10 Common Misconceptions About Pelvic Physical Therapy
Have you ever heard of pelvic physical therapy before? Many have not, but this specialty can be a crucial part of someone’s complete medical care – for women, men, and even children. As one my patients recently said, “I had no idea this sort of thing exists, but I’m sure glad I found it because it has been THE missing treatment I have needed for years!”. Guest post:
10 Common Misconceptions About Pelvic Physical Therapy
I had never heard of pelvic physical therapy prior to beginning my doctoral program at Duke University. I remember very clearly when I first learned that some physical therapists did “that.” One of my fellow students had completed a small half-day observation at a local clinic, and excitedly told us all about his day watching the “Pelvic PTs.” We were blown away. We had always assumed physical therapists treated back pain, helped patients after surgery, worked with people who had strokes…but pelvic pain? Urinary incontinence? Sexual dysfunction? This was shocking and new. Not surprisingly, I was not the only person surprised to hear of this *new* specialty. Of the new patients I see, I estimate that 90% of them have never heard of pelvic PT… and in that, there are a TON of misconceptions people have about my profession. I thought it would be helpful to share a few of the top misconceptions with you today. 1. The only people needing to see a Pelvic PT are women after childbirth. The interesting thing about this one, is that of the patients I treat, only about 5-10% are post-partum women! The other 90% includes young (with our youngest being 8 years old) to old (with our oldest being 95) men and women experiencing a big variety of symptoms: urinary incontinence, difficulties in urination, bowel incontinence, constipation, abdominal pain, low back/SI pain, sexual dysfunction, pelvic pain or coccyx pain, vaginal or rectal pain, penile or testicular pain, as well as men and women prior to or after having pelvic surgery. 2. Pelvic PTs do not treat men. False. We treat many men. Now, I will admit that at our specific clinic, we see more women than men, but this is not true of every pelvic physical therapy clinic. Currently, I would estimate 20-30% of my schedule is men. The most common diagnoses we treat for men are post-prostatectomy related incontinence as well as variations of male pelvic pain—however, we also treat men with bowel dysfunction, sexually related pain, urinary dysfunction, and tailbone pain. 3. If a person is leaking urine, they definitely need kegel exercises (pelvic floor strengthening). We have discussed this in the past in other blog posts, but this really is a very common misconception I often have to fight with my patients. Urinary incontinence is a failed system, not just a failed muscle. From a musculoskeletal standpoint, a person needs a well-functioning pelvic floor muscle group, abdominal muscles, hip muscles, diaphragm, and low back muscles. People need strong, but flexible muscles that tighten when they need to and relax when they need to. If a person has a shortened, irritated pelvic floor, they may have just as much difficulty holding back urine as the person with a weak pelvic floor. It is important to trust your physical therapist to prescribe the specific exercises necessary to help YOU. 4. If a person has tried “kegel exercises” and they did not work, Pelvic PT won’t be able to help them. As a Pelvic PT, I take great offense to that… I mean, honestly, do you think I would need a doctoral degree, 100+ hours of additional continuing education, and a board specialization to teach a person Kegel exercises? That all to say, rehabilitation for the pelvis is much more involved than simply strengthening a muscle group. It involves restoring function—improving muscular support around the pelvis, improving behavioral/dietary habits, and re-training body movements to allow for optimal organ and structural function. 5. If your mother/grandmother/great-grandmother also had constipation/urinary incontinence/diarrhea/etc., then it must be genetic and can’t be helped. Also, not true! Now, I won’t say there aren’t genetic components which may cause a person to be more likely to experience certain conditions than others—but that being said, there is always something that can be done to help! It is important to work with a team of healthcare professionals including physicians, nurses, physical therapists, psychologists and nutritionists to ensure a person gets comprehensive and holistic care to achieve optimal health. 6. People can major in “physical therapy” and become a pelvic PT right after they graduate. I wish that were true—it would have saved me several years of work! Actually, the profession of physical therapy has changed significantly in the past 20 years. Currently, most practicing physical therapists have a Masters or Doctoral degree in physical therapy, and the majority of the current educational programs in physical therapy in the United States are doctoral programs. In order to specialize in pelvic PT, a person must have an advanced degree (doctoral/masters) as well as attend continuing education to gain the knowledge and clinical skills necessary to treat this complex population. This equals a total of 7 years of formal education after high school as well as significant amounts of continuing education. 7. If a person has already had surgery OR is planning to have surgery, pelvic physical therapy won’t help them. The truth is that physical therapists usually work very closely with surgeons to help patients achieve optimal recovery. Surgery will often correct an anatomical problem, but it is important to have improved muscular control and function to help a person attain optimal outcomes after surgery. Research has shown that physical therapy prior to and after surgery improves patient outcomes as well as reduces the need for future surgery. 8. A physical therapist doing vaginal or rectal exams is weird and NOT conventional. Physical therapists specialize in working with the musculoskeletal and neuromuscular systems of the body. The pelvic floor muscles run around the opening of the urethra, vagina (in women) and rectum. The only way to truly assess the pelvic floor muscles is via an examination which is performed with one gloved finger inserted into the vaginal or rectal canal. Although this may seem “untraditional” to some, there is a strong anatomical basis for the exam. Pelvic physical therapists are trained in both internal and external evaluation and treatment techniques, and current medical research supports these techniques in the treatment of this patient population. **Pelvic Guru side note- A physical therapist can assess general function of the pelvic floor by using external observation with cues and/or something called surface emg biofeedback. However, an internal assessment is the “gold standard” for fully assessing the pelvic floor if indicated. If patients are not comfortable with this, they do not have to have this type of evaluation. Some patients are reluctant at first and then choose to do this after a few visits. 9. If a person has a “medical cause” of his/her pain, physical therapy will not help. Often times, certain diagnoses can have musculoskeletal involvement. For example, if a woman has endometriosis which has caused significant pelvic pain she will often have severe trigger points, connective tissue restrictions, and muscular restrictions in all of the muscles around the pelvis as a result of that pain. In many cases, if the endometrial tissue is removed via laparoscopy, but the soft tissue restrictions remain, pain will not go away. That to say, a multidisciplinary approach to pain tends to be the best to help people achieve optimal recovery. 10. A person’s habits (eating, drinking, etc) are not related to pain, urinary or bowel dysfunction. This may seem obvious, but this thought is more common than you would think. Many people believe that if they have had certain habits for a long time, it cannot be related to the problems they are experiencing. Unfortunately, that is not the case. Often times, habits such as drinking coffee, eating fried food, exercising too vigorously, or sitting at a computer for long periods of time can strongly influence a person’s symptoms—even if the symptoms are new. It is important for your physical therapist to evaluate all of your habits to help you understand the steps you can take to improve your health. I hope this information was helpful for you today! What were some misconceptions you had about pelvic physical therapy? Let us know in the comments below! Written by guest blogger: Jessica Powley, PT, DPT, WCS Jessica is a pelvic PT in Atlanta, GA. Jessica received her doctorate from Duke University, and is one of the few board-certified specialists in Women’s Health in Atlanta. She specializes in treating patients with a variety of diagnoses including pelvic floor dysfunction, urinary dysfunction, bowel dysfunction, sexual dysfunction and pelvic pain. She is passionate about treating this population as well as advocating for patients and her profession on a local and national level. She is a member of the Section on Women’s Health, the APTA. and has served the Section on Women’s Health on the Educational Review Committee and the Functional Outcome Measures Taskforce. She is passionate about education and has given presentations both locally to physicians and community support groups. In her spare time, Jessica enjoys spending time with family and friends and staying active outdoors. Join the Pelvic Guru discussions on Facebook! If you are interested in more pelvic health education, please see our online platform, Pelvic Guru Academy for some amazing courses.
Great and thorough post!
Thank you Jessica!
Thank you! I am so glad you enjoyed the post! – Jessica
kerrie – i say, if you’re drinking any cifaefne, you might as well have a little alcohol! no really i understand and fully support waiting because beer doesn’t help the healing process, and healing is your number one goal. i’m with carol cause i bet it won’t be next summer. let us know when, so we can all raise a collective cold one for the occasion! great to see a new blog come in on the feed it’s been a long dry spell and i’m glad you’re back, and excellent to hear about the project. you’ll get in i bet
Thanks, I found this in search of information, assessment tool for readiness etc specific to PH Rehab. We are interested in looking at this. We have a much higher no show rate for these appointments than any other diagnosis and don’t want to make assumptions about why. Any leads you might have would be greatly appreciated. We are a PTD in a large HMO. Do you have this problem at your clinic?
great and thorough post!
Outstanding blog- says it all! Thanks for outlining the role of pelvic floor Physio /physical therapist
Thanks for the comment, Sue!
Well written, love the line about do you think I would need a doctorate degree to teach Kegels exercises!
Also, I would like to see many more postpartum women going for pelvic physical therapy. Do you know that all women in France go for pelvic physical therapy after each and every child they deliver… no wonder French women look so good!
Thanks for your comment! I think they actually do that in the UK too (according to a previous patient of mine). Can you imagine how great it would be if they did that in the US?
Great Description of what Pelvic PT’s do! Thanks for having done this.
Great points made about pelvic floor PT’s…makes me proud to be one!
Thank you for this. It is the best article describing pelvic PT I’ve seen. Wish I had written it myself, lol. I have shared this vis Facebook with everyone I know to help spread the word!
Thanks for this great comment!!
Well written with great points. Plan to share. I did want to point out though under #6 that you do not have to have an “advanced degree” (Master’s or Doctorate ) to specialize in this area. There are many of us with 20+ years of PT experience who still only have our Bachelor’s degree though we have hundreds of hours of advanced training and clinical experience. Agreed, however, that advanced training beyond entry level is certainly required and that any new graduate entering the field would certainly be starting with their entry level doctorate at this point. Our PT colleagues understand this, but to the non-PT professional, this could be misleading. Thanks again for your great article.
Thank you for this comment. This should certainly be known!
Thank you for commenting–that is a great point which I should have clarified. I wanted to make the point to our patients that PTs specializing in Pelvic Health typically have significant advanced training and are well-educated– definitely did not mean to offend! I have so much respect for the more experienced PTs! Thanks again for your thoughts!
I was just looking through the comments to see if anyone else had a concern about this. I have 20+ years as a PT. The last 10 specifically in women’s health. I work with many new grad DPTs and am sick of the “I’m better than you” mentality that many of the new grads have. I had another PT in our city go out and tell physicians that they should send their patients to her as she had her DPT and that I did not.. She hasn’t even gone to a pelvic floor course!!!!!!!! Thank you for replying to this. I really enjoyed the article and appreciate the response from the author regarding Anonymous’s comment.
Much enjoyed, and since we all hear these misconceptions repeated over and over….let’s say amen to getting rid of them for good…may your article live on!
Thanks for the “amen” Deena!!
Thanks for sharing this information… I appreciate this.. keep sharing..
Does pelvic physical therapy help for pudendal neuralgia?
Peggy- We can absolutely work with patients with pudendal neuralgia. You can find a skilled therapist near you via: http://www.womenshealthapta.org/find-a-physical-therapist/index.cfm OR http://hermanwallace.com/practitioner-directory. If you have any other specific questions, feel free to shoot me an e-mail: email@example.com!
[…] you can certainly try this guide on your own. However, I suggest working with a highly skilled pelvic physical therapist who can guide you through this process and evaluate and treat you with complete program of care to […]
Pelvic physical therapy changed my life and helped me leave chronic pelvic pain behind. Thanks for educating the public about this little understood therapy.
Gail- thanks so much for sharing your success with us! That’s wonderful!
[…] a helpful post re physical therapists who specialize in the pelvic area. In Pilates, we are interested in how the […]
[…] 9. 10 Common Misconceptions of Pelvic Physical Therapy […]
[…] Misconceptions of Pelvic Physical Therapy […]
[…] Misconceptions of Pelvic Physical Therapy […]
I am having great success with pelvic floor pt, I cannot say enough great things about pfpt.,its about time people took their head out of the sand and said yes., its not in your head., its in your pelvic and there a lot of professional people out in the field to help get you back on track to good health. I am a believer. thanks to my pt specialist .
Thank you for this article! I have endometriosis and have just gotten a referral to try pelvic floor therapy. When I asked my doctor about getting a referral to see if this could help with my issues, even she said “oh have you tried kegels? That’s what they do”. I told her I had read that there was much more to it and she looked at me like I was crazy. I’m now waiting for my call from the PFT office 🙂
Becki!! I’m so glad you read all about it. Make sure that you find a pelvic PT who understands pelvic pain (and does not just treat incontinence).
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right here! Good luck for the next!
Wonderful article! Thank you for publishing. Please don’t forget about is pelvic floor occuptional therapists! #womenshealthot
Thanks for this comment, Lindsey! Yes- Some OTs do pelvic as well 🙂
I must thank you for the efforts you have put in penning this website.
I really hope to view the same high-grade content from you in the future as well.
In fact, your creative writing abilities has inspired me to
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A very intersting read. I have suffered from pelvic pain for 5 years. It’s at its worst when I sit. Do you have any pelvic floor therapist you could recommend in NJ?
Look up Niva Herzig! If she is too far, she can also help direct you. Tell her Tracy from Pelvic Guru sent you.
[…] The pelvic floor muscle group, just like any muscle, must be strong as well as have the ability to fully relax. Not all pelvic floor rehabilitation involves strengthening or ‘Kegel’ exercises. If your pelvic floor isn’t functioning correctly, don’t just assume it is weak — it may be due to weakness or it may be due to tightness. As well, if your muscles are weak and in need strengthening, are you sure you are doing the exercises correctly? That’s where the expertise of a pelvic floor physiotherapist come in. I’d like to pass on the great blog regarding ’10 Misconceptions Regarding Pelvic Floor Physical Therapy’. Don’t be shy…have a peek… […]
These misconceptions are all too common! Thank you for this article.
Thank you for the above . I just have a question I know and understand that there are other core exercises for women with endometriosis and just wanted to enquire do kegel exercises help in women with endo ?
Jessica here (the author), thanks for commenting! In terms of exercises, I actually wrote a blog post on exercising with pelvic pain a few months ago– you can check it out here: http://jessicarealept.com/2015/01/21/taking-the-first-step-getting-moving-when-experiencing-chronic-pain/ At the end of the post I have several links for other great posts on exercising with pelvic pain.
In terms of kegel exercises, you have to be a little careful with that. Many women with endometriosis actually have tender pelvic floor muscles. Traditional “kegel” exercises tend to make pelvic pain worse and create more tenderness in the pelvic floor muscles. Rather than that, we actually recommend learning to relax the pelvic floor muscles and doing something called pelvic floor drops (basically using your breathing to help to drop and relax the pelvic floor). I discuss the relationship between breath and the pelvic floor in another blog post: http://jessicarealept.com/2015/03/04/6-reasons-why-the-diaphragm-may-be-the-coolest-muscle-in-the-body/
Hope that helps! If you have not done so, women with endometriosis often benefit from working with a skilled pelvic PT! May be worth looking into!
[…] pelvicguru.com. I first wrote for Pelvic Guru in 2013 with 10 common misconceptions of pelvic PT (https://pelvicguru.com/2013/08/05/10-common-misconceptions-about-pelvic-physical-therapy/), and today, I am being featured again with this post on sleep and chronic pelvic pain. I hope you […]
[…] a helpful post re physical therapists who specialize in the pelvic area. In Pilates, we are interested in how the […]
Where’s the best doctor? for Men with this condition?? I can’t get diagnosed. And Im now having a hard tike just waking..
Depends on your specific symptoms. We can try to point you in the right direction. Also depends where you live. Send an email to firstname.lastname@example.org
Congratulations Pelvic Guru! This is a great resource for Therapists and Patients alike!
Sara Maunsell, Women’s Health Physiotherapist from ‘Femme Physiotherapy’ , Milford, Auckland, New Zealand
Thank you! We hope to do so much more in the future!
I’ve been struggling w red, raw, jolts of pain in my vagina for over 5 yrs. I haven’t had sex in 10, now divorced. I get perineal nerve blocks, Botox. Doc just game me Estrace and also last week tried vagifem but both burned so bad plus I have IC w ulcers, so seemed to kill bladder. Do you have any suggestions? I’m desperate. I have a 10 yr old boy who’s crying bc his mommy isn’t that mobile.
Thank you so much!
Hi Diane, I’m so sorry you’re hurting so much! It’s hard to give you a specific recommendation without evaluating you, but I would recommend seeing a gynecologist with a background in vulvar pain, and specifically vulvar dermatology so you can rule out possible contributors to your problem. If you’re not seeing a pelvic physical therapist yet, I would also recommend finding a skilled one near you who is educated in vulvar pain to help you with the musculoskeletal aspects of your pain. I hope that helps! Wish you all the best, Jessica.
Sounds promising!!! Do I have to see an MD first and have a script/referral to see the PFPT or can I just go right to see the PFPT?
In almost all states now you can have direct access to see a PT for at least one visit first (if not more). Call the clinic and ask. ?
Hi Jessica! Thank you for all this information. I have been doing a lot of research and I have stopped doing kegels for now because I think that may not be the answer. I think I would really like to look into the physical therapy. But I live in Kansas city Mo. Do you have any recommendations to how I find a provider like yourself but a little closer to home?
Julie- There are pelvic floor therapists in KC at St.Lukes on the Plaza and Truman for sure…maybe other in the KC area as well. Good luck!
I curious if this technique is something I can learn so I can treat my wife ? I’m kinda of a DYI person. Your thoughts, thank you Dr.
Thanks for this post, Jessica! And for busting some myths surrounding pelvic floor PT. I wasn’t aware of it either until I happened upon it when trying to heal my own pelvic pain. Such a game changer for me! 🙂
What an amazing and encouraging list of information. Jessica thank you so much for your passion and dedication to this field.
I broke my tailbone twice over twenty years ago and have been dealing with the pain and as of recently been seeing a pain management specialist who did 2 different ganglion impar block injections into my tailbone and it did nothing to help with the pain. He is now sending me to a Pelvic Floor Therapist but has told me nothing about what it is that he thinks it is that they will be able to do help with my pain. The pain is at the very tip of my coccxy and I am unable to sit up normal or even sit for any extended amount of time without pain. If you could shed some insight on what it is that they might be able to do to help me with this type of therapy I’d truly appreciate it. Thanks so much!
where can a find a resource for finding PTS qualified in treating this problem in my area? thanks
Our site 🙂 https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/
Sometimes I wonder where all these misconceptions for pelvic physiotherapy originate. I was shocked to learn that it’s actually common for people to believe that a person’s habits are not related to pain, urinary or bowel dysfunction. Overall it was pretty educational on what pelvic PT could do for a person.
Great point. We see and hear many misconceptions. Spread the good word for us. ?
[…] The two most common types of pelvic floor dysfunction that affects the muscles are hypertonic and hypotonic tension. There can also be combinations of muscles that are too tense and too relaxed, which can cause similar symptoms to hyper/hypo tonic pelvic floor muscles at the same time. Hypertonic muscles are when the muscles have too much tension, which often causes pelvic pain, urgency and frequency of the bladder and bowels. Hypertonic tension of the pelvic floor may make it difficult to have sex because the muscles can become so tight, that it makes it difficult for the vagina to be penetrated. A hypertonic pelvic floor can also create difficulty achieving orgasms by prohibiting the muscles from being able to contract (fun fact: when your body jerks during an orgasm, that’s due to muscle contractions, but if the muscles are already contracted due to hypertonic pelvic floor dysfunction, you may not feel as intense of an orgasm). Hypotonic muscles are when the muscles are low-tone and weaker, which can contribute to stress incontinence and pelvic organ prolapse. This is when the organs collapse from the location in the body where they should be. Hypotonic tension of the pelvic floor makes it difficult to achieve an orgasm because the muscles are so lose that penetration may not feel very present. Although the Squatty Potty is not sold as a health solution for pelvic floor dysfunction, the positioning of your body when you squat with help from the Squatty Potty, as opposed to sitting on the toilet without one, can help you relax the muscles of your pelvic floor allowing for an easier pain-free excretion and relief in your pelvic floor. If you’re wondering if your pelvic floor is hypertonic or hypotonic, you can always go for a pelvic floor physical therapy assessment at a physical therapy center near you. The Squatty Potty may have been made to relieve bowel discomfort, but who knew it was a sex device that is capable of relieving painful intercourse, sexual dysfunction, and allow for successful results from hole to hole. Related Articles: 10 Misconceptions About Pelvic Floor Physical Therapy […]
insightful article. Healthy living is a topic I take seriously. I am following a great workout for 40 year old man and older with great results. I hope your readers find it interesting.
Thank you Jesca for interesting and descriptive information about pelvic floor physiotherapist am also physiotherapist from Tanzania even we can share about experience and skills about treatment.
Thank you for the post on the 10 misconceptions about pelvic physical therapy. It’s interesting that the percentage of people who do Pelvic PT is in fact not women who have just gone through childbirth. I would have thought that would be the highest percentage but it makes sense that anyone with any sort of pelvic area issue could use Pelvic PT. Thank you for the information I will have to look into this further.
Interesting article although I have been referred to an PT for cystocele. Do you have experience or suggestions to offer regarding correcting this condition without surgery?
Yes – it depends on the prolapse grade and your symptoms. Typically if the grade is a 3 or 4 AND you find that your symptoms are having a dramatic effect on your everyday life, a surgical consult is recommended (but therapy may still be helpful). MOST people don’t need surgery and benefit from conservative approaches such as pelvic physical therapy for cystocele. Many women have cystoceles (bladder prolapse) after delivering babies (or other reasons too) and there’s a lot of help for managing this. Smaller prolapses (grades 1-2) sometimes improve, but the higher grade prolapses, are more difficult to “correct.” Check out an organization called APOPS as well.
Thank you for all this great information! I’ve been putting this off for about a year now! I guess it’s time to move on.
so having endometriosis, 5 back surgeries, joint replaced knees, both hips replaced, neck fusion, 12 abdominal surgeries, colon resection, all this and more and laying down while they do vaginal touch, does tthis hurt all over the whole area, no thank you, just does not work. simple all they are doing is masterbating the patient, does not work, and in can not believe they the physical therapist does vaginal manipulations on a child. Womens Health is a GYN doctor simply
Thank you so much for this article! My pain management doctor has recommended pelvic PT for my pelvic pain and I was terrified to try it! Thank you for dispelling my myths/misunderstandings and helping me see that PT work could be very beneficial for me.
Thanks for the post Jessica. This was very informative. My question is regarding pelvic pain during pregnancy. Is pelvic PT helpful in this case or do I have to just suffer through it until I have my baby? Thanks in advance for your help!
Thank you so much for this post! I have my appointment scheduled for today, I have rescheduled twice because of nerves already. This made me feel better about going. I am 10 weeks postpartum, my tailbone broke during labor, I have a long history of endometriosis, painful intercourse, bladder issues, and now lack of muscles down below. I can’t do kegels, my muscles just dont work there. I really need this but was so scared. Thank you!
Thanks so much for this post. I have an appointment scheduled with a pelvic PT. I have rescheduled this appointment twice already because I was not sure what exactly the visit would entail. However, I know I definitely need to attend the next appointment. I leak urine and need help desperately. Your post helped me to resolve to go once and for all. Thanks so much.
Thank you, Jessica! My pelvic PT sessions have saved me from a lifetime of chronic sexual pain! So glad I discovered this and was able to pinpoint a therapist within 45 min of me.
Amazing, concise and accurate blog on pelvic floor PT! As a newer PF therapist, I couldn’t agree with these statements more. Love seeing these and knowing there is a growing field out there to help patients understand,break the stigma, and push through the taboo of feeling ashamed or uncomfortable when talking about this topic. Thanks for a great read
The insights about pelvic physical therapy help sort out a lot of queries. It definitely covers all the points of pelvic health physical therapy.