What is Pelvic Floor Therapy?

Hey, #AskEvvy readers! I’m Caitlyn, a pelvic health physical therapist and women’s health advocate, and I’m here to answer all your burning questions about pelvic physical therapy.

If you’ve spent time searching the web for information about recurrent vaginal infections or other gynecological health problems, you’ve probably encountered some content related to pelvic PT.

Perhaps you’ve been wondering if pelvic PT can help you. Maybe you have no idea what pelvic PT is…and you’re wondering why your vagina even needs a therapist! Regardless, you’re in the right place: let’s discuss the basics of pelvic PT and its role in your vaginal health care.

What is pelvic physical therapy and who are pelvic PTs?

The phrase “physical therapy” is a protected term: only a licensed physical therapist with the appropriate education and credentials can provide physical therapy services. To practice physical therapy in the United States, aspiring PTs must earn a clinical doctoral degree* (a Doctor of Physical Therapy, or DPT) from an accredited program and pass a national licensing exam.

As physical therapists enter clinical practice, many choose to specialize in one or two particular care areas and pursue advanced training in their chosen area. Pelvic health is one such specialty focus. 

Pelvic PTs specialize in the treatment of patients with a wide variety of pelvic conditions – (we’ll discuss these in more detail later). We can help people of all ages and genders, including cis-, trans-, and agender individuals.

As pelvic PTs, we strive to help our clients regain optimal function and participate fully in their lives. We design personalized care plans for each patient, which combine specific exercises, hands-on treatment, education, behavioral techniques, and more. 

While other professionals like chiropractors and massage therapists may also perform certain treatments that are similar to those we offer in PT, they are not providing pelvic physical therapy. It’s also important to note that not all physical therapists are pelvic health specialists. We’ll discuss the logistics of finding a specialized pelvic PT in detail later.

*Note: US-based physical therapy educational programs transitioned to doctoral degrees during the 2000s and early 2010s. However, some older physical therapists practicing in the US still hold a master's degree in physical therapy: they have been “grandfathered in” by virtue of their many years of experience and continuing education.

What pelvic conditions can pelvic PT help me address?

A good pelvic physical therapist can help with a myriad of different conditions and symptoms. Here are a few of the most common: 

Bladder problems

• Involuntary bladder leaks (urinary incontinence)
• Sudden, intense needs to pee (urinary urgency)
• Needing to pee quite often (urinary frequency)
• Incomplete bladder emptying
• Painful urination

Bowel problems

• Loss of bowel control (fecal incontinence)
• Sudden, intense needs to poop (fecal urgency)
• Painful pooping
• Certain types of constipation
• Certain symptoms of irritable bowel syndrome (IBS)

• Pain with sex

• Pain with vaginal intercourse/penetration (dyspareunia) 
• Pain with anal sex
• Vaginal muscle spasm (vaginismus)
• Vulvar pain (vulvodynia)
• Painful orgasms 

Chronic pelvic pain, which is common to many medical conditions:

• Endometriosis and adenomyosis
• Uterine fibroids
• UCPPS (aka interstitial cystitis or painful bladder syndrome) 
• Painful periods (dysmenorrhea)
• Pudendal neuralgia

Pain during gynecological exams 

Pain with the use of internal menstrual products 

Pregnancy and postpartum care

Menopause-related symptoms, including:

• Painful sex
• Bladder problems
• Vaginal dryness and atrophy (i.e., thinning of the vaginal walls)
• Muscle and joint pains
• Muscle, joint, and nerve problems related to the pelvis

Transgender care during and after one’s transition

And the list goes on! While this inventory isn’t exhaustive, suffice it to say that pelvic PT can help you optimize your pelvic and vaginal health in multiple ways. Pelvic PT can be particularly helpful for people navigating the menopause transition.

The hormonal changes of menopause directly affect the vagina, vulva, and pelvic organs, leading to the genitourinary syndrome of menopause (GSM). Menopausal people are more prone to vaginal infections, and they’re also more likely to experience painful sex and bladder problems than premenopausal folks. If you’re going through menopause and experiencing some or all of these symptoms, pelvic PT can help!

How do I know if pelvic PT is right for me? 

The best way to determine if pelvic PT can help you is to consult with a pelvic physical therapist. Some providers offer brief, free consultations to help you determine if pelvic PT is likely to improve your condition. 

During your initial evaluation, your pelvic PT will talk with you about your symptoms and goals, perform a thorough examination, and educate you about their impression and expectations for your recovery. Together, you’ll form a treatment plan to help you reach your goals.

How do I find a pelvic PT?

Finding a pelvic PT can be challenging if you aren’t looking in the right places–remember, not every PT is a pelvic specialist. Fortunately, there are a couple of websites that can make your search easier:

• The Pelvic Rehab website, administered by the Herman & Wallace Pelvic Rehabilitation Institute, allows you to search its provider directory by zip code to find a pelvic specialist near you.
• The American Physical Therapy Association’s Academy of Pelvic Health runs a PT locator website that allows you to search by zip code, provider specialty certification, and even the types of symptoms you’d like to address.
• Patricia Ladis PT, CBBA is a friend of Evvy and her practice WiseBody can be a great resource for pelvic floor therapy
• Origin, a online pelvic floor therapy platform that offers virtual care and takes many forms of insurance

It’s important to note that physical therapists aren’t the only providers specializing in pelvic rehabilitation. Some providers from other healthcare backgrounds like occupational therapy, nursing, and rehabilitation medicine also train in pelvic health and provide care for people with pelvic conditions.

What should I expect in a first visit with a pelvic PT?

Patients often tell me they have been putting off pelvic PT because they were nervous about the first appointment, and they didn’t know what to expect. That’s perfectly normal! 

While each pelvic PT will practice somewhat differently, there are many commonalities we all tend to share. Here are a few things to expect at your first visit:

Plenty of talking

Your pelvic PT will spend the first portion of the visit getting to know you: they’ll ask you about the symptoms and concerns that brought you to PT, the goals you’d like to achieve, and the basics of your daily life. 

A comprehensive exam

Your pelvic health can be affected by other body regions, from your hips to your jaw, so a comprehensive physical examination is a key component of the diagnostic process. 

Your physical therapist may ask you to perform movements like bending, squatting, and walking so they can see how your body parts move together. Additionally, this exam often includes detailed assessment of the body regions closest to your pelvis, like your abdomen and lower back.

External and (maybe) internal pelvic floor assessment

For many people with pelvic health conditions, direct examination of the pelvic floor tissues can be extremely valuable. Your pelvic PT may ask to examine the skin of your vulva, checking for signs of skin irritation or sensation changes. 

With your permission, they may also perform an internal examination, using 1-2 fingers to palpate (gently press on) the muscles inside the vagina. This allows them to identify areas of tension or tenderness that they can treat. They may also ask you to perform various movements with your pelvic muscles to measure their strength, endurance, and coordination.

However, an internal examination isn’t always necessary or appropriate during your first visit (or ever!). Your pelvic PT will explain each proposed element of your examination to ensure that you’re comfortable and consenting throughout the process.

Education and explanation

Expect to learn a lot during your first pelvic PT visit and beyond: there’s so much to know about your pelvic health, but your PT will gradually explain the basics in terms you can understand. They will teach you techniques, exercises, and other strategies you can perform at home to manage your symptoms. Together, you’ll build a plan to address your concerns and move you towards recovery.

Can Evvy help me understand if I will benefit from PT?

In my own practice, I often find that people who experience frequent vaginal infections also live with one or more of the conditions from the list above.
The research supports this observation: for example, chronic pelvic pain is frequently present in people who experience recurrent infections. 

Together, Evvy and pelvic rehab can help you tackle several concerns simultaneously. Your Evvy test results will help you better understand your vaginal microbiome and how best to promote its health. This includes identifying that your vaginal microbiome is in a protected state, which may indicate you have something more structural going on, which a Pelvic Floor Therapist can help with. 

And, if you’re eligible for Evvy Clinical Care, you’ll have access to research-backed medications and supplements that will help you address imbalances in your vaginal microbiome.

A multidisciplinary approach to care will help you find solutions to optimize your vaginal and pelvic health. Evvy is here to support you, every step of the way!