- Pelvic floor physical therapy can help women and people with vaginas alleviate problems like painful sex, urinary leakage, and pelvic floor prolapse.
- These conditions are common in pregnant people or older women and may be corrected with physical therapy.
- In PT, patients may work on breathing, relaxation, as well as lengthening and strengthening techniques to train their muscles to function correctly.
Should you exercise your pelvic floor? If so, how do you exercise your pelvic floor? By the way, what is your pelvic floor?
When people talk about exercising the 'pelvic floor,' they’re usually referring to the pelvic floor muscles, which are located at the base of the pelvis, and protect the pelvic organs like the the vagina, cervix, uterus, bladder, urethra, and rectum.
The pelvic organs have several essential purposes, so protecting them is a big job. Pelvic muscles facilitate sphincter function so people don’t involuntarily relieve themselves. They assist in orgasm function, aid in postural support, and help pump lymphatic blood through the body.
When the pelvic floor muscles aren’t functioning correctly, people may experience symptoms like painful sex, prolapse, urinary incontinence, or constipation—which can trigger secondary problems like shame, embarrassment, or anxiety.
These issues can be more common in older women due to hormonal changes that lead to vaginal dryness or thin tissues, Janelle Howell, DPT, WCS, a pelvic floor physical therapist, told Verywell.
"Estrogen is what tells our tissues to stay thick and juicy, as well as ready for sex," Howell said. "As we get older, estrogen is just not as robust as it was when it was younger."
Pelvic floor physical therapy (PT) can help rev up the pelvic floor muscles. With time, commitment, and targeted treatment, the practice can get a person’s muscles functioning properly and increase their confidence and sexual pleasure, Howell said.
"If you're in pain, or if you feel like you have no control over your bladder, or if you're having excruciating sex, or a prolapse, it can be very isolating—and like you don't enjoy the place you live in," Howell said. "Pelvic physical therapy can give you that quality of life back where you understand your body better, you feel better, and you have a grip on what to do going forward."
What Causes Pelvic Floor Problems?
Pelvic floor dysfunction tends to occur with age, during pregnancy, or in tandem with life events linked to plummeting hormone levels, such as the postpartum period and menopause.
People who are pregnant are especially prone to pelvic floor problems during their pregnancy and later in life, Heather Jeffcoat, DPT, a pelvic floor physical therapist and founder of Femina Physical Therapy, told Verywell. That's because of the weight of a pregnant person's uterus, which can put pressure on and strain their pelvic floor muscles. Vaginal childbirth can also stretch the muscles.
People who experience these types of problems during pregnancy are more likely to experience more pelvic floor problems postpartum or even years down the line, Jeffcoat said.
"Pelvic floor dysfunction is increased in anybody that is pregnant, but people might not necessarily know that they have a problem," Jeffcoat added. "They might normalize things [or think] they will get better after delivering—which is not necessarily true."
How Do You Know If You Need Pelvic Floor PT?
Unlike muscles like the glutes and abs, the pelvic floor muscles aren't located in an easily viewable position. As a result, not everyone who needs help may see the signs, Howell said.
"We don't see the pelvic floor because it's in a private area, so we assume that many of the issues that we experienced, privately or intimately, cannot be helped, but they can," she said. "[These issues] are happening from the young to the old, it's just happening more when you're older."
Howell talks about how to recognize the pelvic floor muscles, and signs of weakness within them, on her Instagram, Vagina Rehab Doctor.
Symptoms of pelvic floor dysfunction may include:
- Urinary or stool leakage or incontinence
- Pain in the pelvis region
- Back pain
- Painful urination
- Painful sex
If left untreated, problems can worsen over time.
“It's just a matter of time until people begin to present with sexual pain, urinary incontinence, prolapse, or back pain due to pelvic floor dysfunction," Jeffcoat said. "Pelvic PT should be a part of general wellness visits to catch dysfunction early, and help set patients up better for the rest of their lives."
She recommends that women and people with vaginas schedule at least three pelvic floor physical therapy appointments during pregnancy, at least one during the postpartum period, and at least one at the onset of menopause.
What Can’t Pelvic Floor PT Treat?
Pelvic organ prolapse (POP) can be one of the more severe types of pelvic floor issues. This happens when the pelvic organs drop down and out of their normal positions. In extreme cases, the organs may extend outside of the body.
Depending on the severity of a prolapse, you may feel pelvic pressure and heaviness. Some experts liken the sensation to sitting on a bowling ball.
Pelvic floor PT can’t treat all forms of prolapse, although it can help manage pain and alleviate symptoms. When organs protrude outside of the body, surgery may be required.
What Happens During Pelvic Floor PT?
Pelvic floor physical therapists can guide patients through exercises to train their pelvic floor muscles. Exact recommendations will vary based on a patient's specific issue, but the three main components of the PT can include relaxing, stretching, and strengthening muscles.
To relax the pelvic floor muscles, a PT may have a patient work on their breathing. For a pregnant person, this means preparing to time breaths with contractions. For a person experiencing constipation, breath work can be used to help a person relax and reduce strain.
Stretching the pelvic floor can help relieve tightness, which can assist in comfortable sex. A PT may help their patient stretch the pelvic floor by using more invasive interventions, like intervaginal massages or a vaginal dilator. This type of PT can help loosen tight muscles or gently coax dislocated organs into place.
After the pelvic floor is loose and relaxed, the biggest aspect of pelvic floor work involves strengthening, whether that's the abdominal muscles or the pelvic floor muscles themselves via kegels. Though many people have heard of kegels, experts caution against treating them as a foolproof cure for all pelvic floor issues.
What Are Kegels?
Kegels are exercises in which a person progressively contracts and then releases their pelvic floor muscles in a pulsing motion.
In fact, Jeffcoat said not every patient needs to practice kegels, and those who do should work on them after completing breath work and other techniques first. People who experience pain and tightness during sex should initially avoid kegels, as they can increase unwanted tension to the pelvic floor, she added.
“The emphasis shouldn't always be on contracting those muscles, because if they get short and tight, that is also dysfunctional—they aren't able to do their job,” Jeffcoat said. “You have to also learn how to relax and lengthen them.”
What This Means For You
People may benefit from pelvic floor physical therapy if they experience symptoms like urinary leakage or painful sex, or if they are going through a major life event like pregnancy, pregnancy recovery, or menopause.