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!”.

Recently, my friend and colleague, Jessica Powley, DPT, WCS, wrote this excellent blog article for her Proaxis Physical Therapy Clinic blog.  Jessica is committed to promoting the specialty area of pelvic physical therapy. She wants to spread the word about what we do and agreed to share the post here for a larger audience. Thank you, Jessica!

10 Common Misconceptions About Pelvic Physical Therapy

Pelvic Floor Anatomy PT

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, sexual 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: Jessica Powley, PT, DPT, WCS

Headshot

Jessica is a Pelvic Physical Therapist at One on One Physical Therapy 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.

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PG blog email: pelvicguru1@gmail.com

79 thoughts on “10 Common Misconceptions About Pelvic Physical Therapy

  1. 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!

  2. 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!

  3. 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 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.

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  8. 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 .

  9. 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 🙂

  10. I like the valuable information you provide in your articles.

    I will bookmark your weblog and check again here regularly.
    I am quite sure I will learn many new stuff
    right here! Good luck for the next!

  11. 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?

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  13. 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 ?

  14. Hi Fae!

    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!

    Kind regards,

    Jessica

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  17. 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

  18. Hi Jessica,

    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!
    Diane

    • 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.

  19. 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?

  20. 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!

  21. 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.

  22. 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! 🙂

  23. What an amazing and encouraging list of information. Jessica thank you so much for your passion and dedication to this field.

  24. 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!

  25. 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.

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  27. I am going to go see a pelvic pain therapist on Tuesday. To tell the truth I’m a little nervous. I was sexually abused as a child and have not told many the details, should I tell them.?

    • If you feel it would help the therapist to know your background and decrease your anxieties, the therapist will welcome that info and treat you kindly. However, you do not have to share it immediately. You can also wait for a time when it feels better for you (and/or relevant), if ever. I try to honor my patients with what they are most comfortable with. It does help to know that information when possible. Congrats on taking this step!!

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  32. Not to be dramatic, but my pelvic floor therapist “saved my life” in a way. After 3 c-sections, I was so riddled with scar tissue, I spent months with a urogist trying to sort out why i had raging UTIs without the infection…apparently all the scar fissure was pulling on my ureatha, and the pain was ungodly. She broke through the old scar tissue, and I can function again….and relief…. the pain was so bad before, I truly wondered how I could function, and I missed so many things…. I love my PT!!!

  33. Thank you for the well written and informative post. Do you find you see many people for pelvic floor problems related to prostate or gynecological cancer treatment?

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