woman doing pelvic floor exercises on the floor of a gym

What Is Pelvic Floor Therapy and Do Women Really Need It?

If you’ve read anything in women’s health over the last couple years, you’ve seen the words “pelvic floor therapy” or “vaginal therapy.” It seems like (finally) more women are talking about it and normalizing it.

But just because we’re talking about it more, doesn’t mean we are talking about it enough

There’s still a gap in understanding about what pelvic floor therapy is, why it’s a crucial part of women’s health, and how it works. (Especially for American women.)

Other countries are ahead of the United States. In France, every postpartum woman is offered 10+ pelvic floor therapy sessions as part of normal, postpartum care. They’ve subsidized postpartum pelvic care as “perineal re-education.” 

(As if the tasty croissants, incredible wine, and rich history weren’t enticing enough. We see you, France.) 

If you’re still curious about pelvic floor therapy, here are the answers to your top questions:

What is pelvic floor therapy?

Okay, first let’s talk about what your pelvic floor is: a group of muscles that hold up your bladder, uterus and rectum. They’re an essential part of your core that helps you move efficiently and effectively for activities like squatting, twisting, walking, running, and jumping. And these muscles also help us control when we pee, poop, and orgasm. 

Sounds pretty important, right? 

Pelvic floor therapy is a type of physical therapy where a trained healthcare professional assesses your current pelvic floor function, develops a treatment plan, and helps you work to build a stronger, healthier pelvic floor. 

Treatment can include learning proper breathing techniques, relaxing and contracting your pelvic floor, performing perineal massage and/or c-section scar tissue massage to release points of tension, and more.

Why do women go to pelvic floor therapy?

Most women seek physical therapy when there’s a problem. 

Common problems include urinary or fecal leakage (incontinence), painful sex, or pelvic organ prolapse. And, most of these symptoms arise during or after childbirth. 

During pregnancy, a woman’s pelvic floor muscles carry the weight of the growing uterus and baby for nine months. This, coupled with how you deliver, can lead to some pelvic floor weakness and/or pelvic floor dysfunction (PFD).

PFD is an umbrella term used to encompass several different bowel, bladder, and sexual disorders, and chronic pelvic pain syndromes,” said Dr. Lauren Critchlow, a pelvic health rehabilitation specialist, during an interview with Expecting and Empowered. “These affect or are caused by the pelvic floor muscles inability to contract, relax, and/or bulge effectively. These conditions may or may not have pain associated with them.”

But having kids isn’t the only culprit for pelvic floor issues. One in four female athletes suffer from unwanted urinary leakage. And, these women have not given birth. Since the pelvic floor is an essential part of our core, it can become injured or not working properly, and create issues, especially when stressed with high activity.

Dr. Oswald shared that more women are coming into her clinic to work on their pelvic floor health preventatively, instead of waiting for issues to arise. Part of this preventative care is to prepare women for pregnancy, perimenopause, or improve their sex life.

What happens during an appointment?

For your first appointment, you should expect an external and internal exam of your pelvic floor. If you’re pregnant, the therapist will usually ask for a note from your OBGYN before you have the internal exam.

Yes, the internal exam can be uncomfortable, but it’s part of having a comprehensive pelvic exam. Know that pelvic floor therapists are highly trained and sensitive to their patients. They are aware of how personal this type of physical therapy is and will walk you through every step of the process to make you relaxed.

During the exam, the therapist will ask you to “lift” your pelvic floor, “relax” your pelvic floor, and perform a Kegel. The therapist will also assess the strength of your pelvic muscles by pressing gently on the inside of your vaginal wall and asking if you feel any pain or tightness. (Sometimes we hold more tension on one side due to pregnancy, childbirth or just a normal imbalance.)

“I think it’s important to understand what a strong pelvic floor is,,” Dr. Allison Oswald, board-certified doctor of physical therapy and women’s health specialist, told Well+Good. “We define a strong, healthy pelvic floor as one that can fully relax and fully contract.”

(If you want even more details, you can learn more about what happens in an exam here.)

How much does it cost?

If you pay out-of-pocket, each visit can be $150-300 according to PTProgress. But cost depends on your health insurance provider, location, and how many pelvic floor therapists are around you.

Check with your health insurance first to see if there is a PF PT covered in-network. If not, or you’re curious, here’s a tool to help find a pelvic floor therapist near you.

Should I see a pelvic floor therapist?

Going to see a pelvic floor therapist can be about curing unwanted urine or fecal leakage, seeking preventative care, or experiencing a more pleasurable sex life. 

Any woman can see a pelvic floor therapist to assess and/or improve their pelvic strength. You don’t need to have given birth or experienced issues to start.

If you’ve given birth or you’re pregnant, seeing a pelvic floor therapist can help prevent and treat any normal issues you have. A strong, healthy pelvic floor helps you have the confidence and freedom to enjoy the lifestyle you want.

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