Greater Boston Urology Blog

What to Expect During Pelvic Floor Physical Therapy

If you're new to pelvic floor physical therapy, you're not alone. Most people are familiar with the concept of physical therapy for things like knees and shoulders, but less so when it comes to the pelvic floor muscles.

In this article, we're going to address some of the most common questions we hear from patients—especially those who are new to pelvic floor disorders and the exercises that can help relieve them.

As with all content on our blog, the following information is educational in nature, not medical advice. Always talk to your physician about your specific health care questions and conditions.

In a nutshell, what is pelvic floor physical therapy?

The pelvic floor is a set of muscles that support the pelvic organs. Sometimes the muscles weaken or sustain an injury. Pelvic floor physical therapy helps patients regain control of these muscles, just as traditional PT might help someone recovering from a shoulder or knee injury. Note: All human bodies have pelvic floors.

Does pelvic floor physical therapy work?

When it comes to medicine, there are no guarantees. But as cited in this current opinion in obstetrics and gynecology, pelvic floor physical therapy "has robust evidence-based support and clear benefit as a first-line treatment for most pelvic floor disorders."

In many instances, pelvic floor physical therapy is considered the first-line treatment, meaning it's the treatment option recommend first (before things like medication or surgery).

What are pelvic floor disorders?

The three main umbrellas are bladder dysfunction, bowel dysfunction, and pelvic pain. Under each umbrella are conditions like overactive bladder, prostatitis, and constipation. (This isn't an exhaustive list.)

What to expect during pelvic floor physical therapy

The first appointment

During your first appointment, you and your pelvic floor physical therapist will talk about what's happening with your body and your physical activity goals. Your physical therapist will most likely give a short anatomy lesson, explaining where the pelvic floor is and why it's important. Your PT will then conduct an external and an internal exam.

For the internal exam, you'll undress from the waist down and lie on your back with a drape covering you. (If you're a woman, it's perfectly OK if you have your period.) Your PT won't use any instruments—just gloves and lubrication. Your physical therapist will go very slowly, using one finger to feel for the tone of the muscles that wrap around the vaginal canal (or the rectum, for male patients or for patients who cannot tolerate a vaginal exam).

Your PT will assess the area and ask you to do some funny things like cough, hold your pee, hold your gas, and do a Kegel to see how the area is responding.

From there, you and your PT will make a plan and establish some homework to begin working on addressing what was found during the exam. This plan may change based on how your body responds. You may need to have frequent appointments, especially at first, depending on your condition.

Subsequent appointments

During subsequent appointments, you and your physical therapist will discuss your progress, including whether you're experiencing relief from your symptoms. Your therapist will modify and/or add in new exercises, as needed.

Exercises are always tailored to the condition being treated and your body. (Not every condition requires Kegels!) For example, some conditions might benefit from deep breathing exercises. Others might benefit from the "happy baby" yoga pose. Exercises vary widely and can be modified to work with your body and where you're at.

Note: Your therapist won't necessarily need to conduct an internal exam during every appointment, but again—this depends on the condition being treated.

Does pelvic floor physical therapy hurt?

Many pelvic floor disorders present with pain—the goal of therapy is to reduce or eliminate that pain, not add more pain on top of what you're already experiencing. Your therapist will closely monitor how you're tolerating internal exams as well as exercises so that you don't experience additional pain. Occasional discomfort might be felt from time to time—and even soreness the next day after certain exercises. (Just as you might experience in the gym after learning a new routine.)

Bottom line: Pelvic floor physical therapy shouldn't hurt, though you might experience occasional discomfort. Always tell your practitioner if anything they're doing is resulting in pain.

What to wear for pelvic floor physical therapy?

Pelvic floor exercises will vary, depending on the condition being treated. Regarding what to wear, a good rule of thumb is to dress like you would for the gym. Comfortable clothing, like sweatpants and T-shirts, are good options, along with sturdy shoes, like sneakers.

How long does pelvic floor physical therapy take?

The actual appointment lasts 45 minutes. A variety of factors will influence how long it takes before patients see progress. Your physical therapist will discuss an approximate timeline. Keep in mind, however, that rehabilitation and healing are not always predictable.

I'm interested in pelvic floor physical therapy. What should I do next?

If you suffer from a pelvic floor disorder, talk to your doctor about whether pelvic floor physical therapy would be right for you. Or book an appointment with one of our pelvic floor physical therapists at Greater Boston Urology.

Further reading on pelvic floor physical therapy:

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