Pelvic Floor Physical Therapy: Why Kegel Exercises Aren’t Everything

When you Google “pelvic floor exercises” you’ll likely come across a dozen articles recommending Kegel exercises. While Kegel exercises serve a purpose in strengthening and tightening the muscles down-there, they are not meant to be a cure-all. The truth is there’s a lot more to the science of pelvic floor health that isn’t as often discussed.

In fact, there are a host of pelvic floor disorders that can benefit from a more personalized approach through pelvic floor physical therapy. Before we dive into how this type of physical therapy works, let’s learn a little more about the conditions it can treat.

Common Pelvic Floor Disorders

For context, the pelvic floor refers to a band of muscles that run between the pubic bone and the tailbone – including the uterus, bladder, and bowel. These are important muscles that we use when we go to the bathroom, have sex, and when we give birth.

When these muscles become weakened or put under stress, it can lead to pelvic floor disorders. These disorders are incredibly common and can impact women across their lifespan before childbirth, after childbirth, and during or after menopause. There are a host of pelvic floor disorders, but we’ll just hit on the most common ones here:

Vaginismus:
- Vaginismus is characterized by muscle spasms that can make penetration through sex, a gynecological exam, or even inserting a tampon incredibly painful. This disorder is common in younger women and may be due to previous sexual abuse, a past painful intercourse experience, or other emotional factors.
Stress urinary incontinence:
- Stress urinary incontinence means you leak urine during basic physical activities like laughing, coughing, and sneezing. This type of incontinence is caused by weakened pelvic muscles, which can happen after pregnancy and childbirth or due to natural aging after menopause.
Fecal incontinence:
- Like urinary incontinence, fecal incontinence is an inability to control your bowel movements. This is typically also caused by nerve damage to the area either due to pregnancy and childbirth or aging.
Pelvic organ prolapse:
- Pelvic organ prolapse occurs when any of the pelvic floor organs (the uterus, bladder, bowel) begin to droop below the vagina. This is caused by increased pressure in the abdomen, most commonly during pregnancy, labor, and childbirth.

While these conditions are all common, it’s important not to brush off your symptoms as “normal” and stay suffering in silence. If you’re experiencing any of these symptoms, pelvic floor physical therapy may be able to help ease your discomfort or pain. So, how exactly does it work?

How Pelvic Floor Physical Therapy Works

Unlike the typical physical therapy session, you might imagine in a gym setting, pelvic floor physical therapy is performed in an intimate, private, and calming room. An appointment typically lasts an hour during which your provider will provide a thorough consultation and examination to better understand your concerns and help develop a plan to meet your specific needs.

First, your physical therapist will begin by providing education on how your pelvic floor works, and how to use these muscles correctly.

Then, they will take an assessment of both your psychological and physical health. In many cases, stress or emotional trauma may be a contributing factor to pelvic pain. Just like when we tense our neck and shoulders, it’s common to tense our pelvic floor muscles when we’re stressed. Therefore, ensuring a sound mind-body connection is incredibly important when it comes to treating pelvic floor disorders.

Next, your therapist will conduct a musculoskeletal exam to check your posture and coordination of your external muscles and joints.

Finally, if you’re comfortable and provide your consent, your provider will perform an internal vaginal exam to identify any trigger points. Your provider will also assess how these muscles are working in tandem with the rest of your body. Pelvic floor therapy isn’t just about strength—it’s also about coordination. Therefore, it’s important for your provider to assess how your diaphragm, abs, and pelvic floor are working together.

After your session, your physical therapist will equip you with a set of simple, functional exercises for you to do at-home. This could include something as simple as holding a squat while you brush your teeth or deep breathing exercises to relax the muscles and release tension before sex. Whether you realize it or not, your pelvic floor muscles are always working so it’s easy to incorporate the exercises into your daily routine.

When Should I Seek out Pelvic Floor Physical Therapy?

Pelvic floor physical therapy is often the first step in the process of treating common pelvic floor disorders. It can potentially treat your condition without the need for surgical intervention.

Again, we’ve only hit on a few of the most common pelvic floor disorders here. But, if you are experiencing any of the following symptoms, you should consult with your healthcare provider to determine if pelvic floor physical therapy is right for you:

Pain during sex, vaginal exams, or when using a tampon
Painful bowel movements or urination
Urine leakage when coughing, sneezing or laughing
Prolapse of the pelvic floor organs
A frequent urge to urinate
Hip pain or other orthopedic issues
Chronic lower abdominal pain

Many pelvic floor physical therapists will also recommend treatment for new moms during the postpartum phase as it can help with healing after labor.

If your pelvic floor symptoms are painful, bothersome, and getting in the way of you enjoying your life, pelvic floor physical therapy may be able to help!