What Is Pelvic Floor Therapy?

During my first pregnancy, I was rushed into an emergency cesarean section because my daughter became trapped inside my birth canal after 45 minutes of pushing. My OB-GYN sarcastically refers to it as “the best of both worlds,” because I got to labor until she was crowning before being rushed into surgery.

My pelvic floor doesn’t see it that way. As an added bonus to the physical trauma that I endured, the night after I gave birth, the swaddle my newborn daughter was tightly wrapped in loosened and covered up her face. She was crying—screaming, actually—but my sleep apnea-afflicted partner snoozed away. I thanked my lifelong ability to wake at the sound of a pin drop for helping me snap to consciousness in that moment. Before I could remember that I had a fresh 14-inch long incision across my waistline, I lurched forward to aid my newborn.

Days later, I woke up covered in blood with a split c-section incision. My mom puked at the sight of my partner cleaning up the wound. That’s when I realized I had retraumatized the location when I adjusted my daughter’s swaddle. After a 6 a.m. ambulance to the emergency room, a return trip to the ER a week later due to more bleeding, a subsequent infection, drainage appointments, and two weeks of motherhood, I finally began the journey to physical healing. For more than six years after, though, I suffered from incontinence.

Since giving birth, laughing, sneezing, coughing, jumping on the trampoline with my children, or even screaming along to my favorite song in the car has left me leaking. Sex with my husband was often so painful that we had to stop. When these issues began, I had not yet begun my sexual and reproductive health graduate course and did not know that a c-section could cause a pelvic floor injury.

I thought pelvic floor dysfunction only happened to those who gave birth vaginally. I was wrong.

I know now that pelvic floor therapy, which involves working with a physical therapist to perform exercises like Kegels, squats, and stretching, and using other techniques like hands-on massaging and vaginal dilation, could have helped me with this issue long ago.

The problem did not get better as time went on but in fact, got worse. Over the course of a few months, a childfree friend of mine urged me to tell my OB-GYN that I was struggling with pelvic issues—and to use the information I had gleaned from my graduate training to help me advocate for myself. My OB-GYN happily obliged without a second thought. With private medical insurance backing me, I was ready to get my pelvic floor right.

The first session with a pelvic floor therapist can be the most intimidating. It consists of analyzing the pelvic floor’s response to various stimuli to create a treatment plan. There are “homework” exercises to do outside of therapy sessions, too, like those Kegels and stretches.

I was shocked when, only after the first week, my urgency to urinate decreased from an average of 12 (yes, 12) times in a 24-hour period to an average of nine in the same timespan. (People typically urinate six to seven times in 24 hours, on average.) As an added bonus, for the first time since those witching hours with a newborn seven years ago, I slept for more than six hours without waking up with the urgent need to go.

I was hooked on this therapy that I had previously been so misinformed about, even though I’ve spent nearly a decade researching and advocating for sexual health. Equipped with my personal experience, I spoke with Ruth Macy, a pelvic health physical therapist and co-author of Your Postpartum Body, to clear up some common myths and misconceptions about pelvic floor therapy for others who may be in a similar position.

Is pelvic floor therapy only helpful for postpartum people who had a vaginal birth?

Pelvic floor therapy is helpful for anyone who is pre- or postpartum—and for people who haven’t given birth, too. Pelvic floor therapists can help those with concerns about their bladder health, bowel health, pain or changes in sexual function, gynecological or urological cancers, and bowel cancer. People in gender transition also may need pelvic floor therapy, Macy said.

Is pelvic floor therapy traumatizing?

While pelvic floor therapy can be difficult for survivors of sexual abuse or those who have suffered labor and postpartum injury, history of trauma typically comes up during the consents done at the initial intake session. Patients can opt out of having internal vaginal exams, for example. Oftentimes, my therapist would check my pain as we were completing exercises and always asked my consent before trying anything new. Pelvic floor therapists are trained to treat their patients with care and respect and affirm consent throughout treatment. Macy also told RNG that providers should honor patient autonomy and have “safeguards for stopping a treatment if the patient becomes unresponsive or appears to be fawning to ‘get through it.’”

Is pelvic floor therapy based in science?

Pelvic floor therapy has been used since the days of ancient Greece, and the field has come a long way even since the mid-1900s. Pelvic health care is one of the fastest growing areas of clinical research, and has a strong and growing body of evidence behind it.

In the 1940s, “Margaret Morris [a ballet dancer and choreographer] and Minnie Randell [her mentor and a midwife/physiotherapist] identified that pelvic floor strengthening helped reduce leakage in dancers,” Macy said. “There have been many decades of ‘how to influence the pelvic floor’ since that time.”

Macy added pelvic floor therapists can receive board certification through the American Physical Therapy Association, but it’s not required to practice.

Are women the only people who can benefit from pelvic floor therapy?

Nope! Children and men may find pelvic floor therapy helpful if they are struggling with pelvic floor or related problems. Macy says men most often seek pelvic floor therapy for incontinence after radical prostatectomy. But men could also benefit if they are struggling with sexual dysfunction, any disruption related to the prostate, and testicle pain.

In children, pelvic floor therapy is often recommended when there is bedwetting, urgency, daytime incontinence, or constipation. The difference for children is that they do not receive internal exams. Therapy consists of either behavior modification and/or exercise.

Is pelvic floor therapy only helpful for pelvic floor issues?

One of the biggest misconceptions fails to consider the ways that the pelvic floor is linked to other parts of the body.

“The pelvic floor is a tattle tale, as it reports to different parts of your nervous system,” Macy said. “It will be dysfunctional before other muscular systems. It should be considered in [unmanageable] back, pelvic, sacroiliac joint, and hip pain that is not responding to conventional treatments. It can help with any deficit in walking, transfers, running, and more. It functions as a part of many systems, so I see it involved in a lot of musculoskeletal problems.”

For me, the benefits of pelvic floor therapy were immense. They helped my quality of living, my posture, my sleep, and my sex life. The myths are just that—myths.

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