Your guide to pelvic floor therapy
To begin, search below to find occupational therapists (OTs) with a focus area of pelvic floor therapy near you. Both OTs and physical therapists can practice as pelvic floor specialists. Pelvic Rehab is another option to find pelvic floor therapists!
What is Pelvic Floor Therapy?
Pelvic floor therapy is treatment for problems related to the pelvic floor. In the simplest sense, the pelvic floor is a group of 14 muscles in 3 layers that support our internal organs.
But, pelvic floor therapy is more than just simple exercises. The nature of the pelvic floor necessitates a holistic approach—as these core muscles support everything from intimacy to your posture sitting in a chair. They are also impacted by everything from your stress level to your breathing.
Signs you may need pelvic floor therapy:
- Incontinence/ Leaking pee, poop, or gas
- Pelvic pain
- Pain and discomfort with sex
- Lower back pain
- Abdominal pain
Common conditions pelvic floor therapists may work with:
- Prenatal and postpartum care
- Pelvic organ prolapse
- Diastasis recti abdominis
- Hysterectomy rehabilitation
- Prostatectomy rehabilitation
- Polycystic ovarian syndrome
Can men and children receive pelvic floor therapy?
Yes! Every single person has a pelvic floor, so the reality is that everyone can benefit from pelvic floor therapy.
Many people associate pelvic floor therapy with childbirth, but the truth is that people of all genders and all ages may benefit from pelvic floor therapy.
Bedwetting is a common reason for children to be referred to pelvic floor therapy—as are constipation and fear of going to the bathroom. Pelvic floor therapy can also play an important role in gender-affirming care.
What happens at pelvic floor therapy?
At pelvic floor therapy, you will receive an evaluation and set goals with your pelvic floor therapist. (See more on this below, in what to expect at your first visit.)
Given the complex nature of the pelvic floor, there are multiple approaches to treatment. The best-known exercise is Kegels, an exercise to strengthen your pelvic floor. (But kegels are not appropriate for everyone, and there are cases where they can actually make pelvic floor dysfunction worse.) Other pelvic floor interventions might include:
- Posture work
- Manual therapy
- Relaxation and mindfulness techniques
- Corrective exercises and functional movement training (not just kegels)
- Habit retraining (e.g., bladder/bowel habits)
- Ergonomics (e.g., position used to void – squatty potty)
- Patient education and support!
What about internal exams?
Part of pelvic floor therapy may involve an internal exam, where the therapist uses a gloved hand to check the health of your pelvic floor.
Internal exams provide valuable information that can be used for treatment. However, they are not the only way to gather information about how your pelvic floor muscles are working. Assessments and treatments can be performed intra-vaginally or intra-rectally.
If this is not something you are interested in or comfortable with, just let your provider know.
What exactly happens during pelvic floor internal work?
Internal work begins with a visual assessment of the external tissues to check the ability of your superficial muscles to contract and relax.
The therapist will then take a gloved finger and apply gentle pressure to the superficial muscles or notice any areas of tenderness or tightness (hypertonicity). They may also place their finger at the perineum (space between vagina and anus) to check the quality of the tissue. At the vaginal opening (or rectal opening), the therapist may assess the quality of the muscle to check for muscle strength, tone, and coordination.
Internal assessment can occur at each layer of the pelvic floor. This is all done with consent at each step of the process—and you are allowed to stop the process at any point.
Many therapists keep the sheet covering the area, even while internal work is happening. Pelvic floor therapy work is different than an OB/GYN appointment—meaning that we tend to do a visual assessment of the tissues first, but once that has been completed, we can insert a finger and keep the sheet covering the person…because it’s all about feeling the tone/coordination of the muscles.
Before becoming a pelvic floor provider, I was in the role of a patient myself—and I found it very comforting when I realized someone wasn’t going to be looking at my crotch for an entire 1-hour session. 🙂
Given the intimacy of the pelvic floor and differing levels of priority placed on pelvic floor work, it is important to find the right therapist for you.
How to find the right therapist?
Pelvic floor therapists are highly trained professionals—and here in the United States, most pelvic floor therapists are licensed as occupational therapists or physical therapists.
To find the right fit for you, you can dig into what type of pelvic floor therapy they specialize in and what training they’ve done! We encourage you to call or send a message to ask questions. Here are some options to get you started:
Questions to ask before starting pelvic floor therapy:
- What is your approach to therapy?
- What can I expect during our first session together?
- Are home exercises required?
- How much internal work will happen?
- What if I have a trauma history? How do you deal with past trauma related to the pelvic floor?
- Do you consider mental health as part of your pelvic health work?
- Are babies welcome? Are support people welcome?
Can pelvic floor therapy be done at home?
Yes. Pelvic floor therapy can be done via telehealth. There’s a lot that providers can assess virtually about posture, breathing, body mechanics, and core muscle engagement. Working with a provider in person may help you reach your goals more quickly. However, it is undoubtedly possible to notice significant changes through virtual sessions.
Does your insurance cover pelvic floor therapy?
Maybe. It depends on what kind of OT/PT coverage your specific plan has. Not all pelvic floor therapists take insurance, though. Some are private pay. If you need to pay out of pocket for your session and the cost is a barrier or concern for you, ask if the therapist is able to provide you with a superbill. That way, you can submit it to your insurance to seek reimbursement after your session.
What to expect on your first visit?
What to wear to pelvic floor therapy
Wear comfortable clothes that you can move in, and that allows the therapist to view what’s happening with your body. Leggings/yoga pants/bike shorts and sports bra/fitted tank tend to be best. If you are receiving internal work, you will be asked to undress from the waist down and will be covered with a sheet.
Should you bring your baby?
If you want to! Observing how you hold/carry/lift your baby in relation to any pelvic floor symptoms you are experiencing can be helpful. Most therapy providers are very used to accommodating the needs of baby/parent dyads during the sessions – we make it work!
How long will it take to get better?
The short answer is…it depends. You might experience relief after a handful of sessions (4-6 sessions). However, depending on the root cause, it might take longer. The health of our pelvic floor is closely connected with how we move through our days – if your posture or daily habits are impacting your pelvic floor, it might take a while to retrain those habits.
We encourage you to have a conversation with your provider about any questions/concerns related to your progress in therapy.
Pelvic floor devices and exercise
- Dilators – This can be helpful for people who are experiencing pain with intimacy, vaginismus (involuntary spasm of the muscles around the vagina), and other types of pelvic pain. Dilators work to provide a gentle stretch to the tissues surrounding the vaginal opening. They are typically made out of plastic or silicone and come in varying sizes. Users are educated on how to select the dilator size (beginning with the smallest comfortable), insert with plenty of lubricant, and then try to engage in relaxation strategies that can be used as the tissues gently stretch. When using the dilators, the goal is to help the user learn how to relax using the smaller size before moving up to a larger size.
- Wands (including vibrating and thermal) – can be helpful for the self-management of tender points (trigger points) within deep pelvic floor muscles. They can help with hypertonic (tight) pelvic floor muscles and pelvic pain.
- Vaginal weights – can provide helpful proprioceptive feedback for people having difficulty connecting to their pelvic floor muscles or need to strengthen their pelvic floor.
- Biofeedback – uses electrodes applied externally or internally to help you figure out the muscles you’re using.
How do people become pelvic floor therapists?
Your pelvic floor therapist is highly skilled, as they must first become licensed as an occupational or physical therapist. Here are the basic steps:
- Earn a master’s or doctorate in occupational or physical therapy.
- Get licensed by your state.
- Complete additional training to specialize in pelvic floor therapy.
Additional training for therapists is wide-ranging. The options include:
- OT Pioneers: Introduction to Pelvic Floor Therapy
- Essential Pelvic Health: Pelvic Rehab Manual Assessment and Treatment Techniques (PR-MATT)
- Herman and Wallace Pelvic Rehabilitation Institute
- Biofeedback Training and Incontinence Solutions
- Institute for Birth Healing
- Core Exercise Solutions: Pregnancy & Postpartum Corrective Exercise Specialist Certification 2.0
- Restore Your Core
Bottom line: Is pelvic floor therapy worth it?
Yes! Your pelvic health impacts so much of your daily life. If you have any inkling that you may benefit from pelvic floor therapy, either talk to your doctor or get ahold of your local pelvic floor therapists—and they can guide you through the necessary steps.
Overall, the sooner after a problem starts, the better! (In fact, if you are looking for the most cost-effective time to do pelvic floor therapy related to childbirth, research suggests that the most cost-effective time to do this is before childbirth so you can receive preventative services.)
No matter where you are in the journey, though, I hope this article has helped demystify this critical and holistic type of therapy for you!