find this approach far superior to the standard Kegel exercises which, in far too many women, just make the one small pubococcygeus muscle tight and don’t do much of anything with the rest of the pelvic floor.
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It’s highly unlikely that someone will head into a therapist’s office for a stand-alone “vaginal massage.” Why not? “It’s one small aspect of the whole therapy,” says Laura Y. Huang, MD, assistant professor of physical medicine and rehabilitation at the University of Miami Miller School of Medicine. She notes that pelvic floor muscle training, biofeedback, soft tissue release, and education are some of the many pelvic floor physical therapy treatments used to relieve pain or retrain muscles. Learning techniques and strategies to manage the condition at home is also part of treatment.
Help….I had a preventive hysterectomy seven months ago because of a horrible maternal family history of ovarian and uterine cancer. At 53, I had just started into menopause with skipping periods, but hadn’t gone a year. Now, I have had constant pelvic pain….it’s hard to walk sometimes, hard to stand for more than 30-40 minutes and a cystocopy showed that my bladder was inflamed. All these practitioners are telling me I have IC, but I have no frequency, no urgency or burning. When I finally went to a uro/gyn, during the exam she told me several of my pelvic muscles were tight and I the only pain I had was when touched near my bladder. I think this may be a pelvic floor dysfunction along with a hormonal imbalance, but no one listens and just keeps prescribing Uribel and other bladder drugs and now they want to do instillations. Am I completely off base that this is a wrong diagnosis? Any insights would be helpful.
Surface electrodes (self-adhesive pads placed on your skin) can test your pelvic muscle control. This might be an option if you don’t want an internal exam. The electrodes are placed on the perineum (the area between the vagina and rectum in women, and between the testicles and rectum in men) or on the sacrum (the triangular bone at the base of your spine). This test is not painful.
Every since my hysterectomy 4 years ago I have chronic pain. I’m now 46 years old and have tried everything. They say my muscle tone is good, as I do Kegals daily and my estrogen and testosterone are low but could be worse. The doctor says I have scar tissue on the vault that pushing on nerve endings. I can’t take gabapintin nor lyrica as they are too strong and I hate how it feels. I’ve had pelvic PT and use those skills. They now want to give me steroid shots a the top of the vault. Actually this wk but I’m about to chicken out. It seems everything tried makes it more agitated. Im at my wits end.
For internal massage, your PT may insert a finger into the vagina or rectum and massage the muscles and connective tissue directly. A frequently used technique is “Thiele stripping,” in which your therapist finds a trigger point by feeling a twitch in the muscle underneath, exercising it using a circular motion, and then putting pressure on it to help relax it, repeating the process until the muscle starts to release. Internal massage can also help release nerves. Sometimes, anesthetics can be injected into these trigger points. PTs may do this in a few states, but in most states, a doctor or nurse must administer injections.
Surface electrodes (self-adhesive pads placed on your skin) can test your pelvic muscle control. This might be an option if you don’t want an internal exam. The electrodes are placed on the perineum (the area between the vagina and rectum in women, and between the testicles and rectum in men) or on the sacrum (the triangular bone at the base of your spine). This test is not painful.

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]
It’s helpful to know that bad habits like poor posture or not exercising could contribute to having weaker pelvic floor muscles. My wife has noticed lately that she’s had a much harder time not peeing when she’s laughed hard and similar things. Maybe we should look into things she could do to start strengthening those muscles and help them be able to do their job better. https://www.proactiveph.com/what-is-pelvic-floor-dysfunction
Thank you Dr. Northrup for sharing great information about pelvic floor dysfunction. I am a physical therapist and board-certified women’s clinical specialist. I’ve been practicing pelvic physical therapy since 1999. Over the years I have realized that we as women to not have basic information to take care of our bodies and never discuss the ‘secret’ pelvic area. I have such a passion for bringing this information forward that I wrote a book Pelvic Zone Coach, Every Wonan’s Guide To Pelvic Health and Sexual Vitality (available on Amazon).
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.

Your pelvic floor is the group of muscles and ligaments in your pelvic region. The pelvic floor acts like a sling to support the organs in your pelvis — including the bladder, rectum, and uterus or prostate. Contracting and relaxing these muscles allows you to control your bowel movements, urination, and, for women particularly, sexual intercourse.
Although many centers are familiar with retraining techniques to improve pelvic floor dysfunction, few have the multidisciplinary expertise to teach patients with constipation how to appropriately coordinate abdominal and pelvic floor muscles during defecation, and how to use bowel management techniques, along with behavior modification, to relieve symptoms. Because pelvic floor dysfunction can be associated with psychological, sexual or physical abuse and other life stressors, psychological counseling is often included in the evaluation process.
Strengthening weak pelvic floor muscles often helps a person gain better bowel and bladder control. A physical therapist can help you be sure you are doing a Kegel correctly and prescribe a home program to meet your individual needs. Diet modifications can also reduce urinary and fecal incontinence. Bladder re-training can decrease urinary frequency and help you regain control of your bladder.
As you can now see, there is so much out there that can be done for people suffering with pelvic floor dysfunction. This blog is by no means extensive, and there are even more options you and your physical therapist can explore to help manage your pain or other pelvic issues. Pelvic floor dysfunction requires a multidisciplinary approach for most of our patients. Hopefully, this blog helped to paint a picture of what you will experience with a pelvic floor physical therapist. We advise that you seek out an expert and experienced pelvic floor physical therapist in order to help better your life and improve your function.
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!
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