What is Pelvic Health Physical Therapy?
Oftentimes when I tell people that I’m a pelvic health physical therapist, they look blankly at me and say, “you do what…?”
A brief history of pelvic health physical therapy
Even though pelvic health and women’s health physical therapy (PT) aren’t “new” specialties, a lot of people have no idea what we do or that we even exist! Women’s and pelvic health PT in the U.S. originally started as a response to the growing women’s health and natural childbirth movements in the 1960s and 1970s. If you want an in-depth look into the historical background of women’s and pelvic health PT in the U.S., check out A Historical Review of Organized Women's Health Physical Therapy and the APTA Pelvic Health historical timeline.
Over time, women’s health PT’s who specialize in treating the pelvic floor muscles (PFM) and abdominal and pelvic conditions have developed a more inclusive term of being called pelvic health PT’s. For example, you may have noticed my credential of being a Board-Certified Women’s Health Clinical Specialist; I consider this a misnomer, as the populations and conditions included under the umbrella of being a Board-Certified Women’s Health Clinical Specialist include those not specifically related to cis-women (cisgender meaning someone whose gender identity matches their sex assigned at birth). Populations include cis-men, pediatrics, lymphedema, and oncology conditions, among others. Even our professional organization, APTA Pelvic Health, was previously called the Section on Women’s Health, but had a name change in 2019 to be more inclusive of the populations we treat. This is why when I tell people what I do, I say “pelvic health PT” instead of “women’s health PT”, because I treat all genders and specialize in abdominal and pelvic health conditions.
What types of conditions do pelvic health PTs treat?
Conditions involving pelvic floor muscle dysfunction can be treated by a pelvic health PT. The pelvic floor muscles are a group of muscles at the bottom of the pelvis that help support the pelvic organs, stabilize the pelvis, control bowel and bladder habits, and assist with sexual function. For a quick video about the pelvic floor muscles, check out my video talking all about them!
Some of the main conditions treated by a pelvic health PT include:
Bladder and urinary dysfunction: incontinence, urgency, frequency, difficulty emptying the bladder, pain with urinating, nocturia (getting up at nighttime to urinate)
Bowel and colorectal dysfunction: incontinence (gas or stool), constipation, bowel urgency, pain with bowel movements
Pelvic organ prolapse: descent or drooping of the pelvic organs (bladder, rectum, uterus) into the pelvis
Abdominal, genital, and pelvic pain: testicular and scrotal, penile, vulvar, vaginal, clitoral, sacroiliac (SI) joint, pubic symphysis, low back, and hip and groin pain, just to name a few
Sexual dysfunction: pain with arousal, pain with initial vaginal or anal penetration, pain with external genital stimulation, leakage or pain with orgasm/climax, erectile dysfunction
Pre- and post-operative treatment: gender affirming surgery, phalloplasty, vaginoplasty, hysterectomy, pelvic reconstruction
Conditions such as: interstitial cystitis, pelvic concerns related to menopause, irritable bowel syndrome, chronic prostatitis, and pelvic symptoms related to cancer treatment, among others
This is not an all-inclusive list!
What should I expect at my first pelvic health PT visit?
Pelvic health PT involves a one-on-one relationship with a specialized pelvic health PT in a private room - not out in a gym that most people associate with physical therapy. At the initial evaluation with your pelvic health PT, a thorough discussion about your symptoms, medical and surgical history, and goals will be conducted; this is called the subjective history. This is the most important part of your first visit because it guides the PT in what their examination should include as well as consideration for potential treatment interventions. It’s not unusual to not have any physical or hands-on examination the first visit, especially if you are having complex symptoms or have a complex history that needs to be reviewed.
After the subjective history is complete, a general musculoskeletal physical examination is performed. Some components may include:
Posture
Functional movements like squatting, lifting, bending, getting in and out of bed
Strength testing
Flexibility and range of motion
Joint mobility
Balance
Sensation and reflexes
Palpation (touching) structures like muscles, scars, ligaments, tendons, and bones
Breathing mechanics
Special tests to rule in or rule out certain conditions
Once the general musculoskeletal examination is complete, a pelvic examination may be performed. Whether or not this is performed is going to be dependent on what you’re coming in for, if you have time during the first session (it may be completed the second visit), and what your comfort level is. If you’re not comfortable having a pelvic examination completed, let your PT know! We can do a lot of different treatment interventions based on the subjective history and general examination without a pelvic exam.
What does the pelvic exam include?
You will be in a private treatment room and have covering like a sheet or gown. Most pelvic exams are performed with you lying on your back with knees bent or lying on your side, however you may be asked to lie on your stomach. If a vaginal exam is to be completed, stirrups or speculums are not typically used like at the OB/GYN. Pillows or a bolster may be used to support your legs for comfort; the goal is for you to be comfortable and relaxed! You can also request for a chaperone to be in the room, whether it be another staff member, or a friend or family member if you prefer.
The pelvic examination includes both an external and an internal assessment. “Internal assessment” means a vaginal and/or rectal exam, performed with a single gloved and lubricated finger. The pelvic examination may include assessing:
Tissue health including any irritation, dryness, thinning of the tissues, or any unusual skin changes
Sensation and reflexes
Palpation of muscles, scars, ligaments, and bones (including the tailbone (coccyx))
Pelvic floor muscle functioning: strength, endurance, coordination of quick contractions - assessed internally
Pelvic organ prolapse - assessed internally
For more information about what to expect at your first pelvic health PT visit, watch my YouTube video!
What does pelvic health PT treatment involve?
Once the subjective history and physical examination are complete, now it’s time to treat! Treatment interventions are guided by findings from the examination and may include:
Education on:
Condition
Dietary considerations
Pain science
Posture
Ergonomics
Behavioral and lifestyle recommendations
Stretching and mobility exercises
Strengthening and stabilization exercises
Pelvic floor muscle exercises (kegels, reverse kegels, functional kegels)
Biofeedback (retraining the pelvic floor using special sensors)
Manual therapy to address joint and soft tissue restrictions
Electrical stimulation to help with pain, urgency, or strengthening
Balance exercises
Functional and job duty re-training
and more! It all depends on what you’re coming in for and what the examination reveals.
How do I find a pelvic health PT?
So if you’re ready to take charge of your symptoms, it’s time to find a specialized pelvic health PT! Here are some great resources to find one near you:
When you’re looking at different PT profiles, look for one of several designations that demonstrate the clinician has a high level of training:
WCS - Board-Certified Women’s Health Clinical Specialist
CAPP - Certificate of Achievement in Physical Therapy (Obstetric or Pelvic Health)
PRPC - Pelvic Rehabilitation Practitioner Certification
If they don’t have any of these designations, look into what training they’ve had; you may need to call and speak with them directly to see what training they have. They should be trained in internal examination and treatment, and have taken at least one pelvic health rehabilitation course.
So what are you waiting for? Go take care of your pelvic floor!
