What is pelvic rehabilitation?

The pelvis is the bony structure between the legs and spine. The pelvic floor is the group of muscles that form the bottom of the pelvis. A ligament is a strong band of tissue that holds your joints together or the place where two bones meet.

The pelvic floor muscles: 

• Support the organs in the pelvis
• Help the body to start and stop urine and bowel movements
• Are used during sex 
• Help with posture support and ligament stability 

Problems in this part of the body are called pelvic disorders or pelvic floor disorders. Pelvic rehabilitation can help you with problems in this part of the body. 

How we help

We can help you with many pelvic problems, including: 

• Urinary incontinence — the involuntary leakage of urine when you cough, sneeze, laugh or move
• Urgency or frequency of urination — when you have an abnormal urge to urinate (pass urine) and you have to urinate more than eight times in a day
• Pelvic organ prolapse — when an organ in the body moves out of place
• Chronic or long-term pelvic pain — pain in the stomach area or pelvis that has lasted more than three months and isn’t due to disease or problems like difficult or painful sexual intercourse, menstrual cramps or endometriosis (when the lining of the uterus or womb grows outside of the uterus)
• Pregnancy-related pain or dysfunction — involves problems like diastasis recti (separation of the abdominal wall during or following pregnancy), pelvic floor injury or weakness following childbirth and low back or pelvic pain during or after pregnancy

What to expect at your appointment

A physical therapy pelvic floor appointment consists of us getting your medical history and doing a physical exam. We get your history so we can understand the problems you're having as well as what may be causing it. 

You should expect to talk about the history and contributing factors to your current problem with your physical therapist prior to the physical therapy pelvic floor exam. 

We will talk to you about your history with: 

• Any pregnancies
• Childbirth
• Trauma to the pelvis
• Injuries to the trunk or low back

The physical exam consists of a visual inspection of the pelvic area of your body. We'll look at how well you can move the muscles of the pelvic floor. We'll also do external and internal palpation of the muscles of the pelvic floor.

The purpose of the exam is to find out the strength of your pelvic floor muscles. We'll also be looking for signs of pelvic organ prolapse. There is no imaging or testing required for the physical therapy pelvic floor appointment. 

You should also expect to learn pelvic floor exercises that you will do on your own outside of physical therapy to improve your muscle strength. 

We'll ask you to have routine care with your primary care provider (PCP). This may include an annual physical and Pap test.

How we help build pelvic muscle strength 

Your care may include:

• Retraining pelvic floor muscles with core and pelvic floor exercises, such as Kegel exercises
• Electrical stimulation to strengthen weak muscles 
• Helpful exercises
• Patient education on self-management at home 

How to care for pelvic floor problems 

Pelvic floor physical therapy appointments are usually scheduled every one or two weeks and take about an hour. As your muscles get stronger, you won't need to come in as often. Patients are usually seen for six visits, but this depends on your care needs.

Once your symptoms are better, we typically do a phone or in-person follow up after one month. We usually ask you to keep doing the home exercises on your own.

If you keep doing the home exercises on your own, your muscles will stay strong, and you'll lessen the chances of your problems starting again.

When to think about physical therapy

Talk to your PCP if you think we can help with your physical therapy pelvic rehabilitation. Contact your insurance company to see if you need a referral for physical therapy.

By Kathryn Dove PT, DPT, Cert. MDT