Kegels Don’t Fix Everything — 6 Surprising Facts About Pelvic Floor Therapy

Woman standing uncomfortably due to weak pelvic floor

People say you don't know what you've got until it's gone. They're usually talking about love and money. But for many women, especially if you've given birth, the saying may also apply to your pelvic floor. Here's why.

Your pelvic floor has important jobs — it supports your abdominal organs, helps you go to the bathroom (or hold it in) and allows for pain-free sexual intercourse. When everything works as it should, you probably don't give it a second thought.

But if your pelvic floor is dysfunctional (yes, that's a thing) or the muscles are weak, you'll suddenly be very aware of it. It could mean less control of your bladder (urinary incontinence), painful sexual intercourse or pelvic organs that slip down into your vagina (pelvic organ prolapse).

The good news is that pelvic floor therapy, a form of physical therapy, may be able to help. Kegel exercises — an exercise commonly done to strengthen the pelvic floor muscles — are just the tip of the iceberg. Here are six important facts you should know about pelvic floor therapy:

1. Pelvic Floor Dysfunction Is Common, but You Don't Have to Live With It

Pelvic floor muscles can often be affected by childbirth, medical treatments or certain types of surgery — so it's not uncommon for things to go awry. One out of four women reports having a pelvic floor disorder in her lifetime. But even if you don't want to broadcast the wear and tear you've got down there, you don't have to suffer in silence or accept a pelvic issue as your new normal.

In fact, it's because pelvic floor disorders are so common that treatments — both surgical and nonsurgical — exist. You just have to ask for help. It may be time to see a doctor about your pelvic problems if you've experienced chronic pain for more than three months or problems with urination, bowel movements or painful sexual intercourse.

2. Pelvic Floor Therapy Isn't Just for Female Incontinence

Physical therapy for your pelvic floor can help stop the little leaks that happen when you jump, sneeze or cough. But it can also help with other issues related to your pelvic floor, including:

  • Fecal incontinence, or inability to control your bowels.
  • Hypertonic pelvic floor disorders, when muscles are overactive, contracting and tensing when they should relax (often causing pain or difficulty during sexual intercourse).
  • Overactive bladder, or a frequent urgency to urinate.
  • Pelvic girdle pain and pelvic floor dysfunction happening in pregnancy (peripartum), after childbirth (postpartum) or abdominal surgery.
  • Pelvic organ prolapse (POP), when pelvic organs drop lower in the pelvis and create a bulge in the vagina.

Therapy regimens and treatment plans can differ, but a typical pelvic therapy session takes about 45 minutes. Your therapist will customize a plan of care based on your symptoms, and you'll also be expected to complete exercises at home between sessions. Depending on the severity of your pelvic floor issue, your physical therapy may last a few weeks or continue for several months.

3. Pelvic Floor Therapy Isn't Just for Women

Men can also experience pelvic floor dysfunction. In fact, 4.5% of men in the U.S. over the age of 20 experience urinary incontinence. What's more, chronic pelvic pain is the most common urologic disease in men below the age of 50. The good news is, like women, men can benefit from pelvic floor therapy for a variety of issues, including pain and leakage (common after surgery), groin injury and prostate conditions.

4. Preventative Pelvic Floor Therapy Can Stop Issues Before They Occur

Pregnancy and childbirth (both cesarean and vaginal delivery) can wreak havoc on your pelvic floor. That being said, strengthening your pelvic floor muscles before and after giving birth can help prevent the lasting issues caused by delivery. It's especially helpful in preventing urinary incontinence. And having strong pelvic floor muscles can also help ward off preterm labor and shorten the second stage of labor (pushing and giving birth).

5. Kegel Exercises Aren't the Solution for Everything

Most women are told at one point or another to "do your Kegels" — the magic exercise that involves contracting and relaxing your pelvic floor muscles to strengthen them. But when it comes to pelvic floor issues, don't just assume that Kegels are the answer. If your pelvic issue is caused by muscle spasms or scarring, Kegels might actually make your condition worse.

Before trying to DIY your pelvic floor rehabilitation, make sure to see an expert who can educate you about pelvic function, diagnose the issue and suggest treatment. Common pelvic floor physical therapy interventions include:

  • Manual therapy, including hands-on mobilization and stretching
  • Biofeedback, which uses technology to show how movements affect pelvic floor muscles and coordination
  • Exercise plans, which may include specific exercises and Kegels, to teach women how to strengthen their pelvic floor
  • Vaginal dilation and desensitization, which helps patients lengthen tight tissue and learn to relax the pelvic muscles

6. Pelvic Floor Therapists Have Extensive Training

Pelvic floor therapists are uniquely trained to assess the muscles, tissues and nerves in your pelvic region and apply nonsurgical methods to correct your issue. They're licensed by the American Physical Therapy Association and typically have either a Certificate of Achievement in Pelvic Physical Therapy (CAPP) or are certified as a pelvic health specialist (PHC). Their extensive training means they can offer services beyond exercise suggestions, including:

  • Internal pelvic floor muscle examination using just a gloved finger to check for spasms and prolapse while assessing pelvic floor muscles for tone, elasticity, pain and tenderness
  • External examination of your joints and muscles that surround or attach to the pelvis
  • Education about pelvic floor function

If you're experiencing pelvic floor issues, know that you're not alone. It's more common than people think, and the good news is there are specialists and therapies that can help.


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