Pelvic floor physical therapy (PFPT) is a powerful and often underutilized treatment for a wide range of pelvic health concerns. Before answering the question of when someone should seek a pelvic floor physical therapist, it’s important to first understand the anatomy and function of the pelvic floor, the symptoms that warrant professional evaluation, and the potential treatments available. 

Understanding Pelvic Floor Anatomy and Physiology 

The pelvic floor consists of a group of muscles, connective tissue, and ligaments that form a supportive “hammock” at the bottom of the pelvis. These muscles are integral for maintaining continence, supporting pelvic organs, enabling sexual function, and contributing to core strength and coordination. 

Key structures of the pelvic floor include: 

• Levator Ani Muscles: These muscles are the primary support system for the pelvic organs. 
• Coccygeus Muscle: Located near the tailbone, this muscle supports the pelvic organs and assists in controlling bladder and bowel function. 
• Fascia and Ligaments: Provide additional structural support, ensuring the pelvic organs stay in place. 
• Nerves: The pelvic floor muscles are innervated by the pudendal nerve, which is critical for sensation and motor control. 

Main Functions of the Pelvic Floor 

Support

The pelvic floor muscles support the bladder, uterus (in women), rectum, and other pelvic organs. When these muscles weaken or become dysfunctional, it can lead to conditions like pelvic organ prolapse.

Sphincter Control

Pelvic floor muscles are essential for controlling the opening and closing of the bladder, rectum, and urethra. Dysfunction here can result in urinary incontinence or fecal incontinence.

Sexual Function

Pelvic floor muscles are essential for controlling the opening and closing of the bladder, rectum, and urethra. Dysfunction here can result in urinary incontinence or fecal incontinence.

Circulation

The pelvic floor supports the proper circulation of blood in the pelvic region, contributing to overall pelvic health and well-being.

Strength and Coordination

The pelvic floor works in conjunction with the deep abdominal muscles and diaphragm to provide core stability. Dysfunction in the pelvic floor can affect overall posture and balance.

When to Refer to a Pelvic Floor Specialist 

Several signs and symptoms can indicate a need for a pelvic floor specialist. Conditions may range from minor discomfort to more severe dysfunction, but in all cases, a pelvic floor therapist can provide targeted evaluation and treatment. 

The Big 3: When to Seek Specialized Care

Leakage/Incontinence:

This can be due to several forms of urinary incontinence, including:

• Stress Incontinence: Leakage when sneezing, coughing, or exercising. 
• Urge Incontinence: A sudden, intense urge to urinate that leads to leakage. 
• Mixed Incontinence: A combination of stress and urge incontinence. 
• Athletic Incontinence: Leakage that occurs during physical activity or sports. 

Pressure, Heaviness, Achiness, or Fatigue “Down There”

Feelings of pelvic heaviness or pressure, particularly in the vagina or rectum, can indicate pelvic organ prolapse. 

Pelvic Pain

Conditions like vestibulodynia, vulvodynia, cliterodynia, endometriosis, or SI joint dysfunction can all contribute to pelvic pain that may not respond to conventional treatments. Pelvic pain may also encompass: 

• Dyspareunia (Pain During Intercourse): Pain during intercourse, pelvic exams, or    even tampon insertion can signal pelvic floor issues, whether from muscle tightness or other conditions. 
• Sexual Function Concerns: Lack of desire, inability to orgasm, or painful orgasms can all be linked to pelvic floor dysfunction. 

Other Considerations for Referral: 

• Chronic Constipation or Bowel Dysfunction: Difficulty with bowel movements, straining, or incomplete evacuation may be linked to pelvic floor weakness or poor coordination. 
• Pregnancy and Postpartum Care: Whether you’re considering pregnancy, currently pregnant, or recovering from childbirth (vaginal or cesarean), pelvic floor therapy can help address issues like incontinence, prolapse, and pelvic pain. 
• History of Abdominal Surgery or Pelvic Conditions: Conditions such as abdominal surgeries (e.g., hernia repair, C-sections), Crohn’s disease, IBS, or Colitis can affect pelvic floor health. 
• Menopause: Peri-menopause and menopause can bring on pelvic floor challenges, such as incontinence, vaginal dryness, and pelvic organ prolapse. 
• Chronic Low Back Pain and Urinary Incontinence: Research has shown a strong connection between chronic low back pain and urinary incontinence. 

Potential Treatments from a Pelvic Floor Specialist 

Once referred to a pelvic floor physical therapist, patients can expect personalized care that may include several treatment strategies, depending on their symptoms: 

Downtraining

If the pelvic floor muscles are too tight or overactive, techniques like diaphragmatic breathing and progressive muscle relaxation can help “downtrain” and relax the muscles. 

Postural Strengthening and Flexibility

Improper posture or poor body mechanics can exacerbate pelvic floor dysfunction. Addressing posture, flexibility, and alignment through strengthening exercises is crucial for long-term healing. 

Pelvic Floor Strengthening and Coordination

For weak pelvic floor muscles, targeted strengthening exercises like Kegels are used. Coordination training is also important to ensure the muscles can contract and relax appropriately. 

Manual Therapy

A skilled therapist may use manual techniques to release muscle tension, address trigger points, and improve tissue mobility. 

Biofeedback

This technique helps patients learn how to control pelvic floor muscle function through real-time feedback, such as visual or auditory cues, helping individuals improve coordination and strength. 

Pelvic floor dysfunction can impact many aspects of health, from continence to sexual function and overall quality of life. A trained pelvic floor physical therapist can offer effective, non-invasive treatment options to address these concerns. Whether you’re experiencing leakage, pain, discomfort, or difficulty with bowel and bladder control, seeking care from a pelvic floor specialist could make all the difference. Early intervention and treatment can not only relieve symptoms but also improve your long-term pelvic health. If you have any of the symptoms discussed above, don’t hesitate to consult with one of our specialists to explore how pelvic floor therapy can enhance your well-being. 

— Ashley Jones, DPT