PT Classroom - An Introduction to Pelvic Floor Physical Therapy ׀ by Emily Schwecke, DPT


Emily Schwecke, DPT, received her degree in Kinesiology from the University of Wisconsin – Madison in 2013, and her Doctorate in Physical Therapy from Rosalind Franklin University of Medicine and Science in 2017. Emily is a physical therapist with Froedtert South in Pleasant Prairie, WI, where she is employed as an outpatient physical therapist. She specializes in pelvic floor physical therapy and is currently studying for the Certification in Orthopedic Manual Therapy.


An Introduction to Pelvic Floor Physical Therapy


Nearly one-third of Americans age 30-70 experience bladder control symptoms at some point. Nearly 64% of those never seek treatment. In addition, women wait, on average, 6.4 years to seek treatment, while men wait 4.2 years (1). Out of 1,961 non-pregnant healthy women, 23.7% experienced urinary or fecal incontinence, pelvic organ prolapse, or in combination (2). Thirty eight percent of men and women believe that incontinence is a normal sign of aging (1).Estimates range that 80% of those with incontinence can be cured, or at least improved, by conservative treatments.

Ten percent of women ages 20-39, 27% ages 40-59, 37% ages 60-79, and 50% ages 80+ experience urinary incontinence.

What is pelvic floor physical therapy?
Pelvic floor physical therapy is a subset of physical therapy that involves evaluation of the pelvic floor, which is a group of muscles that supports the pelvic organs. These pelvic organs include the bowel, bladder, and the uterus in women. This can include either vaginal or colorectal examination and treatment.

What is the Pelvic Floor?
The pelvic floor is comprised of a group of muscles, ligaments, and connective tissue structures that provide support to visceral organs, resist intra-abdominal pressure, maintain urinary and fecal continence, and provide various sexual functions. The levator ani group and coccygeus muscles make up the deep pelvic floor (layer three) that act like a hammock or sling. The rectum, urethra, and vagina all pass through the pelvic floor; dysfunction in any of the pelvic floor muscles can affect one or more of these structures (4-6).

The pelvic floor is comprised of 3 layers of muscles:

Superficial Perineum (layer 1)
1. Bulbocavernosus
2. Ischiocavernosus
3. Superficial transverse perineal
4. External anal sphincter (EAS)

Deep Urogenital Diaphragm (layer 2)
1. Compressor urethera
2. Uretrovaginal sphincter
3. Deep transverse perineal

Pelvic Diaphragm (layer 3)
1. Levator ani: pubococcygeus (pubovaginalis, puborectalis), iliococcygeus
2. Coccygeus/ischiococcygeus
3. Piriformis
4. Obturator internus

Common Diagnoses That Are Treatable with Pelvic Floor Physical Therapy
Dysfunction in any of the above muscles can lead to pelvic pain, urinary or fecal incontinence, symptoms of prolapse, or a combination. Below are a few diagnoses that are commonly addressed in pelvic floor PT:
• Pelvic pain, including pain with intercourse or pelvic exam
o Dyspareunia: difficult or painful sexual intercourse
o Vaginismus: involuntary contraction/spasm of pelvic floor muscles
o Vulvodynia: chronic pain surrounding the introitus
o Endometriosis: endometrial tissue growth on other pelvic structures (i.e. ovaries, bowel, lining of pelvic structures)
o Pudendal neuralgia: chronic pelvic pain from irritation/damage to the pudendal nerve
o Interstitial cystitis/painful bladder syndrome: chronic condition causing bladder pressure, bladder pain and sometimes pelvic pain
• Pelvic organ prolapse
• Urinary leakage with or without activity
• Urinary frequency or urgency
• Diastasis recti (separation of abdominal muscles
• Abdominal pain or scar tissue associated with abdominal or pelvic surgery
• Trauma/PTSD
• And many more!

Can’t we just prescribe Kegels to all of our pelvic floor patients?

NO! There are two general diagnoses for various pelvic floor dysfunctions:
1. Overactive/functionally short pelvic floor
2. Underactive/weak pelvic floor

Even when kegels are indicated, an American Journal of Obstetrics and Gynecology research article states that up to 51% of individuals do not perform a kegel correctly (3).


Pelvic Floor Evaluation & Treatment
The initial evaluation for a pelvic floor patient is very similar to a patient with lumbopelvic dysfunction. Posture, gait, spinal mobility, lower extremity flexibility and strength, transverse abdominis stabilization, joint accessory motion, and special tests including lumbar/sacroiliac joint dysfunction and load transfer tests are all appropriate. In addition, pelvic floor PTs perform an internal and external assessment of the pelvic floor region, including skin integrity and scar mobility, sensation, pelvic floor contractile strength and endurance, internal and external soft tissue quality/irritability, and assessment for prolapse (just to name a few!).


If the patient is found to have an underactive pelvic floor, pelvic floor strengthening interventions will be utilized for improved strength and control of the pelvic floor and presenting symptoms. If the patient is found to have an overactive pelvic floor (i.e. pelvic pain, some stress incontinence), pelvic floor relaxation and downtraining interventions will be implemented for decreased resting tone of the pelvic floor.


Common treatments for pelvic floor dysfunction include pelvic floor strengthening or relaxation strategies, internal and external soft tissue mobilization, electrical stimulation for pain management/muscle stimulation, sEMG biofeedback for neuromuscular re-education, spinal and neural mobilizations, dynamic hip strength and transverse abdominis stabilization, lower extremity stretching, education in proper mechanics and behavioral strategies, and a comprehensive home exercise program. Keep in mind that not all of these interventions are appropriate for every patient, and are to be utilized based on objective findings from the initial evaluation.

Last revised: 4/18/19
by Emily Schwecke


1) Muller, Nancy. What Americans Understand and How They Are Affected by Bladder Control Problems: Highlights of Recent Nationwide Consumer Research. Society of Urologic Nurses and Associates. 2005:25(2): 109-115. https//
2) Nygaard, I. Barber, M. Burgio, K. Kenton, K. Meikle, S. Schaffer, J, et. al. Prevalence of Symptomatic Pelvic Floor Disorders in US Women. JAMA. 2008:300(11): 1311-1316.
3) Bump, RC. Hurt, WG. Fantl, JA, Wyman, JF. Assessment of Kegel pelvic floor exercise performance after brief verbal instruction. Am J Obstet Gynecol. 1991:165(2): 322-7
4) Corton MM. Anatomy of pelvic floor dysfunction. Obstet Gynecol Clin North Am. 2009;36(3):401-419.
5) Herschorn S. Female pelvic floor anatomy: the pelvic floor, supporting structures, and pelvic organs. Rev Urol. 004;6(suppl 5):S2-S10.
6) Pelaez M, Gonzalez-Cerron S, Montejo R, Barakat R. Pelvic floor muscle training included in a pregnancy exercise program is effective in primary prevention of urinary incontinence: a randomized controlled trial.
7) Allen T, Real J. Herman & Wallace Level 2B: Pelvic Floor Function, Dysfunction, and Treatment. Lecture Presented: Rehabilitation of Pelvic Pain; May 18-20th, 2018; Kenosha, WI.

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Please review our terms and conditions carefully before utilization of the Site. The information on this Site is for informational purposes only and should in no way replace a conventional visit to an actual live physical therapist or other healthcare professional. It is recommended that you seek professional and medical advise from your physical therapist or physician prior to any form of self treatment.