Would You Benefit from Pelvic Floor Therapy?

The pelvic floor consists of all neurovascular, visceral (organs) and myofascial (muscle and connective tissue) structures that are arranged between the pubic bone to the coccyx bone and laterally between the walls of the ischium.

Typically, healthy pelvic floor muscles help maintain normal bladder and bowel function, as well as enhance sexual response.  When these muscles become weak or are in spasm, a person may experience urinary or bowel incontinence, as well as pelvic pain.  If the ligament structures that hold the pelvic organs up are over-stretched, such as what occurs with intense pushing during childbirth or in chronic constipation, then a prolapse (dropping of the organs through the vaginal wall) can occur.

According to research, the following risk factors can contribute to pelvic floor dysfunction, leading to bladder or bowel incontinence, or even pelvic pain:

  • Menopause – due to decreased estrogen
  • Smoking – chronically increased intra-abdominal pressure (IAP)
  • Constipation – chronic pushing and increased IAP
  • Medications (side effects of some medications can cause constipation)
  • Infections
  • Lung disease (including asthma) – chronically increased IAP
  • Surgery
  • Obesity – IAP
  • Occupation – heavy lifting

Fortunately, these promoting risk factors can be prevented and/or modified by changing behavior patterns (smoke cessation) and by learning new physical habits in physical therapy (proper body mechanics to avoid increasing intra-abdominal pressure with lifting, voiding bowels without straining, massage to pelvic floor muscles to increase blood flow in menopausal patients).

Additionally, an inciting (unavoidable) risk factor that contributes to pelvic floor dysfunction is childbirth.   However, research has found with pregnancy and delivery that a decreased risk of developing pelvic floor dysfunction and prolapse occurs with decreasing second stage labor, having no episiotomy, and reducing delivery that requires operative assistance.

24 studies examined from 1995-2005 revealed that pelvic floor therapy cure rate was 73%.  Furthermore, prolapses did not worsen when pelvic floor exercises were performed in 83% of 754 women studied, revealing a preventative effect.  Consequently, 72% of the women with prolapses, who did not do pelvic floor exercises, developed worse prolapses.

If you identify with any of the risks or symptoms above, then it would be recommended to seek treatment from your physician, who can determine if you would benefit from pelvic floor therapy.


Herschorn S.  Female Pelvic Floor Anatomy:  The Pelvic Floor, Supporting Structures, and Pelvic Organs.  Rev Urol.  2004; 6(Suppl 5):  S2-10.

Bump RC, Norton PA.  Epidemiology and natural history of pelvic floor dysfunction.  Obstet Gynecol Clin North Am.  1998; 25:  723-746.

Bump RC, McClish DM.  Cigarette smoking and pure genuine stress incontinence of urine.  A comparison of risk factors and determinants between smokers and non-smokers.  Am J Obstet Gynecol.  1994; 170:  579-582.

Norton C.  Prevention and management in pelvic floor disorders. In:  Pemberton JH, Swash M, Henry MM (eds.).  The Pelvic FloorIts Function and Disorders.  London:  WB Saunders; 2002.

Landefeld CS, Bowers BJ, Feld AD, et al.  National Institutes of Health state-of-the-science statement: prevention of fecal and urinary incontinence in adults.  Ann Intern Med.  2008; 148:  1-10.

Piya-Anant M, Therasakvichya S, et al.  Integrated health research program for the Thai elderly:  prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women.  J Med Assoc Thai:  2003; 86:  509-515.



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  2. Gina Jay

    Thank you. I appreciate your comment.

  3. I experienced terrible pain after pelvic floor therapy. Is this normal? I have 5 more to go.

  4. Gina Jay

    Pelvic floor therapy consists of many facets. Although one component is strengthening, other components include achieving normal resting tone levels, the ability to coordinate contract and relax, postural alignment, addressing any orthopedic dysfunctions from the lumbar spine down to the feet because imbalanced gait (ambulation) affects pelvic floor tone (due to obturator internus muscles that attaches to the hip joint), manual scar mobilizations, tissue mobilizations to decrease tension in the pelvic floor, and breathing/relaxation techniques.

    Pain with doing kegels is usually due to chronic muscle tension and/or spasms in the pelvic floor. Any time a patient is having pain while performing kegels, then the treatment plan should focus on not doing kegels until pelvic floor muscle tone is further evaluated. The resting tone of the pelvic floor should be normalized prior to doing strengthening exercise. This can be done by massage (both internal and external), stretching, and breathing/relaxation techniques. Biofeedback can be an adjunct to therapy to help patients learn how to let the muscles relax. Muscle relaxation is often the first step with many patients prior to strengthening. Thus, you won’t be able to strengthen until you learn to “let go.”

    I would advise you to stop doing kegels and let your therapist know you are having pain. Your pelvic floor should be evaluated for non-relaxing muscles. Your treatment plan should be adjusted, because you will not be able to gain strength if your muscles are already chronically spasming and fatigued. (It’s like holding a bicep always in contraction and asking you to curl weight with an already tense, fatigued muscle. You won’t gain power this way.)

    There are also other things that can contribute to pelvic pain, but it would be a good idea to start with evaluation of muscle tone.