As physical therapists, are our hands are amazing gifts and phenomenal diagnostic tools that we can use to assess restrictions, tender points, swelling, muscle guarding, atrophy, nerve irritation and skeletal malalignment. We also use our hands to treat out these problems, provide feedback to the muscles, and facilitate the activation of certain muscle groups. There have been a great number of manual techniques that have evolved over the course of physical therapy’s history. Let’s go over a few.
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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.
Some pelvic floor physical therapists may have the opportunity of getting a lot of time to speak one-on-one with a patient to determine possible causes of his or her symptoms, educate the patient and to guide them to other practitioners who may optimize their physical therapy results if necessary. We truly can find out so much by just listening to what our patients have to say. A fall, or infection can be significant as well as a patient’s feelings and knowledge about their current condition.

But while “vaginal massage” is a general, nonspecific term, it may be used to treat the musculoskeletal system of the pelvic floor, notes Dr. Huang. Sometimes this may be internally through the vagina or anus, though the target isn’t the vagina itself, but rather the muscles. “Some muscles, like hip rotator and pelvic floor muscles, are better accessed internally,” she says. (Imbalances in other muscles like those found in the abdominal wall or hip girdle are best treated from the outside.)


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!
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.
The term “vaginal massage” may not be legit—practitioners don’t like to use it—but the treatment is. In fact, it’s part of a well-rounded therapy regimen for pelvic floor physical therapy. Certified specialists in this field can help women who are dealing with pain during sex—something 75% of women experience at some point in life, according to research.
As many as 50 percent of people with chronic constipation have pelvic floor dysfunction (PFD) — impaired relaxation and coordination of pelvic floor and abdominal muscles during evacuation. Straining, hard or thin stools, and a feeling of incomplete elimination are common signs and symptoms. But because slow transit constipation and functional constipation can overlap with PFD, some patients may also present with other signs and symptoms, such as a long time between bowel movements and abdominal pain.
The muscles of the pelvic floor must work together and in coordination to perform specific tasks. The pelvic floor has to contract, elongate and relax in very precise ways to perform basic functions like urination, defecation, support the pelvis and organs, and sexual function and pleasure. If your pelvic floor muscles and/or nerves fail to do what they are supposed to do at the right time, problems like painful sex, erectile dysfunction, constipation, and incontinence can occur.

^ Bernard, Stéphanie; Ouellet, Marie-Pier; Moffet, Hélène; Roy, Jean-Sébastien; Dumoulin, Chantale (April 2016). "Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review". Journal of Cancer Survivorship. 10 (2): 351–362. doi:10.1007/s11764-015-0481-8. hdl:1866/16374. ISSN 1932-2259. PMID 26314412. S2CID 13563337.
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.
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.
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

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?
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.
Home exercise and therapy is also a mainstay of PFD rehabilitation. Because the goal of PFD therapy is to learn to control and, especially, relax the pelvic floor, therapists will teach you techniques for use at home to build on the therapies they do in their offices. This usually begins with general relaxation, stretching the leg and back muscles, maintaining good posture, and visualization—part of learning to sense your pelvic floor muscles and to relax them.
Pelvic floor dysfunction is a common condition where you’re unable to correctly relax and coordinate the muscles in your pelvic floor to urinate or to have a bowel movement. If you’re a woman, you may also feel pain during sex, and if you’re a man you may have problems having or keeping an erection (erectile dysfunction or ED). Your pelvic floor is a group of muscles found in the floor (the base) of your pelvis (the bottom of your torso).
My problem seems to be neurological as I have a burning pain, numbness radiating from an area near my vagina (sometimes numbness extends up my right buttock) that is bothering me 24 hrs, 7 days a week. This has gone on 4 years or more with varying intensity. I had seen a pelvic floor therapist while i was i Arizona and a anesthesiologist for pudendal nerve blocks. I am going back to the therapist. The nerve blocks have not helped. Is there blocks for other nerves around there?

In order for the processes of urination and defecation to go smoothly, the various muscles within the pelvis need to act in a coordinated manner. In some cases, the muscles contract when they should be relaxing, or the muscles do not relax sufficiently to facilitate coordinated movement. Problems with the pelvic floor muscles can lead to urinary difficulties and bowel dysfunction. PFD is experienced by both men and women.
The “pelvic floor” refers to a group of muscles that attach to the front, back, and sides of the pelvic bone and sacrum (the large fused bone at the bottom of your spine, just above the tailbone). Like a sling or hammock, these muscles support the organs in the pelvis, including the bladder, uterus or prostate, and rectum. They also wrap around your urethra, rectum, and vagina (in women).
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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