Pelvic floor therapy: an explainer

How pelvic floor therapy can help manage urinary incontinence


I’m all too familiar with the challenges of living with a bladder condition; since 2005 I’ve had interstitial cystitis (IC), a chronic, inflammatory condition marked with urinary urgency, frequency, and continuous pain. When I first sought answers and treatment options for IC, I was amazed at how few resources there were for people struggling with all types of pelvic floor dysfunction, including urinary incontinence.

As an occupational therapist, I became motivated to help people get back to living life in spite of whatever medical condition they were enduring. I began training in pelvic biofeedback, one of the many treatment options offered by a pelvic floor therapist.

Whether you’re new to managing incontinence or you’ve been dealing with it for many years, pelvic floor therapy might be one solution to consider. Here, we take a closer look at it and how it can help you heal. 

What is the pelvic floor?

The pelvic floor is known as a “sling” or “hammock,” and it’s a complex network of muscles, ligaments, connective tissues, and nerves that support the organs of the pelvis, including the bladder, the uterus, the vagina, and the colon. When the pelvic floor is healthy, the supportive network of tissues allows these organs to function correctly. But when there’s injury, trauma, illness, or muscle weakness in the pelvic floor, the organs can’t perform optimally, and dysfunction, like urinary incontinence, can arise.

What is pelvic floor therapy?

In most cases, a pelvic floor therapist is a physical therapist with an advanced degree and specialized training to rehabilitate the pelvic floor using a variety of treatment modalities.

If you have stress or urge incontinence or an overactive bladder, studies have shown that pelvic floor therapy is an effective tool to manage and potentially alleviate all types of urinary incontinence. If you’re dealing with UI while pregnant, pelvic floor therapy is a reasonable option for you to try; there are many, safe exercises and treatment options to address your concerns.

Kegel exercises are one type of activity used to strengthen the pelvic floor—and one you've probably heard of if not already tried. But a PT with expertise in pelvic floor dysfunction and urinary incontinence may implement a wider range of ideas to create a treatment plan for you. Some of the other techniques a pelvic floor therapist uses include:

  • An internal and external assessment of the pelvic floor muscles
  • Stretching, strengthening exercises, relaxation, and release work (such as myofascial release and trigger point therapy) of both the internal and external musculature
  • Biofeedback (an electrical way to monitor the strength of muscle contractions and relaxation, in this case, of the pelvis muscles)
  • Correction of your postural alignment
  • Education and training so you can manage the condition on your own
  • Recommendations for lifestyle modifications

What should I expect at a pelvic floor physical therapy appointment?

Each pelvic floor physical therapist likely has a particular way they approach a visit, but an initial session may look something like this.

When you first arrive at your appointment, you’ll be evaluated by the PT to create a treatment plan. During the evaluation, the therapist will interview you to gather a detailed account of your medical history, list of symptoms, and what you hope to accomplish throughout your treatment. Following the interview, a therapist will typically conduct a physical examination. She’ll examine the alignment of your spine, core strength, pelvis, hips, and more.

Next, she’ll assess the pelvic floor. The therapist can do this is a couple of ways. The first is to insert a gloved finger intra-vaginally to palpate the muscles and tissues that might be causing UI. If you’re uncomfortable with the idea of an intra-vaginal examination, some therapists may be able to use external biofeedback to determine how the pelvic floor is functioning.

On a personal note, I’ve seen three pelvic floor physical therapists, and they each slowly walked me through the steps of their internal examination, making sure I was aware of what they were doing and asking me to let them know if I was uncomfortable in any way.

If you’re nervous about your appointment, talk with the therapist about your concerns; she’ll help you feel more at ease. Each person’s circumstance is unique, so it’s important to keep the lines of communication open between you and your therapist, so she can tailor the treatment plans to meet your specific needs.

How often should I see a pelvic floor therapist?

After you’ve had your initial evaluation, your therapist will talk to you about the how often you’ll need to see her. If you have a severe case of UI, you may need to schedule appointments three times a week at first, reducing the frequency of the visits as symptoms improve. If your symptoms are minor, you might see a breakthrough in symptoms in one to two visits. The frequency of visits differs from person to person, but the goal is to resolve UI or reach a manageable level.

Keep in mind, your insurance may only allow for a certain number of physical therapy visits in a given year. When this occurs, the therapist will determine the best course of treatment for you within the allotted timeframe. It’s important to note that no matter how many sessions your insurance covers, you can still experience benefits from pelvic floor therapy.

How do I find a pelvic floor therapist?

First, you’ll need to talk with your doctor about obtaining a referral for pelvic floor physical therapy, and it’s possible your physician may be able to provide you with recommendations. Although any physician can write a referral for physical therapy, you’ll want the doctor who’s treating for UI (like an OB-GYN or a urogynecologist) to do it, so they can receive updates regarding your progress. If your doctor can’t recommend anyone, check out the PT Locator on the American Physical Therapy Association’s Section on Women’s Health to locate a pelvic floor physical therapist in your area.


About the author

Jenny B.
Jenny Lelwica Buttaccio, OTR/L is a Chicago-based health writer and licensed occupational therapist. She has both personal and professional experience with pelvic floor dysfunction. Find her on Twitter at @lymeroad.