By Emma McGowan

You’ve heard of physical therapy for the rest of your body! Now get ready for *drumroll*... physical therapy for your nethers. Pelvic PT is a specialized form of physical therapy that can be incredibly beneficial for people experiencing pelvic pain or dysfunction. While we believe pelvic PT can benefit pretty much everyone, this piece is here to get you acquainted with what signs and symptoms have us saying “get thee to a pelvic PT.”

Although it may feel uncomfortable or embarrassing to discuss these issues, remember that these are trained professionals who are here to help you. So even if you giggle every time you say “butthole,” you can rest assured that they won’t. 

But enough about buttholes… how can you know if pelvic PT is for you? Let’s take a look at what pelvic PT is, what to expect from your first appointment, and how it can improve your quality of life.

Do I need pelvic PT?

“If anyone's having any symptoms between the ribcage and the knees, that’s a good general starting point,” Dr. Rachel Gelman, PT, DPT, tells The Pelvic People. “More specifically, people having bowel, bladder, or sexual dysfunction or any type of pelvic pain should consider seeing a pelvic PT.”

Here are some symptoms to look out for:

1. Pain during sex: Pain during sex can feel like stabbing pain when something tries to penetrate, pain deep in your pelvis, or any other kind of uncomfortable feeling around your vulva, vagina, or abdomen when you’re getting busy. This can be a sign of pelvic floor dysfunction, which can be caused by muscle tension or weakness in the pelvis.
2. Erectile dysfunction: Erectile dysfunction (aka when a person with a penis “can’t get it up”) can also be a sign of pelvic floor dysfunction, which can be addressed with pelvic PT.
3. Urinary issues: If you often feel like you really have to go, you’re peeing a lot, or if it hurts when you pee, it could be a result of pelvic floor dysfunction. Pelvic PT can help you feel better by improving muscle function down there.
4. Bowel movement issues: Constipation, feeling like you're not fully emptying out when you poop, and pain when you go can all be signs of pelvic floor dysfunction.
5. Tailbone pain and pain with sitting: Pain in your tailbone or discomfort while sitting can be caused by pelvic floor dysfunction.
6. Pregnancy and postpartum considerations: It’s a punchline these days that people who have given birth pee a little bit when they sneeze or laugh. It doesn’t have to be that way! Pelvic PT can help! And if you’ve had a c-section, that means the doctor cut through all of your abdominal muscles. Pelvic PT can help you build the strength back after that major trauma. 
7. Pelvic surgery and cancer treatment: Pelvic surgery and cancer treatment can also lead to pelvic floor dysfunction. Pelvic PT can help address any muscle tension, weakness, or other issues that may have developed as a result of these treatments.

I’m kind of nervous about my pelvic PT appointment…

It's totally understandable to feel anxious or uncomfortable about pelvic PT, but it's important to know that pelvic PTs are highly trained professionals who are here to help you. Creating a comfortable environment, educating yourself about the process, and communicating openly with your provider are essential in addressing any anxiety or uncertainty you may have.

"Most of us as providers know that people don't know what to expect and are anxious, so we want to make people feel comfortable,” Dr. Gelman says. “The first part of most appointments is a lot of talking and getting to know the patient. All parts of the exam are optional and you can say no to anything.”

During your initial appointment, the pelvic PT will conduct an evaluation to determine if pelvic PT is the right treatment option for you. They will discuss your symptoms and medical history and might perform a physical exam to assess your pelvic floor muscles. Based on their evaluation, they will develop a personalized treatment plan tailored to your needs.

Oftentimes, Dr. Gelman’s patients don’t even have to get undressed during the initial appointment. Unlike an OB/GYN appointment, where the doctor “makes a beeline right away for your vagina,” she says, a pelvic PT appointment involves a lot of examination of external muscles first. 

“Then, if I think it's appropriate, I tell them I want to do an internal exam and why I want to do it. If they don't want me to do the exam, that's fine,” Dr. Gelman says. “We don't have to do it because I can get a lot of information outside of that area. But then if they consent to the internal exam, I'm not using a speculum; I'm not using stirrups. It's just one gloved, lubricated finger and they are welcome to say ‘yea’ or ‘nay’ to that exam or stop it at any time.”

It’s important to note that pelvic PT is a safe and non-invasive treatment option that can provide significant relief for many people. The exercises and techniques used in pelvic PT will vary depending on the patient's individual needs and goals, but they can include kegels, biofeedback, manual therapy, relaxation techniques, and education.

Finding a qualified pelvic PT provider may require some research (need help? Check out these directories!), but it is crucial to feel comfortable with your provider and their approach to treatment. Don't hesitate to ask questions and advocate for yourself—these appointments are for you. 

If you’re having trouble finding a PT in your area, Pelvic Gym is a great online resource for getting started with the basics on a budget and Origin offers virtual pelvic PT for individualized care from the comfort of your own home.

So if you're experiencing pelvic pain or dysfunction, don't hesitate to seek help! Imagine your life without needing to pee all the time or icing your vulva after sex or struggling to have a BM that doesn’t totally suck. There are qualified and experienced pelvic PTs available who can provide the support and care you need.