What to Expect With Pelvic Floor Physical Therapy

Pelvic floor physical therapy focuses on the muscles that support the bladder, bowel, and uterus. These muscles are called the pelvic floor. They help control when you urinate and have bowel movements. They also hold the organs in your lower belly in place.

Pelvic floor therapy includes a range of exercises. Kegels are one type of pelvic floor exercise that you may have heard of. A physical therapist who works in this area provides exercises, hands-on techniques, and education. Pelvic floor therapy helps strengthen pelvic muscles and also helps to relax them if that's what you need.

This type of therapy can help with a range of conditions. A doctor may refer you if you have:

• Urinary incontinence. This is leaking urine.
• Fecal incontinence. This is trouble controlling bowel movements.
• Pelvic pain. This includes pain during sex.
• Pelvic organ prolapse. This occurs when pelvic organs drop lower than they should.
• Recovery needs after childbirth or pelvic surgery.

Your first appointment is mostly a conversation. Your therapist will ask about your symptoms, medical history, and bladder and bowel habits. The therapist may examine your back and legs and watch how you walk and move. You'll also talk about your goals for treatment.

Your therapist may offer an internal exam. This helps them get a better sense of how your pelvic floor muscles are working. This exam is done with one or two gloved fingers gently placed in the vagina or rectum. You don't need to have the exam. You can say no at any time.

Your therapist may build a plan based on what your pelvic floor muscles need. The therapist may also teach you how your bladder, bowel, and pelvic floor work together.

Pelvic floor muscle exercises are a key treatment. For weak muscles, this often involves squeezing and holding (sometimes called Kegel exercises) and then fully releasing. You may also be taught exercises for your low back, abdomen, and hip. For muscles that are too tight, you may learn down-training. This focuses on relaxing and lengthening instead of squeezing.

Your therapist may check that you are using the right muscles. Many people tighten nearby muscles without realizing it. You will also be given exercises to do at home between sessions.

Biofeedback uses sensors connected to a device that shows your muscle activity. This lets you know if you are tightening or relaxing the right muscles as you exercise. It can help with both strength and relaxation goals.

Electrical stimulation sends a mild current through electrode pads or a small probe near the pelvic floor. Depending on how electrical stimulation is used, it can help weak muscles tighten or help tight muscles relax. Most people find it painless or only slightly uncomfortable.

Tibial nerve stimulation uses a thin needle (percutaneous) or an electrode pad (transcutaneous) placed near the ankle. The needle or pad sends mild electrical pulses along the tibial nerve. This nerve connects to nerves that control the bladder and pelvic floor. It's used most often for overactive bladder and the sudden, strong urge to urinate.

Manual therapy involves hands-on techniques to release tight muscles and connective tissue. A therapist may work on the belly, hips, lower back, and inner thighs. They may also use gentle internal techniques to release muscles deeper in the pelvis.

Dilator therapy may be offered for pelvic pain or vaginismus, which is muscle spasms. They can make vaginal penetration painful. Smooth, tube-shaped devices in several sizes may be used to gently stretch the vaginal muscles over time.

Treatment often lasts 6 to 12 weeks. But it depends on your condition and how your body responds. Most people see their therapist once a week or every other week. Some people see improvement in the first few visits.