If you leak urine during exercise or when you sneeze, you may have heard that you should do Kegels. But what if you also have pelvic pain, trouble with bowel movements, or symptoms that haven’t improved with the exercises you’ve tried?
Pelvic floor physical therapy can help address muscle and movement problems that contribute to certain bladder, bowel, and pelvic pain concerns. Treatment starts with finding out how the muscles are working, because strengthening is only one possible part of care.
What does the pelvic floor do?
The pelvic floor is a group of muscles at the bottom of your pelvis. These muscles help support pelvic organs and contribute to bladder and bowel control and sexual function. Everyone has a pelvic floor.
These muscles need to do more than squeeze. They also need to relax and coordinate appropriately. Pelvic floor PT may address weakness, muscle tension, or difficulty using the muscles effectively, depending on the evaluation findings.
What concerns can pelvic floor PT address?
Reasons to seek an evaluation may include:
- Urine leakage during coughing, sneezing, lifting, or exercise.
- Urinary urgency or frequent bathroom trips.
- Constipation, straining, or difficulty with bowel movements.
- Pelvic pain or discomfort during sexual activity.
- Pelvic health concerns during pregnancy, after childbirth, and during menopause.
These symptoms can have causes beyond the pelvic floor muscles. Physical therapy may be one part of care, and additional medical evaluation may be needed. Having symptoms does not automatically mean you need pelvic floor strengthening.
Why aren’t Kegels always the answer?
Kegels involve contracting and relaxing the pelvic floor muscles. They can help some people with urinary leakage when weakness contributes to the problem.
For others, treatment may need to focus on relaxing tight muscles or improving coordination. NIH guidance for people with interstitial cystitis, also called bladder pain syndrome, specifically cautions against pelvic floor strengthening exercises unless working with a physical therapist.
The useful question is not simply, “Is my pelvic floor weak?” It is, “What do these muscles need to do differently?”
An assessment helps answer that question. Your symptoms alone cannot tell you whether strengthening, relaxation, coordination training, or another approach is appropriate.
What happens at a pelvic floor evaluation?
Your therapist will ask about your symptoms, medical history, bathroom habits, and activities that are difficult or uncomfortable. The physical assessment may include breathing, movement, strength, and flexibility.
An external or internal pelvic floor examination may also be discussed. An internal examination is optional and requires your consent. You can ask questions, decline it, or request that it stop.
You do not need to know what is wrong before the appointment. Details such as “I leak toward the end of a run” or “sitting becomes uncomfortable after an hour” help explain the problem more clearly than a general description alone.
How does treatment help beyond the appointment?
Depending on the findings, treatment may include muscle strengthening or relaxation, coordination exercises, hands-on care, and education about bladder and bowel habits. Exercises may also address relevant muscles around the hips, pelvis, and trunk.
Your therapist may help you apply those skills to activities such as lifting, squatting, exercising, or getting up from a chair. The aim is to connect treatment to the situations where you are having difficulty.
A home program should give you clear instructions about what to practice between visits. Useful questions to ask include:
- What is this exercise intended to help with?
- How will I know I’m doing it correctly?
- What should I do if it causes discomfort?
- What changes should I watch for?
What does progress look like?
Progress should relate to the concern that brought you in. For someone with urinary leakage, that may mean fewer episodes during exercise. For someone with pain, it may mean sitting or moving more comfortably.
There is no fixed number of visits that fits everyone. Your therapist will discuss the expected frequency and duration of care and reassess the plan as needed. Results vary, and complete symptom relief cannot be guaranteed.
Taking the next step at Optimum Therapies
If bladder, bowel, or pelvic symptoms are affecting your day, contact Optimum Therapies to ask about pelvic floor physical therapy and available providers. When you call, mention the concern you would like help with so our team can help identify an appropriate provider.
Visit our Pelvic Floor Therapy page to learn more.
This article provides general education and does not replace medical evaluation, diagnosis, or individualized treatment advice.
Reviewed by Nicole Pederson, PT, DPT, OCS