Ladies: Should You See a Pelvic Therapist?

Leaky bladder? Painful sex? Chronic constipation? These are all signs you may need a pelvic floor therapist.

doctor patient discussion

Medically reviewed in March 2022

Few things are as embarrassing as leaking urine in public. But for many, it’s unfortunately common. Many women know the struggle—a cough or a sneeze leads to a temporary loss of bladder control. Aside from wearing daily pantyliners or seeking out medical or surgical treatments, what can you do to avoid this awkward situation?

Pelvic therapy has grown in popularity in the last few years. It’s a way to treat various forms of pelvic floor disorders that can lead to incontinence and other problems like pain with sex or constipation. Deborah Weber, MPT, a Honolulu-based physical therapist, sheds some light on this form of therapy.

Who might benefit from pelvic therapy
Pelvic therapy is a form of physical therapy that focuses on the pelvic floor, a group of muscles that act like a sling to support pelvic organs such as the bladder, uterus and bowel. These muscles help control the flow of urine, sexual function and bowel movements.

Weakness of the pelvic floor can lead to a host of problems including pelvic pain, urinary or bowel incontinence or constipation. A healthcare provider (HCP) can evaluate your symptoms prior to your seeking pelvic therapy to make sure they don’t indicate a more serious condition.

Other causes of pelvic pain include fibroids or bladder problems. Once these are ruled out, your HCP may diagnose pelvic floor weakness or other conditions and suggest pelvic therapy. Some physicians may work directly with patients on pelvic strengthening exercises instead of sending them to a specialist.

Pelvic floor weakness can also lead to pelvic organ prolapse. If the pelvic floor is unable to support the pelvic organs, they can drop down. This can cause urine leakage or problems emptying the bladder completely, trouble having bowel movements and lower back pain. In some cases, the pelvic organs may bulge out from the vagina or anus. Although most pelvic therapy is for women, there are some men that may also benefit from it.

What to expect during treatment
In Weber’s practice, pelvic therapy begins by talking to patients about their current medical conditions and health history. She also provides education on specific conditions that a patient may be concerned about, such as constipation.

Then, she will perform a manual pelvic examination to assess muscle tone. Keep in mind, pelvic therapists should all undergo additional training to be able to perform these manual exams. In the United States, most therapists receive training through the American Physical Therapy Association (APTA) or Herman & Wallace Pelvic Rehabilitation Institute. Be sure to check your therapist's credentials before scheduling an appointment.

The APTA recommends that only physical therapists who have received specialized training should perform pelvic examinations. You always have the right to refuse a pelvic examination, but this step will help the therapist assess the problem and determine the best course of treatment.

Weber also uses electromyography (EMG) during her assessments to check muscular function. “EMG reads what your pelvic floor muscles are doing, just like an EKG reads how your heart is working,” she explains. Not all physical therapists will use EMG, but manual physical examinations and manipulation are common in pelvic therapy.

The timetable for treatment varies for each patient. Typically, Weber will see patients for 8 to 12 sessions, assigning homework with specific exercises and helpful videos to watch between appointments.

“Mostly, what we do in pelvic therapy is create body awareness, teaching the person how to find and access these places in the body, whether they’re just trying to empty their bowels, control their urine or have a baby,” says Weber.

To Kegel, or not to Kegel?
Kegels, or pelvic strengthening exercises, are often touted as the solution for any and all pelvic problems. But the truth is that not everyone should do Kegels, Weber cautions.

“Some people, for whatever reason physiologically, have very high muscle tone in their pelvic floor,” she explains. “It starts to mimic things, like having a urinary tract infection [UTI]. So, they'll experience the frequent urination, and the burning with urination and the pain. We try to find and correct the source of these overworked muscles to decrease symptoms.”

Unless these women are specifically evaluated for their muscular composition, a muscle tone issue is often missed. This can lead to unnecessary treatments for UTIs or other conditions that the woman doesn’t actually have. Kegels may not help these women, while pelvic relaxation techniques might.

“If the person does not have a history of pain with sex, doesn't have a history of bladder retention or chronic constipation, doesn't have a history of pain with gynecological exams, or things like pain with inserting a tampon—if those things are clear, then they will probably be safe doing Kegels,” Weber explains.

She points out, however, that many people don’t do these exercises properly. As a result, they’re ineffective. Weber says she has seen patients who say they’ve been doing Kegels for years and have experienced no improvement in their symptoms. “A lot of times, I’ll get them in here, and they’re doing absolutely the wrong technique,” she notes.

The ‘right way’ to do Kegels
For women, Kegel exercises activate three regions in the pelvic floor that you can think of as front, middle and back muscles.

  • The front muscles control the flow of urine. You could isolate these muscles by imagining that you are stopping and re-starting urination midstream. (It’s important to avoid actually doing this while urinating since it can cause urinary problems.)
  • The middle muscles make up the vagina. One way to identify these muscles is to insert a clean finger into the vagina. Then, try to squeeze your finger with your vaginal muscles.
  • The sphincter muscles are the back muscles. Imagine the feeling of holding in gas—that’s the feeling of contracting the sphincter. Hint: You do not need to contract your gluteal (buttocks), abdominal or inner thigh muscles to activate rear pelvic muscles.

Kegel exercises will work on contracting these three muscle groups and hopefully strengthen them over time. Exactly how you should perform these exercises and how often will depend on your specific health concerns. A pelvic therapist can help identify which of the three muscle groups you should work on and create a routine designed to meet your specific needs.

Yoni eggs aren’t what they’re cracked up to be
One pelvic fad for women is the yoni egg. Also called jade eggs or love eggs, these devices are supposed to be inserted into the vagina and held there by your vaginal muscles. Proponents claim yoni eggs enhance sexual performance and pleasure and may also help to strengthen and tighten pelvic floor muscles in a way similar to pelvic therapy.

Experts like Weber aren’t convinced. “I feel like it's the same as telling somebody just walk around all day with a five-pound weight in your hand, and you're going to have awesome biceps,” she says.

Essentially, you want to train your muscles functionally, exposing them to the activities that they’ll be doing. So, unless you are training to be able to hold and carry items using vaginal muscles over long distances, yoni eggs likely won’t help you. There is no scientific evidence that yoni eggs will strengthen vaginal muscles or improve sexual function, but they may pose a health risk. Some experts have warned that jade is a porous stone which could be a breeding ground for bacteria.

Article sources open article sources “Patient education: Pelvic floor muscle exercises (Beyond the Basics).” October 2020. Accessed November 10, 2020.
The American College of Obstetricians and Gynecologists. “Pelvic Support Problems.” January 2020. Accessed November 10, 2020.
Harvard Health Publishing. “Pelvic physical therapy: Another potential treatment option.” October 13, 2020. Accessed November 10, 2020.
American Society of Colon & Rectal Surgeons. “Rectal Prolapse Expanded Version.” 2020. Accessed November 10, 2020.
National Institute of Diabetes and Digestive and Kidney Diseases. “Kegel Exercises.” April 2014. Accessed November 10, 2020.
Mayo Clinic. “Urinary incontinence.” April 13, 2019. Accessed November 10, 2020.
SS Faubion, LT Shuster, & AE Bharucha. “Recognition and management of nonrelaxing pelvic floor dysfunction.” Mayo Clinic Proceedings. February 2012. 87(2), 187–193.
Memorial Sloan Kettering Cancer Center. “Pelvic Floor Muscle (Kegel) Exercises for Women to Improve Sexual Health.” December 18, 2018. Accessed November 10, 2020. “What Are Yoni Eggs?” 2020. Accessed November 10, 2020. “Vaginal weights for training the pelvic floor muscles to treat urinary incontinence in women.” July 8, 2013. Accessed November 10, 2020.

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