What is the Pelvic Floor and how do Physical Therapists Treat It?

Written by: Dr. Jessica Papa, PT, DPT


Our pelvic floor is a difficult muscle to visualize and understand, yet the role these muscles play is vital in many of our unconscious everyday activities. How can we train a muscle we can’t see and sometimes, can’t even feel? ‘I pee when I jump, I pee when I cough, I have pain during sex,’ are common red flags that you may be experiencing pelvic floor dysfunction. While these symptoms can sometimes be embarrassing and uncomfortable to discuss, through physical therapy, exercise, and education they no longer need to be part of your daily life. 

The pelvic floor muscles are the layer that support the pelvic organs, which are the bowel, bladder, and uterus in women. These muscles span the length of our ‘sit bones’, the bones most prominent when sitting on a chair. Many therapists describe this area as a muscular ‘trampoline’ that has the ability to move up and down. In women, the pelvic floor has three passages: the urethra, vagina, and anus, where its main function is assisting in keeping these cavities shut. A pretty important task if you ask me. This muscle can be trained just like a bicep or a quad muscle in order to keep these passages working efficiently. 

Certain activities can disrupt the function and resilience of the pelvic floor including pregnancy, childbirth, straining on the toilet, chronic cough, heavy lifting, high impact exercise, age, and obesity. Pelvic floor muscles are also important in the role of sexual function in both men and women. In women the pelvic floor provides voluntary contraction that enhances sexual sensation and arousal. It plays a vital role in helping women reach orgasm and making sex comfortable (that’s right, painful sex is not normal.) Did I mention the pelvic floor’s role in chronic low back pain? This muscle is integral in stabilizing the low back and supporting our lumbar spine. 

What does pelvic floor physical therapy look like? The answer to that question is going to be different for everyone. Listed below are some commonly utilized techniques that may pertain to your unique situation. 

Education: First and foremost, your session will begin with an education and understanding of your unique anatomy. Education may also entail leaning about how different habits or hygiene may effect symptoms. 

Exercise: Understanding how to contract and relax this muscle, breathing techniques, and improving flexibility.

Manual therapy: Evidence based techniques implemented by a physical therapist using massage to assist with stretching, blood circulation, and mobility. 

Biofeedback: May be used in order to help patients visualize how their muscles are working in order to enhance their ability to contract.

Electrical stimulation: Utilizes a very low current to assist in neuromuscular re-education (the messaging between the brain and the muscle) to create improved coordination between muscle contractions.

Vaginal Dilators: These are devices which can help women learn to relax their pelvic muscles under the guidance of a therapist.

In many cases, pelvic pain goes undiagnosed or misdiagnosed because doctors in the field of gynecology remain hyper-focused on the bladder, uterus, or vulva, ignoring the pelvic muscles almost entirely. A 2012 article in the Journal of Obstetric, Gynecologic & Neonatal Nursing estimated that myofascial pelvic pain in women may be the underlying cause of chronic pelvic pain in 14% to 23% of cases and up to 78% of cases of interstitial cystitis, which is a type of otherwise unexplained bladder pain. 

Find a therapist you trust in order to clearly articulate your symptoms and map out an appropriate plan of care. Physical therapy has been shown to improve patient outcomes with pelvic floor dysfunction without the use of medication, surgery, or other invasive techniques. 


Harvard Health Publishing. “Pelvic Physical Therapy: Another Potential Treatment Option. Harvard Health, 2018, www.health.harvard.edu/womens-health/pelvic-physical-therapy-another-potential-treatment-option.

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