Pelvic Floor Physical Therapy: Process, Conditions Treated – Verywell Health

Kristen Gasnick, PT, DPT, is a health writer and a physical therapist at Holy Name Medical Center in New Jersey.
Laura Campedelli, PT, DPT, is a physical therapist with experience in hospital-based acute care and outpatient therapy with both children and adults.
Pelvic floor physical therapy involves pelvic floor muscle strengthening, relaxation, and coordination to help treat pelvic floor muscle tightness or weakness and the associated problems that result. When the pelvic floor muscles have normal strength and tone, the pelvic organs are adequately supported and control normal urination, bowel movements, and sexual function.
Pelvic floor muscle tone can become altered when the muscles become too stretched and loose, often from childbirth or weakening with aging, or too tight and restricted, often due to stress. Both decreased and increased muscle tone in the pelvic floor muscles can lead to pelvic floor dysfunction.
Current clinical evidence supports pelvic floor physical therapy as a minimally invasive treatment option that should be used as a first-line method for treating various types of pelvic floor dysfunction, including issues such as pelvic organ prolapse, urinary or fecal incontinence, and painful intercourse.
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On the day of your pelvic floor physical therapy evaluation, you will be brought into a private treatment room where your physical therapist will go over your medical history, symptoms, and complaints. Your physical therapist will then perform a physical exam, which will consist of an external and internal component.
During the external exam, your physical therapist will assess your lumbar spine, sacroiliac joints, and muscles that surround or attach to the pelvis—including the rectus abdominis, iliopsoas, and piriformis—to check for pain, tightness, or tenderness.  
During the internal exam, your physical therapist will assess your pelvic floor muscles for tone, elasticity, and pain and tenderness. Your physical therapist will insert one or two gloved fingers into your vagina and/or rectum to palpate the pelvic floor muscles from the inside. A lubricant is often used to help ease the discomfort.
Your physical therapist will also examine your ability to perform voluntary contraction and relaxation of your pelvic floor muscles, as well as movement of your pelvic floor with your breathing patterns. 
After your physical therapist has completed the external and internal examinations and made a clinical assessment about the possible causes of your symptoms, you will be scheduled for follow-up sessions. Each session will take place in a private treatment room. 
Your treatment may consist of the following:
Pelvic floor physical therapy involves specialized treatment from a physical therapist who is specifically certified in treating pelvic floor disorders. A physical therapist will either obtain a Certificate of Achievement in Pelvic Physical Therapy (CAPP) or more extensive training and specialization as a Women’s Health Clinical Specialist (WCS) to evaluate and treat all diagnoses related to women’s health.
Pelvic floor physical therapy is used to treat all types of disorders classified as pelvic floor dysfunction. Pelvic floor dysfunction can be subdivided into hypotonic, or low tone, and hypertonic, or high tone, disorders.
Muscle tone refers to the amount of resting tension in a muscle when it is not contracted. Too little or too much tone in the pelvic floor muscles can cause different forms of pelvic floor dysfunction.
When a muscle has low tone, the muscle is more relaxed and looser than normal, making it difficult to actively contract. When the pelvic floor muscles are weak due to low tone and you have difficulty actively contracting them, your core cannot be adequately supported and your control over your bladder and bowel movements may be affected.
Low tone pelvic floor disorders include:
When a muscle has high tone, the muscle is tighter and more restricted than normal. This can often cause pain when you try to relax or stretch the muscle. When the pelvic floor muscles are excessively tight due to high tone, you may experience pelvic pain, muscle spasms, and pain and difficulty with insertion during intercourse or during a gynecological exam.
High tone pelvic floor disorders include:
To prepare for pelvic floor physical therapy, you should arrive dressed in comfortable clothes that allow you to move your legs freely without restricting your movement. Your exam includes an internal component, so make sure your groin and genital area is clean before your appointment.
It is helpful to come prepared with a list of questions or concerns you want to ask your physical therapist during your exam and evaluation. Give yourself extra time to arrive at the physical therapy facility to fill out initial paperwork before your first visit.
You should bring the following with you to your first appointment:
Pelvic floor physical therapy is appropriate for those with low tone or high tone forms of pelvic floor dysfunction and related pelvic floor muscle pain.
Pain in the pelvic region may not always be related to pelvic floor muscle dysfunction, however. The following symptoms may be signs of a more serious condition:
Make sure to contact your primary care physician or gynecologist if you have been experiencing any of these symptoms. You may have an infection or another condition related to your gastrointestinal, urinary, or reproductive organs that requires further medical treatment.
Pelvic floor physical therapy is a treatment option for pelvic floor dysfunction, whether the pelvic muscles are too tight or too weak. It can help with problems with urination, sexual intercourse, and more. The initial assessment for this type of physical therapy includes an internal exam. Check with your healthcare provider to make sure this is an appropriate treatment for you.
Pelvic floor physical therapy involves physical methods of strengthening and/or relaxing the muscles of the pelvic floor to help improve core stability and control over urination, bowel movements, and sexual function. Pelvic floor physical therapy uses a variety of different methods to increase pelvic floor muscle control, improve awareness of contraction and relaxation patterns, and decrease pain, disability, and symptoms of pelvic floor dysfunction.
Pelvic floor physical therapy is completed in a private treatment room one on one with your physical therapist. Your physical therapist will instruct you in specific exercises targeted at either improving activation or relaxation of your pelvic floor muscles, and provide different techniques and therapeutic modalities to help address your symptoms. You will also be given a program of exercises and equipment to use at home to help with your progress with treatment.
When you are in extreme pain, always make sure to contact your doctor to discuss your symptoms and determine the next appropriate step in your treatment. If you are having severe pain, pelvic floor physical therapy may not be appropriate until you have further testing done to determine if there is a more serious problem present.
Pelvic floor physical therapy should be initiated as soon as you start to notice symptoms that interfere with your daily functioning, including control over your urge to urinate and comfort during sexual intercourse. The longer you wait to begin pelvic floor physical therapy, the longer it may take for your symptoms to improve, as they tend to get worse over time. Tightness or weakness in the pelvic floor muscles can cause problems with sexual intercourse and incontinence, which will tend to get worse without treatment. 
Symptoms of pelvic floor dysfunction tend to get worse over time and can have a significant impact on your quality of life. Starting pelvic floor physical therapy as early as possible can help alleviate pain and other symptoms to help you regain control over your life. Pelvic floor physical therapy is effective for treating and managing low tone and high tone pelvic floor dysfunction and related pelvic floor muscle pain.
If you have been experiencing chronic pain for more than three months or problems with urination, bowel movements, or sexual intercourse, contact your doctor to see if additional testing is needed to determine if there is a more serious issue underlying your pelvic symptoms.
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Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019;31(6):485-493. doi:10.1097/GCO.0000000000000584

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