What Is Pelvic Floor Physical Therapy?
If you’ve ever experienced discomfort, pain, or dysfunction in your pelvic area, you’re not alone—and there’s help.
Pelvic floor physical therapy is a specialized branch of physical therapy that focuses on treating conditions related to the pelvic floor muscles. These muscles form a sling-like structure at the base of your pelvis and play a crucial role in bladder and bowel control, sexual function, and core stability.
But what exactly is pelvic floor PT, and who is it for? Let’s break it down.
Understanding the Pelvic Floor
The pelvic floor is made up of muscles, ligaments, and connective tissue that support organs like the bladder, uterus, and rectum. Dysfunction in these structures can cause a variety of challenges, including urinary dysfunction (urinary incontinence, urinary hesitancy, overactive bladder, incomplete emptying), bowel dysfunction (fecal incontinence, diarrhea, constipation, increased urgency, flatulence), pregnancy and postpartum related issues, pain (pelvic, vulvar, vaginal, testicular), sexual dysfunction (pain with arousal, intercourse, orgasm). Hormonal changes including gender affirming hormonal treatments, perimenopause, and menopause can also affect pelvic floor function. Pelvic floor PT is for people of all genders and ages.
Here are some of the concerns and questions that patients often bring up:
Bladder/Urinary:
- “When I cough, sneeze, or laugh, I pee.”
- “When I jump, run, or squat, I leak.”
- “I feel like I always have to pee, like I’m never fully empty. It can affect my sleep.”
- “I can’t always hold it in and I’m afraid I’m going to have an accident.
Bowel:
- “My bowel movements are so painful. And the pain can last even after I’m done.”
- “My hemorrhoids make everything worse.”
- “I’m always constipated, I feel so backed up.”
- “My diarrhea makes me so uncomfortable.”
Pelvic Pain:
- “I have deep pelvic pain, and I don’t know what to do to make it better.”
- “It’s painful to touch my vulva and the opening of my vagina.”
- “My testicles are very painful, but all of my tests came back normal.”
- “My OB-GYN is great, but the exams are so painful, and I just want it to be easier.”
Sexual Dysfunction and Pain:
- “I have pain with sex.”
- “I’ve never had pain with sex until after I gave birth. Is this just the way it is now?”
- “When I’m aroused, I start experiencing pain.”
- “Whenever I orgasm, I have a lot of pain.”
Gender Affirming Care
- “I’ve started having urinary leakage since I started estradiol. Can you treat that without changing my hormones?”
- “I’m really happy taking T, but I’ve noticed some dryness and discomfort there.”
- “I want support before and after my gender affirming surgery.”
Pregnancy and Postpartum:
- “How do I stay healthy throughout my pregnancy and prevent tearing during labor?”
- “My back and hips hurt all the time. Is there anything I can do or is this only going to get worse as my pregnancy progresses?”
- “I get sharp pubic pain when I roll over in bed or stand up.”
- “I was diagnosed with prolapse after I gave birth. It feels so heavy down there, especially as the day goes on.”
- “I had perineal tearing with labor. It’s fully healed, but it doesn’t feel right.”
Surgical:
- “I knew that prostate surgery would be a big deal, but I thought afterwards, things would just get better on their own.”
- “My c-section scar is fully healed. But there are some areas where it feels numb and other areas where it feels very painful.”
- “Everything went well with my vaginoplasty, but I want more support with using my dilators.”
Perimenopause/Menopause:
- “I was diagnosed with genitourinary syndrome of menopause and I also heard the term ‘vulvar atrophy.’ Is there anything I can do? My mother had a terrible experience and I don’t want that.”
Pelvic Floor PT can help with all of these issues! Let’s discuss how:
What Happens in Pelvic Floor PT?
Pelvic floor PT is not one-size-fits-all. It’s highly personalized and can be adapted to your goals, identity, and anatomy. Finding a professional that helps create a program specific to your needs and goals is crucian and here are the major components:
- A trauma-informed assessment, with full consent at every step. We begin with a detailed discussion around your experiences and needs. Evaluation includes assessing your movements, breathing patterns, and posture. A pelvic exam (external or internal) is performed only if you are comfortable. You’ll always have the option to decline or postpone.
- Education around anatomy, pelvic function, and ways your unique experience may affect your pelvic health. You’ll learn how to engage or relax your pelvic floor, optimize toileting habits, and make posture or lifestyle changes that support healing.
- Movement-based therapy, such as exercises to strengthen, relax, or retrain your pelvic floor and surrounding muscles.
- Manual therapy, including gentle, hands-on techniques to release tension or improve mobility.
- Gender-affirming care that respects your name, pronouns, body, and boundaries.
Final Thoughts
Pelvic floor issues can be frustrating and sometimes feel isolating—but they are incredibly common, and you don’t have to live with them. Pelvic floor physical therapy offers a gentle, evidence-based path to relief, strength, and connection to your body. Contact us to learn more and speak with our pelvic health therapist if you are not sure how to get started – we are here to help you achieve a pain free life!