Pelvic Floor Physical Therapy - What Is It & Is It Right For You?

Laurence Monneret

While scrolling on TikTok, you might land on videos about the “pelvic floor” or “pelvic floor therapy” filled with advice and exercises. The TikTok hashtag #pelvicfloor has garnered over 578 million views so far.

Some of the videos are from physical therapists trying to educate and spread awareness, but many are not — and before you know it, you may be diagnosing yourself with a pelvic floor problem in between watching videos about NyQuil chicken and the corn kid.

So what is pelvic floor therapy and who can benefit from it? We spoke to experts to find out.

What is the pelvic floor?

The pelvic floor is “almost like a hammock of muscles lining the bottom of the pelvis,” Dr. Charles Ascher-Walsh, Division Director for Urogynecology in the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai told TODAY. The main component of the pelvic floor is called the levator ani muscle, which is actually a series of muscles that support everything in the pelvis, Ascher-Walsh explained.

Basically, these pelvic floor muscles keep the organs in your body from falling out, Dr. Jaclyn Bonder, Medical Director of Women’s Health Rehabilitation at Weill Cornell Medicine and NewYork-Presbyterian told TODAY. These organs include the bladder, bowel, rectum and uterus.

When they work normally, the pelvic floor muscles also help control certain bodily functions, said Bonder. “They are muscles that help us control urination and bowel movements (continence), and sexual intercourse — whether it’s orgasm and pleasure or sexual function,” Bonder added.

These muscles work a bit differently in women and men, the experts noted. “The design of a woman’s pelvis has to do with the fact that women are able to get pregnant and deliver a baby, so there are more openings to allow this,” said Ascher-Walsh. In men, some of the pelvic floor muscles assist in controlling and maintaining an erection, said Bonder.

What is pelvic floor dysfunction?

Pelvic floor dysfunction occurs when the pelvic floor muscles do not work properly, which can lead to a range of conditions and symptoms. Generally, there are two types of pelvic floor dysfunction — either the muscles are too weak (hypotonic) or the muscles are too tight (hypertonic), the experts noted. This can lead to things like incontinence, constipation, prolapse, muscle spasms, pain, and more.

What causes weak pelvic floor muscles?

Weak pelvic floor muscles can be caused by childbirth, problems with the nerves coordinating and controlling those muscles, problems with the bladder or bowels, or trauma, said Bonder. During a vaginal delivery, for example, the pelvic floor muscles can become stretched or tear and down the line this can lead to weakness in postpartum women, Bonder added.

Aging is another common cause of weakened pelvic floor muscles, said Ascher-Walsh. “It’s becoming more and more of an issue as we live longer,” he added.

One of the most common conditions associated with weak pelvic floor muscles is incontinence, or the inability to control urination or bowel movements, the experts noted. “Basically, when you’re learning to be potty trained, you’re learning how to control the pelvic floor muscles … so if those muscles are not working properly, sometimes you’ll leak urine or fecal matter or not be able to hold it well,” said Ascher-Walsh.

Weak pelvic floor muscles can also cause urine to leak with movements like coughing, sneezing, laughing, or jumping, said Ascher-Walsh — this is called stress incontinence.

If the pelvic floor muscles are unable to support the pelvic organs, this can lead to prolapse. “A prolapse is sort of when things start to sort of drop downward in a woman’s pelvis … (which) occurs to some extent because of a weakness of the pelvic floor muscles,” said Ascher-Walsh.

What causes tight pelvic floor muscles?

Tight pelvic floor muscles may be caused by overuse, stress, other pelvic health conditions, trauma, or anxiety, the experts noted.

Just like some people hold tension in their shoulders, some hold tension in their pelvic floor and will clench or hold these muscles too often, said Bonder. “I think that there’s a certain percentage of women who show that tension in their pelvic floor… their muscles are sort of in a constant spasm to some degree,” Ascher-Walsh said.

When these muscles are spasming, they may be tender to touch which can lead to chronic pain, said Ascher-Walsh. “That obviously leads to very uncomfortable sex,” he added. This can also cause pain with arousal, pain with ejaculation, and pain with orgasm, said Bonder.

In addition to painful sex, tight pelvic floor muscles can cause pain with urination, bowel movements, and gas, said Bonder. When it comes to bodily functions, a tight pelvic floor can actually lead to constipation and increased urinary frequency or urgency, so people may feel like they need to pee more often or very quickly, Bonder noted.

Tense pelvic floor muscles can also be a result of trauma or injury, said Bonder, which can lead to a “guarding response." For example, if someone has endometriosis, they may tend to guard against pain by tightening or clenching their muscles, which can cause additional pain in the muscles, Bonder added.

“Tensing the muscles and guarding against things tends to happen in (both men and women) who have higher anxiety and higher stress levels,” said Bonder. Doctors have seen increasing reports of pelvic floor dysfunction and pelvic pain during the pandemic which may be linked to increased stress, TODAY previously reported.

Pelvic floor dysfunction and pelvic pain has also been linked to psychological trauma and abuse, said Bonder.

What is pelvic floor therapy?

Pelvic floor therapy aims to treat pelvic floor dysfunction by helping the muscles work properly, which may mean strengthening or relaxing the muscles depending on the underlying problem.

“Pelvic floor therapy usually refers to physical work … whether it’s for weakness or tightness, a lot of times the first line of treatment is working with a highly trained pelvic floor physical therapist,” said Bonder.

People who have any symptoms of pelvic floor dysfunction should consult their doctor or OB-GYN before attempting any pelvic floor therapy exercises on their own, the experts noted.

Types of pelvic floor therapy

For weak muscles

“The simplest way of thinking of pelvic floor therapy is to try to keep that sort of hammock of muscles stronger,” said Ascher-Walsh. “We often prescribe pelvic floor therapy as a way of trying to strengthen those pelvic floor muscles to combat the weakness that’s leading to prolapse and incontinence,” he added.

Kegels are a popular exercise to help strengthen the pelvic floor, said Ascher-Walsh, and these involve contracting and relaxing the pelvic floor muscles repeatedly. Kegel exercises can be done with the help of a pelvic floor physical therapist or at home.

“To learn how to do kegels, put a finger inside the vagina (or rectum) and squeeze your vaginal (or rectal) muscles down on your fingers so that you can feel that you’re using the right muscles,” said Ascher-Walsh. According to The Mayo Clinic, you can also identify these muscles by holding and stopping urination mid-stream.

It’s also easy to do kegels wrong, the experts noted. “I would say, almost a third of women, when I ask them to do kegel exercises ... don’t really have a good sense of how to contract those muscles down,” said Ascher-Walsh. A pelvic floor physical therapist can help teach you how to do these exercises correctly and safely.

There are also types of “concentrated pelvic floor physical therapy” which involve using probes to help monitor and strengthen the pelvic floor muscles, Ascher-Walsh said. These devices deliver an electrical stimulation to the pelvic floor muscles to make them contract, said Ascher-Walsh, so you can then try to mimic the same contraction on your own.

Pelvic floor therapy exercises like kegels are appropriate for both men and women. “Men with fecal incontinence, for example, would be offered pelvic floor therapy to try to strengthen their pelvic floor,” said Ascher-Walsh.

For tight muscles

“If you have hypertonic or spastic muscles in your pelvic floor, then you need sort of the opposite treatment,” said Ascher-Walsh.

In those with tight or tense pelvic floor muscles, pelvic floor physical therapy may involve physical or breathing exercises, massages, and behavioral modifications to help relax the muscles, according to the experts.

“They (often) need specialists who will go in and sort of massage these muscles and stretch them out,” said Ascher-Walsh.

There are different types of “myofascial release” or manual work that a physical therapist will do to help the muscles get less tense, Bonder said, and exercises patients can do on their own to relax or “down-train” the muscles.

“There’s a lot of breathing patterns that we try to correct in patients with these types of issues because a lot of patients will hold their breath or not use their breath correctly ... that can affect the pelvic floor as well,” said Bonder.

Is pelvic floor therapy right for you?

Pelvic floor physical therapy is a first-line treatment for many conditions, but it’s not a cure-all and some people with pelvic floor dysfunction will require further treatment, the experts noted.

If someone has incontinence that does not improve with pelvic floor physical therapy, for example, they would need to see a urologist or urogynecologist to explore medications or surgery, Bonder said.

“It’s very, very unlikely that pelvic floor therapy would ever reverse the problems of prolapse,” said Ascher-Walsh. In patients with pelvic organ prolapse, they may need surgery or something called a pessary (a non-surgical device inserted into the vagina to provide support, according to the Cleveland Clinic).

“There’s a variety of different treatments … it can be confusing to somebody who doesn’t really understand pelvic floor therapy and just thinks they just need to exercise their pelvic floor to help with the problem,” said Ascher-Walsh. “You really should discuss it with your doctor and see a specialist, then sort of approach it tailored for you,” he added.

What if you don’t have pelvic floor dysfunction? “If you’re not having any kind of symptoms, and you’re trying to just kind of maintain a healthy pelvic floor, I think it’s fine to do (exercises),” said Bonder. “But there is also a balance and doing too many of either type of exercise can also cause problems,” she added.

If you have any concerns about pelvic floor dysfunction or questions about pelvic floor therapy, talk to your doctor.

This article was originally published on TODAY.com