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

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 guest blogger: 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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64 Comments

  1. Anonymous August 5, 2013 at 1:30 pm - Reply

    Great and thorough post!
    Thank you Jessica!

    • proaxispelvicpt August 5, 2013 at 4:36 pm - Reply

      Thank you! I am so glad you enjoyed the post! – Jessica

      • Claudinei January 1, 2014 at 4:26 pm - Reply

        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

  2. tiffany August 5, 2013 at 1:31 pm - Reply

    great and thorough post!

  3. Sue Croft Physiotherapist August 5, 2013 at 4:33 pm - Reply

    Outstanding blog- says it all! Thanks for outlining the role of pelvic floor Physio /physical therapist

  4. MRPT Physical Therapy August 5, 2013 at 5:52 pm - Reply

    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!

    • proaxispelvicpt August 5, 2013 at 9:51 pm - Reply

      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?

  5. Michelle August 6, 2013 at 12:30 am - Reply

    Great Description of what Pelvic PT’s do! Thanks for having done this.

  6. Nancy Suarez, MS, PT, BCB-PMD August 6, 2013 at 8:47 am - Reply

    Great points made about pelvic floor PT’s…makes me proud to be one!

  7. Teresa Aponte, DPT August 6, 2013 at 10:53 pm - Reply

    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!

  8. Anonymous August 7, 2013 at 2:23 pm - Reply

    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.

    • Pelvic Guru August 7, 2013 at 4:02 pm - Reply

      Thank you for this comment. This should certainly be known!

    • proaxispelvicpt August 9, 2013 at 5:13 pm - Reply

      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!

    • PFPT April 8, 2014 at 12:38 am - Reply

      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.

  9. Deena Goodman, PT, WCS August 8, 2013 at 5:45 am - Reply

    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!

  10. Henryjoel August 13, 2013 at 9:37 am - Reply

    Thanks for sharing this information… I appreciate this.. keep sharing..

  11. peggy August 19, 2013 at 3:51 pm - Reply

    Does pelvic physical therapy help for pudendal neuralgia?

  12. […] 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 […]

  13. Gail Kenny Life Coach September 10, 2013 at 7:24 pm - Reply

    Pelvic physical therapy changed my life and helped me leave chronic pelvic pain behind. Thanks for educating the public about this little understood therapy.

    • Anonymous September 15, 2013 at 5:45 am - Reply

      Gail- thanks so much for sharing your success with us! That’s wonderful!

  14. […] a helpful post re physical therapists who specialize in the pelvic area. In Pilates, we are interested in how the […]

  15. teshalegaruma October 8, 2013 at 8:15 am - Reply

    its good

  16. […] 9. 10 Common Misconceptions of Pelvic Physical Therapy […]

  17. […] Misconceptions of Pelvic Physical Therapy […]

  18. […] Misconceptions of Pelvic Physical Therapy […]

  19. anonymous January 21, 2014 at 9:27 pm - Reply

    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 .

  20. Becki June 11, 2014 at 2:10 pm - Reply

    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 🙂

    • Pelvic Guru June 13, 2014 at 7:56 pm - Reply

      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).

  21. evandicken.com July 14, 2014 at 9:08 am - Reply

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    right here! Good luck for the next!

  22. Lindsey vestal September 9, 2014 at 9:36 pm - Reply

    Wonderful article! Thank you for publishing. Please don’t forget about is pelvic floor occuptional therapists! #womenshealthot

    • Pelvic Guru September 9, 2014 at 10:48 pm - Reply

      Thanks for this comment, Lindsey! Yes- Some OTs do pelvic as well 🙂

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  24. Anonymous October 27, 2014 at 1:29 am - Reply

    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?

    • Pelvic Guru October 27, 2014 at 1:47 am - Reply

      Look up Niva Herzig! If she is too far, she can also help direct you. Tell her Tracy from Pelvic Guru sent you.

  25. […] 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… […]

  26. Bridge For Pelvic Pain December 9, 2014 at 9:20 am - Reply

    These misconceptions are all too common! Thank you for this article.
    http://www.bridgeforpelvicpain.org

  27. Fae March 4, 2015 at 10:23 am - Reply

    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 ?

  28. jesspreale March 11, 2015 at 12:33 pm - Reply

    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

  29. […] 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 […]

  30. […] a helpful post re physical therapists who specialize in the pelvic area. In Pilates, we are interested in how the […]

  31. Gary Manis, Jr. August 11, 2015 at 7:20 pm - Reply

    Where’s the best doctor? for Men with this condition?? I can’t get diagnosed. And Im now having a hard tike just waking..

    • Pelvic Guru August 13, 2015 at 12:29 pm - Reply

      Depends on your specific symptoms. We can try to point you in the right direction. Also depends where you live. Send an email to info@sherpelvic.com

  32. Sara Maunsell October 3, 2015 at 7:58 pm - Reply

    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

    • Pelvic Guru October 3, 2015 at 10:17 pm - Reply

      Thank you! We hope to do so much more in the future!

  33. Diane lessard April 10, 2016 at 12:48 am - Reply

    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

    • jesspreale April 18, 2016 at 11:32 am - Reply

      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.

  34. Annette Kaja April 11, 2016 at 12:16 pm - Reply

    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?

    • Pelvic Guru April 11, 2016 at 3:31 pm - Reply

      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. 😀

  35. Julie April 18, 2016 at 5:31 pm - Reply

    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?

    • Amber April 20, 2016 at 10:21 pm - Reply

      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!

  36. Glenn J May 13, 2016 at 9:27 am - Reply

    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.

  37. Stephanie Yeager May 25, 2016 at 9:59 am - Reply

    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! 🙂

  38. Jovanna Martinez June 7, 2016 at 10:35 pm - Reply

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

  39. Rebekah June 10, 2016 at 2:46 am - Reply

    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!

  40. Aviva Diamond June 23, 2016 at 6:53 pm - Reply

    where can a find a resource for finding PTS qualified in treating this problem in my area? thanks

  41. Zequek Estrada June 24, 2016 at 8:45 pm - Reply

    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.

    • Pelvic Guru June 24, 2016 at 9:46 pm - Reply

      Great point. We see and hear many misconceptions. Spread the good word for us. 😉

  42. […] 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 […]

  43. Exercise for men over 40 November 7, 2017 at 6:46 pm - Reply

    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.

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