Medically reviewed by Ashlie Crewe
Women’s health physical therapists evaluate and treat conditions impacting the joints, muscles, nerves and organs in the pelvis. While these conditions can occur in people of all genders, they tend to be even more common in women and people assigned female at birth. If you hesitate to share symptoms like incontinence and pelvic girdle pain with your provider, you should know these conditions are common—and treatable.
Physical therapy offers more than just hope. It offers solutions for a wide range of health concerns without the need for long-term prescription medication or surgery. Learn more about how pelvic health physical therapy helps people stay active and mobile at every age and stage of life.
A physical therapist who specializes in pelvic health has completed additional training to evaluate and treat physical conditions that affect this area of the body. They have in-depth knowledge of the unique needs and concerns of people regarding their pelvis through various stages of life, from reproductive age well into the elderly years.
In 2006, the American Physical Therapy Association (APTA) House of Delegates approved board certification for women’s health, encompassing specialty knowledge of pelvic health in folks of all genders as well as other conditions that commonly occur in people assigned female at birth.
As of June 2023, the American Board of Physical Therapy Specialties (ABPTS) has certified more than 700 women’s health physical therapists. Their goal is to help people of all ages feel, move, and function better and without pain using conservative therapies.
Physical therapists who specialize in pelvic health are qualified to assess, diagnose, and treat a wide range of musculoskeletal symptoms and conditions.
Pelvic pain occurs in the abdomen, the pelvis, or the perineum which is the area located between the rectum and the vagina or scrotum. It impacts 20% of people in the U.S., and has a wide range of causes.
Along with pelvic pain, some patients also experience aching, sharp, or stabbing pain in the hips, buttocks, public bone, or tailbone. Chronic pelvic pain syndrome is pain that lasts six months or more.
Someone with pelvic pain may find it challenging to perform routine motions like sitting, standing, and walking. Sexual activities can also be uncomfortable. Urination and bowel movements can be too urgent, too infrequent, or painful altogether.
Physical therapists treat pelvic pain associated with pelvic floor dysfunction (PFD.) The pelvic floor is a group of muscles, ligaments, tendons, and nerves that support and stabilize the pelvic area. It plays a key role in bowel control, bladder, and sexual function. PFD develops when these muscles or connective tissues weaken or become injured.
Urinary incontinence is the loss of bladder control. It can feel like a sudden, urgent need to go, or leaking of urine during coughs or sneezes. Bowel incontinence is difficulty controlling the bowels. Although these conditions are actually very common, many find them embarrassing to talk about.
Bladder and bowel issues keep too many individuals from doing the activities they enjoy as well because they are worried about having an accident. But it may be possible to reduce leakage with pelvic floor exercises. Pelvic health physical therapy involves incontinence treatment for changes associated with pregnancy and childbirth, injuries, systemic conditions, and age-related changes.
The body undergoes immense and incredible changes during pregnancy and childbirth. Physical therapists specializing in pelvic health help patients with muscle and joint problems, and pelvic pain during pregnancy.
They help patients stay active before and after childbirth with safe, approved stretching and strengthening exercises, and low-impact aerobics which are good for overall mental and physical health.
Many people experience the symptoms we’ve already touched on during pregnancy and throughout the post-partum period, including pelvic floor pain and incontinence. Physical therapists treat these symptoms to help people stay active and pain-free at every stage of pregnancy and beyond.
Painful sex, or dyspareunia, is genital pain that occurs before, during, or after intercourse, in people who have a vulva. It is a common problem, affecting up to more than one-quarter of women and people with a vulva during their lifetime.
You should never hesitate to discuss your symptoms with your providers because, left untreated, this condition can have significant negative impact on quality of life. Physical therapy helps folks achieve improved coordination of the pelvic floor muscles and improve the function of the nerve receptors to help make intercourse pain-free and enjoyable.
Your first physical therapy session begins with an initial evaluation. During this assessment, your physical therapist obtains your health history, particularly your bladder, bowel, and sexual health and goals. Next, they perform a physical exam to determine the length and strength of the external muscles of the low back, trunk, and hips.
From there, your therapist may perform a pelvic floor muscle assessment, which can be accomplished in several ways, depending on your comfort level. Options include an external assessment, a vaginal assessment, or rectal assessment.
All of these options are different in comparison to the pelvic exams that you experience during a gynecologist or urologist appointment. They are inspecting the strength, endurance, tension, and coordination of your pelvic floor muscles. Based on this evaluation, they create a custom treatment program to address your symptoms.
Therapies and treatments are customized to your unique needs and goals, but commonly include a combination of hands-on therapy, therapeutic exercise, bladder and bowel retraining, functional training, and education on lifestyle changes you can make to improve your outcome. The frequency and duration of physical therapy depends on your condition, and how you progress during treatment.
Pelvic floor therapy is one of the fundamental tools used to treat pelvic health conditions. This form of physical therapy specifically addresses pelvic girdle pain, weakness, and/or dysfunction in the pelvic floor muscles.
Pelvic floor dysfunction exercises can vary depending on your symptoms and the muscles that are affected. Some muscles will benefit from strengthening, while others need to be released and lengthened.
It’s important to note that the pelvic health conditions we have described are highly-complex. Many require treatment beyond the scope of physical therapy. Your physical therapist coordinates with your other providers to ensure you receive the appropriate treatment based on your health and wellness needs and goals.
Have you been holding back from seeking treatment for your symptoms? Help is available. Find a physical therapy clinic near you.