Pelvic Physical Therapy: What To Expect

Patient undergoing pelvic physical therapy

Nobody likes to admit it when they have a problem, especially when that problem is affecting their everyday life. Furthermore, it’s even more difficult to recognize a problem when it involves the pelvic area. Pelvic problems are common, yet they are not normal. There are ways to treat pelvic problems without invasive surgery or medication. It’s called pelvic physical therapy.

Pelvic physical therapy is not as invasive as surgery, nor does it require recovery time because it is your recovery! Furthermore, because of the nature of the program, it gives you much control since you’re the one doing the exercises.

There are a lot of benefits to pelvic physical therapy. But, what does it look like and what should you expect?

What Can Pelvic Physical Therapy Treat?

Physical therapy is used to treat any number of pelvic health conditions. The majority of problems are with the pelvic floor, called pelvic floor dysfunction and can sometimes show itself as urinary incontinence or chronic pelvic pain. Most of the time, pelvic problems are caused by weakened pelvic floor muscles. Just like any other muscle in the body, if it’s weak, it cannot function properly or give your body the support it needs. This means that the internal organs of the pelvic region cannot function properly, resulting in incontinence.

Despite what many people believe, leakage and being unable to hold it until you make it the bathroom is not necessarily a bladder or intestinal problem. More often than not, it’s a problem with your pelvic muscles. The fix? Strengthen them through exercises, and this is what pelvic physical therapy is all about.

Pelvic problems that physical therapy can treat include:

  • Urinary incontinence (urge, stress, or mixed types)
  • Urinary urgency, frequency, or hesitancy
  • Pelvic organ prolapse (cystocele, rectocele, uterine prolapse)
  • Chronic pelvic pain
  • Vulvar pain
  • Interstitial Cystitis (IC)/Painful Bladder Syndrome (PBS)
  • Dysparenuria
  • Vaginismus
  • Pelvic floor muscle weakness or tension
  • Low back, sacroiliac joint, pubic, or coccyx pain
  • Pregnancy-related and postpartum musculoskeletal complaints
  • Diastasis rectus abdominis (DRA)
  • Myofascial restrictions and impaired scar mobility (scars such as those from cesarean sections or episiotomy)

Elizabeth Johnston, DPT, a physical therapist at OSR Physical Therapy, specializes in pelvic health, pelvic conditions, and their treatments through exercises. She sees many diagnoses that are the result of these weakened muscles, which are a part of the musculoskeletal system. This is why physical therapy is so appropriate to treat pelvic problems when it is a diagnosis of the musculoskeletal system.

“Dysfunction of the musculoskeletal system in the region of the pelvis, particularly pelvic floor muscle dysfunction, can be large contributors to the diagnoses that I see and treat,” Johnston says. “This is why I approach treatment of pelvic health conditions from an orthopedic perspective – the same perspective as physical therapy.”

What Is Pelvic PT?

Pelvic physical therapy is unlike any other treatment for pelvic floor dysfunction, urinary incontinence, or any other pelvic problems. Like other problems that physical therapy treats, it focuses on how your muscles are performing and if strengthening those muscles will help solve the problem.

“Pelvic health physical therapy is very similar to orthopedic physical therapy,” says Johnston. “During a session for any other problem, I look at the dysfunctions of the musculoskeletal system. This is no different from pelvic physical therapy. It typically involves looking at and working with the muscles, ligaments, and bones of the pelvis.”

Pelvic physical therapy works to strengthen the muscles of the pelvic floor as well as teach the patient to relax. Sometimes, too much tension can also be the cause of pain and problems in that area. Relaxation, mobility, and control of the muscles are the focal points of physical therapy.

What To Expect

Pelvic physical therapy is similar to any other physical therapy session. If you’ve ever been to PT, then you already know what you can expect. However, if you’ve never had to go to physical therapy for treatment, then you can expect to work your muscles as if you were at the gym.

Well, pelvic physical therapy isn’t exactly a workout at the gym. However, the focus is on strengthening that region, so you should be prepared to work at some level. Before beginning the treatment, however, a physical therapist will assess to determine the right treatment.

“I perform a general movement screen of patients and continue my examination more specifically from there based on what I find,” says Johnston. “I assess the pelvic floor muscles for their resting level of tension and strength of contraction. I’ll look for any muscle tender points in and around the pelvis and/or any mobility restrictions. Then, I just treat what I find!”

Treatment can include manual therapy techniques such as joint mobilizations, soft tissue mobilization, trigger point release, passive movement, and/or stretching, and scar mobilizations. It will also include re-learning and teaching your body how to function properly by focusing on when to tighten and when to relax your pelvic muscles. A physical therapist will also instruct in therapeutic exercises for the muscles in and around the pelvis.

“Another important treatment method we use is re-teaching the body how to function properly,” Johnston noted. “We’ll do functional activities training, such as sit to stand, rolling in bed, walking up and down stairs, squatting, lifting, etc. These activities are done while focusing on the usage of the pelvic muscles.”

In all, pelvic physical therapy is extremely beneficial for just about anyone. It’s non-invasive and oftentimes cheaper than any other treatment and is often covered by health insurance.