“Wait…you do what?”

Pelvic Floor Physical Therapy

“Wait, you do what?!”

In my final year of physical therapy school, I received one three-hour lecture about Pelvic Floor Physical Therapy (PFPT). I remember sitting there, staring wide-eyed, at the PowerPoint presentation that was being delivered by a PT alum (Go Emory!) who specialized in this area. She passionately explained what PFPT was, why it was important, and how there was a great need for more clinicians to join this newer specialty. At the conclusion of her talk, I leaned over to my classmate and whispered, “There is NO WAY that I will EVER treat THAT. Glad to know somebody wants to, and I’m glad I know to refer out if I get a patient who needs that type of help, but that’s definitely not for me. I’m sticking with sports and orthopedics for sure.”

Fast-forward three years into practicing, I quickly learned the importance of pelvic floor rehab from my sport and orthopedic patients. They were brave enough to share with me their challenges “down there”. They explained how paralyzed they felt by needing to know where every bathroom was when they were out for fear of not being able to make it in time, how embarrassed they felt by their leaking when they were working out and always wore a pad and black gym clothes to hide their accidents just in case, and how ashamed they felt about not wanting to be intimate with their partners because sex was too painful…these were only a few of their personal stories. I was floored by their honesty and heartbroken that many had been told that “they just have to deal with it” or “this is normal, especially after having kids” or “it’s all in your head.” As I heard more and more stories like these, I quickly came to realize the magnitude of these pains and the significant impact pelvic floor function has on one’s quality of life. It wasn’t long after that I found myself eagerly attending my first pelvic floor continuing education course…never say never, right?! Who knew it would become one of my favorite areas of the body to treat and reeducate.

In this post, I’m going to share what the pelvic floor is and why it’s important (ps: men have one too!), what PFPT is (spoiler: it’s not just for women), and myth bust some common misconceptions about this specialty (get excited!!). This is something I love speaking about now, especially since many people have no idea what PFPT is, let alone that this specialty is within a PT’s scope of practice. What I’ve also come to find out though this process is that once someone is brave enough to start the conversation, more people begin to share about their pelvic health challenges. They’re much more common than most people realize, many are just too ashamed or shy to talk about them publicly for fear of feeling embarrassed. Being shy about these issues isn’t helping anyone! Normalizing pelvic health is important and PFPT is here to help!!

What is the pelvic floor and why is it important?

The pelvic floor is another body part just like your shoulder or hip. It’s made of muscles and fascia that attach to bones and serve an important purpose as part of the human body. Our pelvic floor is made up of an intricate muscular sling that sits like a hammock in the bottom of the pelvis. It participates in bowel and bladder control, hip/pelvic stability as part of our central core system, holds the contents of our internals organs within our abdominal cavity, and is vitally important for sexual and reproductive functions. While some of the anatomy is slightly different between men and women, a large majority of the pelvic floor organization is similar amongst the sexes.


What is PFPT and what conditions do these clinicians typically treat?

PFPT is a specialty within the physical therapy field, just like orthopedics, pediatrics, geriatrics, etc…. PTs in this area have their Master’s or clinical Doctorate’s in PT and then have chosen to complete additional pelvic floor coursework after graduating from PT school. Pelvic floor rehab is not part of the traditional PT school curriculum…yet. We PFPTs are hopeful that this will change as the specialty continues to grow. It’s only been around since the mid 90’s, so it’s still fairly new.

PFPT’s can treat both men and women (Dr. Christine is only trained in female pelvic conditions) and incorporate both internal, vaginally and/or rectally, and external treatment modalities depending on what’s needed for assessments and interventions. Pelvic floor muscles can be tight and require soft tissue work to be released, or muscles can be weak and need manual facilitation for activation reeducation, or there can be scar tissue from trauma/childbirth/surgeries/etc that require manual work to be performed to reestablish proper tissue elasticity. In some cases, patients need a combination of all the above.

The most common pelvic conditions treated (but not limited to) by PFPTs include:

  • Incontinence: bowel or bladder leakages due to muscle weakness, poor muscle coordination, and/or overactive tight muscles. This is common for women after pregnancy, but is not unique to them alone. Men, children and women who have not had babies suffer from these challenges as well.
  • Constipation: this too occurs due to muscle weakness, poor muscle coordination, and/or overactive tight muscles that impair one’s ability to pass a bowel movement and/or to do so without pain or discomfort.
  • Pelvic Pain: This can occur anywhere throughout the male and female pelvic region (internally or externally). It may also be associated with pain while voiding, pain during or after intercourse, discomfort following pelvic surgeries, pressure sensitivity caused by clothing or when sitting on a hard surface or while exercising, or a combination.
  • Low back, tailbone, public bone, hip and knee pain: Yes, these are common too with pelvic floor pathologies since these regions share similar muscles, fascia and boney landmarks with the pelvic floor directly.
  • Note: PFPTs are trained to treat all orthopedic conditions, not just the pelvic floor. So within a comprehensive plan of care with a PT, patients will learn how to reorganize their pelvic floor muscles within the greater picture of whole body movement reeducation.

What are common misconceptions about PFPT?

  • Is PTPT only for women who have had children?
    • No! It’s for men, women, and children. Remember, every human has a pelvic floor! Children are experiencing urinary incontinence and constipation more often than most people are aware of these days and can be greatly helped with PFPT treatment. There are also plenty of women who have pelvic floor challenges that have never had children or even been pregnant. More men are also being diagnosed with pelvic floor challenges; most just don’t talk about it (think erectile dysfunction, muscle spasms during or after intercourse, incontinence issues especially those related to prostate pathologies).
  • Does PFPT always involve internal treatment?
    • No, not always and is based solely on the patient’s comfort level. Patients get to decide what type of treatment they want to participate in. There are many alternative ways to treat pelvic floor pathologies, but the gold standard of care involves internal assessment and treatment.
  • If someone has been suffering with pelvic floor challenges for many years, can they still benefit from PFPT now
    • YES!!! There is no expiration date on when you can see a PFPT for long-term pelvic floor challenges. Dr. Christine has worked with patients who have suffered with their symptoms for over a decade before learning about PFPT and seeking treatment. If you, or someone you know, has pelvic floor challenges, there is hope and help available! If you’re local to Santa Barbara, CA, Dr. Christine can provide you with that support. If you’re not near by here is a directory of pelvic health professionals so you can find one near you.
  • Why don’t more people know about PFPT?
    • Great question! We’re working on it but need everyone’s help! Please share this information with friends, family, and your healthcare providers so that there’s more awareness around this effective and conservative type of care for everyone. You never know who’s suffering from pelvic floor challenges in silence. Let’s create a safe space to discuss and treat these conditions together!


    Pelvis photo source:

    1.https://www.google.com/url?sa=i&source=images&cd=&ved=2ahUKEwi2ovS5xujcAhVPXKwKHaeLDcQQjRx6BAgBEAU&url=http%3A%2F%2Fwww.siansmale.com%2Fpilates-blog%2F2015%2F8%2F21%2Fpelvic-floor-muscle-exercises-the-best-way-to-have-the-best-technique&psig=AOvVaw3EDWbMm7hZUDJoYTXVqNgU&ust=1534198839446719. Accessed 8/12/18