Pelvic Floor Physical Therapy

What is pelvic floor physical therapy?

Pelvic floor muscle therapy (PFMT) is recommended when the muscles in the pelvis that surround the urethra, bladder and rectum become weak or stretched out. These muscles perform a very important functional role by holding the pelvic organs in place, and by relaxing appropriately when you need to urinate or have a bowel movement. Rehabilitation of these muscles is considered first-line therapy for leakage of urine from urge and stress incontinence, and to maintain tone in the vagina. This is important for sexual health, as well as to prevent the pelvic organs from sagging down. A pelvic floor physical therapist has special training in the anatomy and function of these muscles as well as the surrounding deeper muscles in the pelvis, hip and groin area.

Is it effective?

There is significant evidence in the medical literature that shows PFMT is very effective. A large analysis of studies on the efficacy of PFMT was conducted by the Cochrane group in 2018. They compared 1,817 women who underwent either pelvic floor muscle therapy, no treatment, or inactive treatment.  Based on the data, the authors concluded that women with stress incontinence in the PFMT group were eight times more likely to report being cured than women in the other groups. For women with all types of incontinence, both their incontinence and quality of life were improved in the PFMT groups. Negative side effects of performing PFMT were extremely rare, and minor in those who reported them.

The authors concluded that PFMT can indeed cure or improve the symptoms of both stress and urge incontinence. Despite the strong evidence to support the use of pelvic floor physical therapy, very few women are informed about this option. It is very important to talk to your urologist or urogynecologist about getting a referral if you are suffering from incontinence issues.

How do I choose a pelvic floor physical therapist?

After taking a thorough history and performing a physical exam, Dr. Kumar will determine whether you may benefit from pelvic floor physical therapy. In many instances, she will recommend this alongside other modalities of treatment. Dr. Kumar will provide you with a list of physical therapists who she knows and specifically recommends, as well as a doctor’s referral note. It may be covered by insurance, depending on your coverage and which therapist you chose.

How long do I need to do it for?

At the time of your first visit, the therapist will examine you and make plan for how often you need to come in. A rule of thumb for most women is once a week for 6 weeks. If you are going to pelvic floor physical therapy for pelvic pain, or problems with the muscles being too tight, it may take a longer period of time to correct.

Can I do pelvic floor physical therapy at home?

It is best to work with a pelvic floor physical therapist initially to gain a good understanding of what the pelvic floor muscles are and how to properly contract and relax them. Many women perform the exercises incorrectly and that is why they have felt like “doing kegels,” wasn’t helpful. It is a common mistake to squeeze the gluteal, inner thigh, or abdominal muscles instead of isolating the ones in the pelvic floor. Once you have learned how to properly contract your pelvic floor muscles, it is an excellent idea to continue the exercises at home. This can be done via a program of exercises the therapist gives you, or with an at-home device. Some devices will actually contract the muscles for you, and some can offer feedback about whether you are doing the exercises correctly.

  1. Dumoulin  C, Cacciari  LP, Hay‐Smith Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews 2018, Issue 10. Art. No.: CD005654. DOI: 10.1002/14651858.CD005654.pub4.