What to Expect from Pelvic Floor Physical Therapy

Problems affecting the pelvic floor are not uncommon. Men and women can experience them. Since these problems can affect a person’s quality of life, the best thing to do is to see a doctor and be proactive. Your doctor may recommend pelvic floor physical therapy. In this post, you’re going to learn everything you need to know about this type of pelvic therapy and what to expect from it.

Who needs pelvic floor physical therapy?

You are a good candidate for pelvic floor physical therapy if you have muscle pain in the pelvic floor or a low or high tone form of pelvic floor dysfunction.

Doctors usually recommend pelvic floor physical therapy to patients who experience symptoms such as:

  • Chronic pelvic pain
  • Urinary incontinence
  • Difficulty with urination and bowel movements
  • Pain during sexual intercourse

Women with endometriosis may also need pelvic floor physical therapy. Additionally, pelvic floor exercises are beneficial for women with the risk of vaginal prolapsed and those with problems affecting bowel and bladder. Women recovering after childbirth could also benefit from pelvic floor physical therapy.

A healthcare provider may recommend this physical therapy to men with premature or painful ejaculation. Men who underwent prostate surgery are good candidates for pelvic floor physical therapy as it can speed up their recovery, decrease the risk of rectal prolapse, and improve bowel and bladder control.

Keep in mind pain in the pelvic region isn’t always related to dysfunction of pelvic floor muscle. Instead, it may be a sign of a more serious underlying problem if these symptoms also occur:

  • Fever and chills
  • Nausea and vomiting
  • Abnormal vaginal discharge
  • Heavy bleeding during menstruation
  • Irregular periods
  • Burning sensation when urinating
  • Severe menstrual cramps
  • Blood in urine/stool

If you experience the abovementioned symptoms, contact your doctor.

What conditions does pelvic floor physical therapy treat?

As mentioned above, people with high and low tone pelvic floor dysfunction may need physical therapy. But, it’s impossible not to wonder what this means.

Generally speaking, pelvic floor physical therapy is used for all types of disorders that account for pelvic floor dysfunction. Not all cases of pelvic floor dysfunction are the same, which is why we can subdivide them into low tone (hypotonic) or high tone (hypertonic) conditions.

The “tone” here refers to pelvic muscle tone, i.e., the degree of resting tension in a muscle when it’s not contracted. Both too much and too little muscle tone are problematic.

A high tone means the muscle is tighter and more restricted than it should be. High tone conditions include:

  • Dyspareunia – pain from vaginal penetration during sexual intercourse
  • Pelvic floor myofascial pain – chronic pain due to tight pelvic floor muscles
  • Vulvodynia – pain and discomfort in the vulva
  • Vaginismus – involuntary, uncontrolled muscle spasms during penetration in the vagina

Low tone muscles are looser, i.e., more relaxed than they are supposed to be. As a result, it’s difficult for these muscles to contract. Low tone conditions are:

  • Anal incontinence – uncontrolled and involuntary leakage of fluid, gas, or stool from the rectum
  • Overactive bladder – urinary urgency and frequency
  • Pelvic organ prolapse – occurs when organs in the pelvis descend abnormally from their usual positions
  • Stress incontinence – involuntary leakage of urine during activities associated with higher intra-abdominal pressure

How do I prepare for pelvic floor physical therapy?

Pelvic floor physical therapy doesn’t require special preparation. Just make sure to wear comfortable clothes that will allow for free movement of legs, without restriction.

For the first appointment, which includes evaluation and examination, it is important to ensure the groin and genital area are clean.

The best thing to do is to come to the first appointment with prepared questions for the physical therapist. Think about all questions and concerns you have, write them down, so you don’t forget them, and use the appointment as the perfect opportunity to get your answers.

Don’t forget you’ll need to complete forms during the initial visit. You should bring a form of identification and a health insurance card. If needed, you will also have to bring the prescription from the referring physician. Persons who are taking medications for their underlying health condition should also inform the physical therapist about the specific drugs they’re taking.

What happens during assessment for pelvic floor physical therapy?

There is more to pelvic floor physical therapy than it seems. A common belief is that you just schedule the appointment and start with sessions and exercises. But, you need to undergo pelvic floor evaluation first.

The pelvic floor evaluation consists of several steps:

  • History intake – the integral component of any evaluation. It’s not just about reading a patient’s medical chart; the pelvic floor physical therapist is interested in what you have to say. The reason is simple; pelvic floor dysfunction is a multifactorial problem.
  • Postural examination – changes in skeletal alignment can also alter the tension and length of musculature in the pelvic floor. A physical therapist needs to evaluate your posture as you’re standing and sitting. Addressing and improving bad posture can also improve pelvic floor dysfunction.
  • Movement analysis – involves analyzing the quality of the movement to understand whether a patient has movement pattern impairment. For example, if a woman complains of stress incontinence when picking up a child’s toys off the floor, the physical therapist may ask her to mimic the movement. In case a patient has movement pattern impairment, the physical therapist customizes the therapy sessions to address it.
  • Orthopedic assessment – includes evaluating spine, sacroiliac joints, rib cage, hip joints and evaluating breathing patterns. If a therapist finds dysfunctions, they will make sure to adjust the therapy sessions to fix them.
  • Pelvic floor assessment – examination of both internal and external pelvic area, vagina, and rectum. The purpose of this assessment is to determine the strength of the pelvic floor and customize physical therapy accordingly.
  • Patient education – this is the part where a physical therapist informs a patient about all the findings, discusses the course of physical therapy, and provides useful tips and recommendations that will help relieve problems found during assessments.

Once the assessment and evaluation are performed, the treatment, i.e., physical therapy, begins.

What does pelvic floor physical therapy include?

Pelvic floor physical therapy includes several approaches. We are going to discuss them below.

Trigger point therapy

Trigger point therapy is a type of soft tissue technique whose main objective is to release tension and pain in fascia and muscles that people often experience as a knot in the muscle. In pelvic floor, trigger points stem from multiple reasons such as:

  • Stress
  • Excess weight
  • Injury or previous surgery in the pelvic area
  • Joint problems
  • Pregnancy or injury during childbirth
  • Misuse of pelvic muscles, e.g., incorrectly performing Kegel exercises

Men and women alike can have trigger points in the pelvic area. They may experience trigger points in the form of persistent pain and reduced range of motion in the affected area.

Trigger point therapy includes applying pressure on trigger points internally and externally. You may get anesthesia to decrease discomfort.


Biofeedback is a form of alternative medicine that relies on special devices to check the pelvic floor muscle contraction. The physical therapist may use biofeedback to evaluate the progress and see how exercises are going. To do that, the physical therapist may place electrodes on the external area, such as between the anus or vagina. Another option is to use the internal probe to measure the relaxation and tension of muscles in the pelvic floor. You can see the results on the computer screen, and the physical therapist explains everything they find.

When it comes to pelvic floor dysfunction, biofeedback helps patients learn to relax or strengthen the muscles in this area and thereby improve the function of the bowel and bladder. With this approach, the patient starts using the correct muscles and stops using the incorrect ones.

Kegel exercises

Kegel exercises are stretch-and-release exercises that strengthen the pelvic floor muscles. While everyone thinks Kegels are for women, men can and should perform these exercises too. Your physical therapist will teach you how to perform Kegel exercises at home.

Not only do Kegels prevent leakage of urine, but they also prevent accidental passing of gas and stool. They can also improve your orgasm.

To do Kegels, you need to contract pelvic floor muscles, hold them for a few seconds, then release them. First, you need to identify pelvic floor muscles. The easiest way to do it is to stop urination midstream. Muscles you use to stop urine are pelvic floor muscles.

The physical therapist will recommend a certain number of reps to do each day. For example, 10 reps two to three times a day. The best thing about Kegel exercises is that you can do them everywhere and whenever you want.

Electrical stimulation

Electrical stimulation helps alleviate muscle spasms and pelvic pain. The physical therapist can perform it in their office or teach you how to use special equipment and do it at home. During the stimulation of the pelvic floor, a low-grade electrical current stimulates the muscles in this area. This makes muscles contract. Basically, muscles respond similarly to how they react to Kegel exercises.

How long do pelvic floor physical therapy appointments last?

The actual length of one physical therapy appointment may depend on several factors. These include the nature of the appointment, the course of the treatment, and the severity of pain, discomfort, and other symptoms of pelvic floor dysfunction you experience. In most cases, the appointments range from 30 or 45 minutes up to an hour. The length of the session may change as you progress with the therapy and strengthen the pelvic floor.

How many pelvic floor physical therapy sessions do I need?

The magic number that works for all persons who need pelvic floor physical therapy doesn’t exist. The length of the physical therapy depends on the course of the treatment, the severity of your problem, and how your pelvic area responds to the physical therapy.

For instance, some people need two to four appointments only. On the other hand, most people achieve optimal improvement in their symptoms after eight to 12 sessions.

Remember, pelvic floor physical therapy isn’t just about attending sessions and appointments. You will also get exercises to do at home between physical therapy sessions. Make sure to attend your appointments regularly, don’t skip them. Otherwise, you’d slow down your recovery instead of strengthening pelvic floor muscles.

When will I start feeling better?

There is no “right” answer that applies to everyone. The severity of pelvic floor dysfunction is the most important factor here. Most people notice improvement within four to six weeks. For many patients, it may take about three months to notice a significant change.

Does insurance cover pelvic floor physical therapy?

Most health insurance providers do cover pelvic floor physical therapy. Bear in mind every health insurance plan is different. Some therapists are in-network or partnership with specific health insurance carriers and not others.

What you can do here is contact the pelvic floor physical therapist or your health insurance carrier to learn whether your sessions would be covered. If the therapist isn’t in-network with a specific healthcare insurance provider, they will inform you about the costs and financing options.

It’s also useful to remember that some pelvic floor physical therapists work in cash pay clinics out of network. In these cases, they do not accept healthcare insurance. The costs of physical therapy in these clinics can vary from one location to another.


Pelvic floor physical therapy helps patients improve muscle control and strength in the pelvic area but also alleviates pain, spasms, and other symptoms. The physical therapy program is extensive, and it takes several weeks to notice major improvements. But, it is a natural way to improve symptoms and overall quality of life. Make sure to consult your doctor about physical therapy and attend all sessions regularly.