Pelvic Floor Therapy: What It Is, How It Helps, & What to Expect

Nina was delighted after the vaginal birth of her twins without complications. However, after 12 weeks, she still dribbled urine whenever she strained to pick up something heavier than about 20 pounds.

After a visit to her gynecologist, Nina was told she had pelvic floor dysfunction—something she had never heard of. She was told she might be helped by seeing a special type of physical therapist specializing in this condition. After researching her problem, she agreed to seek the support of a pelvic floor therapist who helped her work through the issues.

Pelvic floor therapy helps thousands of women like Nina who have uncomfortable urinary, bowel, or painful symptoms after giving birth or following pelvic surgery.

A pelvic floor therapist can help individuals regain bowel and bladder function without surgery and often without medications. Instead, they apply specific techniques and sound physical therapy practices to correct a variety of pelvic concerns.

This guide goes over everything you need to know about pelvic floor therapy, including what it is, how it helps, what to expect in a visit, how much it costs, and more.

What is the pelvic floor?

The pelvic floor is a collection of 14 muscles and their associated ligaments that form a sling across the lower pelvic region to support the organs of the abdomen and pelvis. They use parts of the pelvis as anchor points to secure these organs against gravity.

The pelvic floor muscles cannot form a solid shield across the lower region of the pelvis; they must allow for the urethra, vagina, and anal canal to pass through the muscle complex.

Childbirth, surgical trauma, abuse, obesity, aging, medications, and difficulties with bowel movements dating from early childhood can all contribute to these muscles becoming weak, spastic, or out of sync with one another in some way.

The symptoms of pelvic floor dysfunction can include any one or more of these symptoms:

• Urinary incontinence or retention
• Constipation or fecal incontinence
• Pain with intercourse
• Generalized (often unexplained) pelvic pain
• Pelvic organ prolapse

Pelvic floor therapy is rapidly becoming the treatment of choice for these disorders, helping many men and women avoid years of discomfort or surgery. The goal is to restore the normal synchrony of this muscle group and to enhance the patient’s quality of life.

Why can pregnancy and giving birth cause pelvic floor issues?

Pregnancy and childbirth are common predisposing factors to having pelvic floor dysfunction even when the pregnancy and delivery are normal. There are several factors involved that can contribute to the development of pelvic floor dysfunction:

1. The effects of gravity and pregnancy. The extra weight in the abdomen and pelvic region from the baby and heavier uterus can stretch the pelvic floor muscles. Women can develop incontinence of urine because these muscles have become lax.
2. Vaginal delivery issues. The passage of the baby through the birth canal, even without tears or rips in the vagina or perineum (the skin and tissue between the vagina and rectum), can cause laxity of the pelvic muscles after childbirth.
3. Episiotomy or tearing. Tears that affect the vaginal tissue or perineum can cause the muscles in this region to work improperly. If you have an episiotomy as part of the delivery process, the effect is the same as a tear, even if it is adequately repaired.

The most common symptoms related to the pelvic floor after delivery include scar tissue pain, urinary incontinence, and prolapse of the uterus, bladder, or part of the anal canal. Most women have reduced quality of life with these symptoms, many of which can be more than just embarrassing or annoying.

What is a pelvic floor therapist?

Most pelvic floor therapists are trained in physical therapy, obtaining a four-year college degree followed by three more years of training in occupational or physical therapy.

Once trained in either of these specialties, extra coursework and experience are needed to learn more about the pelvic floor and ways to treat its dysfunctions.

The extra training may involve coursework in pelvic floor anatomy, pelvic floor function and dysfunction, and biofeedback.

Once the coursework is completed, the therapist must practice pelvic floor therapy for 2,000 hours under supervision. They may then take the Pelvic Rehabilitation Practitioner Certification (PRPC) examination. If they pass the test, the therapist can be certified in pelvic floor therapy.

With so much extra education and training, the person certified in this field of therapy is fully capable of addressing a wide variety of pelvic floor concerns.

>> Find a pelvic floor therapist who accepts your insurance

What issues can pelvic floor therapy help with?

There are many benefits of pelvic floor therapy, primarily the relief of issues you are dealing with. Your therapist will be able to evaluate your concern and provide a treatment strategy that can improve your symptoms:

• Urinary incontinence. Urinary incontinence can happen when the bladder is full and sags onto the weakened pelvic floor. The pelvic floor therapist can teach you ways to strengthen the muscles to reduce incontinence symptoms.
• Bulging of the uterus (uterine prolapse). Just as the bladder can sag to cause incontinence, the uterus can sag through the vagina. This often happens after several vaginal deliveries. The therapist can also recommend treatments to support the uterus and can teach you how to strengthen the pelvic floor through exercises.
• Urinary hesitancy and dribbling. If the uterus or bladder sags, the urethra can be impinged on to interrupt urine flow. This means the bladder does not empty well or that the muscles that keep urine back are weakened. Again, exercises can help reduce these symptoms.
• Rectocele. The rectum is adjacent to the vagina. After trauma or vaginal birth, the rectum can sag into the vagina, leading to incomplete defecation. There are ways to help you reduce your rectocele symptoms without surgery that your pelvic floor therapist can explain.
• Constipation. Constipation may be due to dyssynergia of the pelvic floor muscles; it means they don’t operate in the proper sequence to allow for coordinated bowel movements. The pelvic floor therapist can evaluate the problem and may recommend biofeedback to help the muscles coordinate better for more normal bowel movements.
• Fecal Incontinence. Fecal incontinence can come after trauma or relaxation of the pelvic floor after childbirth. The pelvic floor therapist can check the issues you may be having and recommend biofeedback or exercises to reduce symptoms.
• Painful intercourse (Dyspareunia). Dyspareunia involves pain with intercourse. Not all instances of dyspareunia come from pelvic floor issues. Your pelvic floor therapist can determine if pelvic floor spasticity contributes to these symptoms.
• Vaginismus. Vaginismus means that the vagina tightens during penetration from sudden spasticity of the pelvic floor muscles. Through biofeedback and other exercises, this symptom can be reduced.

When should I see a pelvic floor therapist?

Your pelvic floor therapist should be PRCP-certified. This means you can see them for any symptoms related to the pelvic floor, most of which are due to weak muscles, spastic (tight) muscles, or muscles that are not coordinated.

Anytime you are experiencing persistent symptoms related to the urinary tract, bowels, or vagina, or if you have unexplained pelvic pain, you may be helped by seeing a pelvic floor therapist for an evaluation. Testing can be done to ensure that these muscles are fully intact and functioning properly.

Women often see a pelvic floor therapist during pregnancy (often starting as soon as the first trimester) as well as after giving birth.

>> Find a pelvic floor therapist who accepts your insurance

What are common pelvic floor therapy treatments & exercises?

So, what can a pelvic therapist do or recommend to help with issues related to the pelvic floor? Surprisingly, treatments for pelvic floor dysfunction are often highly technical, involving specific exercises and therapeutic techniques, such as:

• Exercises. Exercises can range from Kegels that strengthen the entire pelvic floor to those that strengthen specific muscles. There are also exercises for relaxing muscles that are too tight or spastic.
• Trigger point therapy. Some pelvic floor pain is due to a specific tight and painful muscle or ligament. The pelvic floor therapist can identify where the affected area is located and can use massage or possibly acupuncture to relieve the localized tension.
• Electrical stimulation. Electrical stimulation is a great method of reducing muscle laxity in the pelvic region. It is painless and may help reduce the number of hours you must spend on strengthening exercises.
• Biofeedback. Biofeedback involves using a device to measure muscle tension in the pelvic floor region. Using the feedback from this device, you can retrain your pelvic muscles to relax and tighten in ways to resolve dyssynergia of the muscles.
• Use of specific pelvic floor therapy devices. There are numerous devices your therapist can recommend, including dilators to help with vaginismus and a specialized TENS unit that can reduce pelvic floor pain. Such devices can isolate the pelvic floor and make exercises more effective.

What should I expect in a pelvic floor therapy appointment?

The pelvic floor therapist may already have specific orders from the doctor or may need to freshly evaluate your concerns. This might involve an examination of the pelvic floor, an evaluation of rectal tone, and an assessment to see if there is prolapse of any pelvic organs.

Once the problem is identified, the therapist can help you with an exercise or treatment plan to restore the function of your bowels and bladder, allow for less painful sex, or reduce pelvic pain. In most cases, the evaluation is performed in a doctor’s office similar to an office where you’d have a gynecological examination.

Treatments are privately done with your therapist, although exercises and biofeedback can be done at home. Sessions with your therapist are longer in the beginning (perhaps an hour for the first visit) with shorter visits done every week or more until the symptoms go away.

How long does pelvic floor therapy last?

Pelvic floor therapy generally takes a single visit to evaluate and create a treatment plan. Once done, visits can continue for a few weeks or several months, depending on the concern you have.

Many problems can be treated within about 6 weeks. In 6 weeks, you may have 3 to 6 visits to ensure effective treatment.

How much does pelvic floor therapy cost? Is it covered by insurance?

If your insurance pays for physical therapy sessions of any kind, pelvic floor therapy should also be covered. These sessions are outpatient visits, so Medicare patients will have them covered under the Part B plan.

Most other insurance plans allow for physical therapy coverage, but as these are rarely urgent, you can call your company to make sure the sessions are covered and to see how many can be paid for without requiring reassessment.

Here at Zaya Care, we can help you find a pelvic floor therapist who accepts your insurance.

If you don’t have insurance or are paying out-of-pocket for another reason, you can expect to pay $75 to $200 per session for pelvic floor therapy.

Where can I find a pelvic floor therapist?

If you’ve determined that a pelvic floor therapist could be beneficial for you, there are many ways to find one.

As mentioned, we can help you find a pelvic floor therapist here at Zaya Care using our pelvic floor therapist search tool. Our website is an excellent resource for finding certified therapists and other maternal health specialists.

Your obstetrician, gynecologist, urologist, or gastroenterologist may also be able to suggest a nearby therapist. Most physical therapy centers have pelvic floor therapists who work specifically with individuals having pelvic floor concerns.

Be sure to seek out a therapist with a Pelvic Rehabilitation Practitioner Certification (PRPC) or who has completed an APTA Specialist Certification Program in Women’s Health.