Maybe your doctor handed you a referral note after years of waiting for a way to manage your pain. Maybe a friend told you how pelvic floor therapy changed her pregnancy and her life. Maybe you’re an athlete who couldn’t figure out why you were having pain during practice, or a man who didn’t know pelvic floor therapy is for everyone too. So you start researching what pelvic floor therapy is, and you’re still left with questions.

I know it can be intimidating to understand everything pelvic floor therapy can do. If you’re feeling nervous about it, you’re not alone. Most of my patients walk in feeling exactly the same way, and it doesn’t stay that way for long. In this blog, I’m breaking down what a session actually looks like, who it helps, and how it can help you feel better long term.

What IS the Pelvic Floor?

The pelvic floor is made up of a lot of small muscles at the bottom of your pelvis that sit like a bowl. They support all of the organs sitting on top of them, and they help you manage pressure. Like any other muscle in the body, they can be tense, they can be weak, or a combination of both. The key to a healthy pelvic floor is a balance of mobility and strength.

What Is Pelvic Floor THERAPY?

Pelvic floor therapy is a specialized form of physical therapy. As a pelvic floor physical therapist, I treat the pelvis as part of the whole body, but it’s very specialized compared to other forms of traditional physical therapy. Once I evaluate your pelvic floor muscles and the surrounding areas, I build a treatment plan around that, which might include hands-on work, exercise, or breathwork and pressure management strategies.

Pelvic floor therapy can treat a variety of conditions. Common conditions may include leaking, pain, and pregnancy. For example, pain could range from pelvic pain during intercourse, chronic back pain, or hip pain. The aforementioned conditions are among the more common that I see, but there are many more we can help treat.

What Happens During a Pelvic Floor Therapy Session

My first session involves quite a bit of talking in order to get to understand the person in front of me. I’m getting to know your case as a whole person, so I might ask questions that don’t seem directly related to the pelvic floor. I typically use a pelvic model to show you what the pelvic floor and pelvis look like, and what I’ll be doing during the visit.

Another component of pelvic floor therapy sessions is an internal exam, which is an evaluation of how your pelvic floor is moving.

Here are important things to know about internal exam:

You do not have to have an internal exam your first visit. It happens if and when you feel comfortable, not on a set schedule.
No speculum, no stirrups. You’ll be in a private room with sheets and your legs supported on pillows.
One gloved, lubricated finger is used to check for issues and get a feel for the muscles (tension, weakness, etc.).
It’s not required. If you don’t feel comfortable, or if you’re a pediatric patient, always communicate that with your pelvic floor therapist, and they can assess you in other ways, including externally.

You’re in control the entire time, and your comfort is our priority!

After getting to know you during the evaluation, my next step is building a personalized plan. Whether that’s pelvic floor down-training (teaching tight or overworked muscles how to relax and lengthen), strengthening the pelvic floor, or both. This can include exercises in the clinic and at home.

In addition to your exercises and home exercise program, I also work with you in sessions to teach tools like this for managing your own condition, so you feel empowered and capable of caring for yourself, not dependent on me.

Common Misconceptions About Pelvic Floor Therapy

“You’re only doing internal work every visit.” Sessions are more well-rounded than that, usually a mix of internal work, external work, conversation and check-ins, and exercise. I believe movement is medicine, and my goal is to empower you with movement and tools you can use to help.

“Imaging came back clear, so nothing’s wrong.” Conditions like endometriosis often do not show up on a vaginal ultrasound. Even if your condition hasn’t been officially diagnosed with imaging, pelvic floor physical therapy is often encouraged to address symptoms such as pelvic pain.

“I’ll just be told to do Kegels.” In my own practice, it is one piece of treatment. Most people need a fuller approach that builds strength around the pelvic floor instead of 100% focus on pelvic floor muscle strengthening.

“It’ll be embarrassing and I am afraid to talk to someone about these things.” This is the one I hear most, and I promise this is a safe space. Whatever you’re dealing with– leaking, constipation, urinary retention, or pelvic pain–I promise I hear it daily and it does not faze me. My job is to help, not judge.

Conditions People Don’t Realize Pelvic Floor Therapy Can Help

A big note to mention is that ANYONE can go to pelvic floor therapy, regardless of gender. Here are some of the conditions I see most often that people don’t always connect to the pelvic floor:

Stress incontinence. Leaking with coughing, sneezing, running, or jumping.
Urge incontinence. Arriving home and getting out of the car, and suddenly feeling like you must go right now, or having trouble holding it once you see a bathroom.
Pregnancy and Postpartum care. Pelvic floor therapy isn’t just for after delivery. Doing it while you’re pregnant works like prehab before a major surgery as labor, no matter how you deliver, puts strain on your body.
Diastasis recti abdominis (DRA), or abdominal separation. This can be common in pregnancy, but isn’t limited to just that. I recently evaluated a male soccer player with a small diastasis and an inguinal hernia that likely resulted from a sports hernia due to an inability to properly manage intra-abdominal pressure.
Hernias.
Pain during intercourse or gynecological exams.
Pain with tampon usage.
Chronic pain in general.
Chronic low back pain.
Pain in sport. Sports-related pain can be pelvic floor related too, and we treat athletes.

Pelvic Floor Therapy Can Also Help Chronic Conditions Like:

Endometriosis. This is a systemic condition where tissue similar to the uterine lining grows outside of the uterus. That tissue can only be removed surgically, but the pain this causes can be addressed in pelvic floor therapy. Your pelvic floor often tenses in response to that pain, so I help relax those muscles and build strength in the surrounding areas so your body doesn’t have to work so hard to protect itself. Read more about pelvic floor therapy for endometriosis.
Symptomatic hypermobility and hypermobile Ehlers-Danlos Syndrome (hEDS). These patients often have a mix of tense and weak pelvic floor muscles, so I focus on releasing tension while building strength and stability elsewhere.
TMJD – temporomandibular joint disorder. The anatomy of the vocal cords and pelvic floor is similar, so people with pelvic tension often clench their jaw too. It’s a full-body system!

One Of My Favorite “Wins” As A Pelvic Floor Therapist

I’m currently treating a patient who came to me after her third endometriosis excision surgery, as well as a procedure to help manage interstitial cystitis (a chronic bladder condition that causes pain and pressure). In that first visit, we spent most of our time on breathwork, and she told me no one had ever looked at her breathing before, or looked at her as a whole person instead of solely focusing on the pelvic floor.

From there, we moved onto bladder retraining. A bladder diary showed she was going to the bathroom 25 times a day, so we used hourly check-ins, not to stop her from going, but to help her tell the difference between an actual physical need and an urge her brain had just gotten used to acting upon. Over time, this trains the bladder to hold more, and her symptoms have improved significantly since.

What people may not know about me as a provider is that I have gone through pelvic floor therapy for endometriosis pre- and post-operatively, so I understand what it feels like wanting someone in your corner to listen and help!

Finding the Right Provider

Every provider practices a little differently, and that’s a good thing. If a pelvic floor therapist isn’t quite the right fit, it’s okay to look for someone else you connect with better. Finding a provider you really trust makes a real difference in how treatment goes, and direct access in Arizona and Texas means you have the freedom to go find that fit.

Pelvic floor care also requires specialized training beyond what physical therapists or occupational therapists learn in school. For me, that meant extra coursework in pelvic health outside of my schooling, and a ten-week clinical rotation in my third year of my doctoral program. Asking a potential provider about their training helps you feel confident in who you’re working with.

A great pelvic floor therapist should be a great listener, an advocate, and someone who helps you feel like yourself again. To find a Spooner pelvic floor therapist to help you get back to doing what you love, schedule an appointment today!

Spooner Sports Performance

Spooner Personal Training

Treatments

Equipment

Programs

Arizona

Texas

Patient Resources

Provider Resources
Refer a Patient