Is the leakage of urine when you laugh, cough, sneeze or have sex is affecting your self esteem? This certainly is a discussion you should have with your Gynecologist but most women don’t.

Or you might have pain with intercourse or pelvic exam. Even inserting a tampon can cause pain. These are all symptoms of pelvic floor dysfunction.  The pelvic floor muscles can be too tight or too loose.

The muscles, tendons, ligaments and tissues creates the pelvic floor and  supports the rectum, vagina and bladder. The nerves in this area adds to sexual arousal. The sphincters of the rectum and urethra prevents us from urinating and defecating on ourselves.

Lastly strong pelvic floor muscles supports our mobility and movement.

Pelvic floor therapy is a specialized form of physical therapy that  offers an alternative treatment for women who are struggling with issues with weakness or too tight pelvic floor muscles. Biofeedback and pelvic floor exercises, teaches women how to relax and strengthen their pelvic floor muscle. This special kind of physical therapy has shown to improve various type of pelvic floor muscle dysfunction.

To start you need to know why your pelvic floor is weak or too tight.

The most common reason why pelvic floor muscle becomes weak is vaginal delivery. Your vagina, bladder and rectum are supported by the muscles in your pelvic floor. Impairment of the muscles in this area will cause symptoms related to your vagina, bladder and rectum.

Due to scarring and poor healing any kind of trauma to the pelvic floor region can cause tightness.

Why You Need It?

Pelvic floor physical therapy may be necessary for your pelvic floor health and general wellness. Below are some of the most common conditions it can help you out with.

Pelvic pain

Women, at some point in their lives, will experience pelvic pain. It can involve their vulva, clitoris, bladder, tailbone, and even their rectum. Too tight pelvic floor muscles can cause pain.

If you’ve seen your doctor and you’ve undergone tests only to find out no specific disease is causing your pain, seeing a pelvic floor physical therapist may help you out. She can help find the soft tissue dysfunction that’s contributing to the pain you’re experiencing.


Incontinence is mostly due to the weakness of the pelvic floor. If you are experiencing “leaks,” your physical therapist may help you re-train your bladder habits and strengthen your pelvic muscles.

Pre and Post Partum Wellness

During pregnancy, your body releases a hormone called relaxin. It increases joint laxity, which makes you prone to injuries in your pelvic floor, lower back, and sacroiliac joint.

After childbirth, your muscles may be too weak or uncoordinated that you become at risk of pelvic organ prolapse, incontinence, and painful sex.

Seeking physical therapy in your post-partum period is essential to re-learning coordination of your pelvic floor muscles.

Where to Find the Right Pelvic Floor Therapist for You

Majority of hospitals and clinics have physical therapists who are trained to perform pelvic floor therapy services. You can interview people, ask for recommendations, and look for someone who’s knowledgeable in managing and treating your condition.

If you are unsure where to start, you can ask your primary care provider. If he/she is  unable to refer you to one, it doesn’t mean that you won’t be able to see a pelvic floor therapist. There are physical therapists that offer self-referral or direct access.

What to Expect on Your First Appointment


On your first visit, your pelvic floor therapist will conduct a careful but thorough interview about your experience. She will ask a series of questions to get a clearer understanding of your pelvic floor issues.

Don’t worry or feel awkward about sharing sensitive information about your symptoms, history, and lifestyle. Pelvic floor therapists are generally trained to handle personal and intimate topics that relate to your health.

If you had experienced any sexual trauma or abuse, they will need to know this information.

Apart from doing an interview, the therapist will also carefully evaluate your hips, back, and posture. An internal exam via your rectum and will also be required. However, this can be delayed until you are ready.

In most cases, a biofeedback examination is performed to complete the evaluation. It involves the placement of an internal sensor either inside the rectum or the vagina or external sensors on the skin.

The sensors won’t cause any pain as their basic purpose is to read your muscles’ electrical activity. This will help your therapist know how your pelvic floor muscles work.

This procedure will enable your physical therapist to know the strength and flexibility of the muscles in your pelvic floor area. For women, the procedure will be through the vagina. In cases where there’s extreme pain, this may not always be possible.

You don’t necessarily have to undergo a biofeedback examination on your first visit, particularly if you are experiencing pain. It can be done during the succeeding sessions or when your therapist has a clear idea of your condition and discomfort.

If you are menstruating and experiencing heavy flow, you have the option to use a menstrual cup and push through with your appointment. However, if you feel uncomfortable with it, you can wait until your menstrual cycle is over.

For very light flow, you’ll have no problem seeing your therapist. Just remember that the examinations won’t be completed if there’s a tampon in place. Since a vaginal examination might be necessary, you should disclosure this information to the therapist and let them tell you how to proceed with the appointment.

In the treatment room, you’ll be with your physical therapist. Depending on your preference and the situation, you can have another person in the room with you.

As for what you should wear during a session, there’s no need to be in a certain kind of clothing. You will be asked to wear a gown during the assessment, and you’ll be asked to undress from the waist down.

There will be sheets and drapes so you won’t have to worry about your privacy. Usually, treatment rooms are located close to a bathroom.

The first appointment focuses more on assessment and education. The second appointment, on the other hand, should offer you with a more concrete and complete treatment plan. It may change depending on how your body responds and the rate of your progress.

In general, here are some of the things your session may include:

● Stretching

● Lifestyle change

● Changes in nutrition

● Pelvic floor exercises

● Breathing techniques

● Yoga

● Different pain management methods

● Strength-building exercises

The time frame of your treatment plan will depend on a lot of factors, as healing doesn’t always happen at the same time for all people. You should be clear in setting realistic goals with your therapist and monitor your progress with her.

Goals for Tightness


  • Able to insert tampon
  • Abe to engage in vaginal intercourse
  • Able to endure a vaginal exam
  • Increase size of dilator

Goals for Looseness


  • Hold in a tampon
  • Hold in Vaginal weight
  • No urine leakage



A lot of women need pelvic floor therapy without realizing it. If you are experiencing pelvic pain, incontinence, or painful sex, you may want to talk to your primary care provider about getting a referral to a pelvic floor therapist. Just like with other muscles, a weak pelvic floor becomes weaker over time resulting in worsening symptoms and possibly surgeries.

If you’re not able to secure one, reach out to hospitals and clinics as majority of them have trained and skilled therapists that can help you manage your condition. Ask around and don’t feel embarrassed about asking for help.

Leave a Reply