Pelvic Health Physical Therapy: The Ultimate Guide — Renegade Movement and Performance

Have you been wondering if pelvic floor physical therapy is a fit for you?

Have you been told that women’s health physical therapy may be a solution for the pelvic symptoms that you’ve been experiencing?

Maybe you just want to know if you have pelvic floor dysfunction.

Pelvic PT is becoming more well-known in the health and wellness space, but with that comes more questions from women who may be told they need pelvic floor pt.

In this blog, we’re going to break down everything you need to know about pelvic floor PT and pelvic health in general so that you can decide if you’d like to reach out to a pelvic floor physical therapist near you (and how to go about doing so!)

We’re going to go over:

What is pelvic health physical therapy?

Pelvic health physical therapy is known by a lot of different names. You may also hear it called pelvic floor physical therapy, women’s health physical therapy, or shortened to pelvic PT or pelvic physio.

No matter the name, this type of physical therapy focuses on symptoms and conditions that relate to the pelvic region and beyond (because EVERYONE has a pelvic floor!)

But wait.. let’s back it up for a second.

What is the pelvic floor?

You may be wondering what the area pelvic PT focuses on is all about, so let’s dive in.

The term pelvic floor refers to the group of muscles and connective tissues that form a supportive bowl at the bottom of your pelvis. In this area, you also have blood and lymphatic vessels, nerves, and organs that are intertwined with the pelvic floor in this region.

Below, you can see the bony pelvis (cream-colored) and the pelvic floor muscles (the red and pink-colored sections).

What does the pelvic floor do?

The pelvic floor muscles have many functions.

One way of categorizing the multitude of great things this system does for us is the 5 S’s.

Stability (of trunk pelvis and hips)
Support (of pelvic and abdominal organs)
Sphincteric (keeping body orifices closed until they need to be opened)
Sump-Pump (aiding in the circulation of blood and lymphatic fluid)
Sexual (optimal sexual function relies on a healthy pelvic floor)

A healthy pelvic floor allows you to:

Move, live, cough, laugh, breathe, jump, run with your kids, and work out without leaking (your pelvic floor helps you not pee your pants during movement or at rest).
Have great core bracing and stability to avoid injury during athletic performance
Have pain-free intercourse
Optimize your breathing for life and performance
Move through life without discomfort, pain, pressure, and more inside the pelvic region

As you may have already guessed, pelvic floor physical therapy focuses on helping those who are experiencing symptoms related to the pelvic region. The goal is to eliminate pain and pelvic floor dysfunction in general.

A large focus in pelvic PT is, certainly, the pelvic floor. But we know that nothing in the body EVER works in isolation. So while treatment focuses on the pelvic floor, many other areas of the body will also be looked at and treated in order to get to the root cause of your pelvic dysfunction.

Still with us? Let’s keep going.

Kyle Brunelle and pelvic health physical therapy in Bedford NH

What makes a physical therapist a pelvic floor physical therapist?

A pelvic floor therapist is a physical therapist who has gone through extensive training outside of the typical physical therapy curriculum. Fun fact! There are also pelvic floor occupational therapists and some chiropractors, too!

Once a physical therapist decides they are interested in learning more about the pelvic floor and they attend coursework related to assessing and treating the pelvic floor, they are able to call themselves a pelvic floor physical therapist.

One thing that we want to make sure we highlight is that some physical therapists are NOT trained in internal examination.

While internal examination (to be discussed later on in this blog) is not a requirement, it is important to understand that you will have different information about the function of your pelvic floor if you have an exam done with a therapist who is trained in internal examinations and treatment.

We recommend that you find a therapist who is trained by the Herman and Wallace Institute or the APTA, as these courses train therapists in internal work and a whole-body approach.

How to find a pelvic floor physical therapist near you

If you’re looking for a pelvic PT in your area (and you are not local to Bedford, NH where Renegade is located), then we suggest checking out the following directories to find a pelvic therapist:

Pelvic Guru and the Global Pelvic Health Alliance: https://pelvicguru.com/directory/
Herman and Wallace practitioner directory: https://pelvicrehab.com/
APTA pelvic provider locator: https://aptapelvichealth.org/ptlocator/

If you are located in Bedford, NH or surrounding areas of Southern NH, Renegade has two pelvic therapists treating inside of our clinic.

Who is pelvic floor PT for?

Pelvic floor PT is for everyBODY! Everyone has a pelvic floor. While we know that the topic in itself is taboo, anyone can benefit from pelvic floor PT.

Keep in mind that some providers do not treat women, some do not treat men, some do not treat kids, etc. The best way to figure out if a provider local to you is trained in treating your diagnosis and/or body is to use the directories listed above or to reach out prior to booking.

We also want to point out that optimizing your pelvic floor can help with athletic performance, as the pelvic floor helps with bracing, breathing, and power. It is not JUST for those who have symptoms related to birth, postpartum, pain in the pelvic region, pelvic injury, etc.

We know you’ve probably seen the 2013 CrossFit games video of women being interviewed about peeing their pants while lifting and celebrating it …that may be celebrated among athletes, but you can also lift weight that is heavy without peeing your pants, too (and if you’re able to optimize that pressure, you’re going to be able to improve your overall strategy and performance, which means lifting heavier weight!) PS— this video makes us cringe.

What diagnoses are treated in pelvic PT?

The list of diagnoses that are treated in pelvic floor PT is very long because the pelvic region is SO important!

We’ll list out some diagnoses here, but as you already know from reading this far, nothing in the body works alone. And if the pelvic floor has a huge role in breathing, you already know that many diagnoses can lead us down a path of optimizing pelvic floor health.

Pelvic pain: pain in the pelvic region as a whole is treated in pelvic floor therapy. At Renegade, we’ve had folks who have pain with exercise, pain in the pelvis during sex, pain at rest and with running or other athletic activities, pain with urination or defecation, pelvic pain during pregnancy or after pregnancy, and more.
Folks often describe this pain as shooting, burning, pulsating, or deep (deep pain is a very common type of pelvic floor pain). Oftentimes folks will also experience a deep pain in their hip joint/hip region. While this is not always related to the pelvic floor, we find that more often than not, it is.
Prolapse: pelvic organ prolapse is a common diagnosis treated in pelvic PT. If you have prolapse, you may have a feeling of heaviness in your pelvic region after prolonged periods of sitting and standing, when you are experiencing periods of increased stress, or while you’re lifting. Sometimes athletes will also feel fullness in their pelvic region when they are bearing down and bracing.
Most folks describe their prolapse symptoms as “heaviness” in the pelvic region, “pressure”, or a general feeling of fullness inside their pelvis.
Urinary incontinence, urinary urgency, fecal incontinence, fecal urgency: Pelvic PT can help with urinary urgency and involuntary loss of urine, which most folks refer to as leaking. Leaking can occur with walking, lifting, sneezing, coughing, running, etc.
Ideally, you don’t want to lose urine or feces unless you’re trying to go to the bathroom (on purpose!) You also should aim to be able to control fecal and urinary urgency (you know, like when you put your key in the door and just HAVE to go), and avoid JIC pees. Yep, that’s an acronym for just in case pees.. Those ones you do before you leave the house or just before bed or a workout, even though you don’t “have to go”.
Tailbone or pubic symphysis pain: pain in the tailbone region can occur after a fall or as a result of tight pelvic floor muscles
Pregnancy and postpartum: pelvic PT can help patients have a pain-free pregnancy and/or improve birth outcomes (reduce cesarian section odds, improve mobility of the pelvic floor, reduce the incidence of tearing) and birth experience (ensuring that moms are aware of the entire process of birth) through education and specific pelvic floor exercises and mobility. Strengthening and fitness programs can also be prescribed to pregnant women to maintain strength during pregnancy and prepare the body for birth and beyond.
After baby is born, pelvic floor PT can help with return to sport and life without pelvic symptoms that are common after birth (leaking, pain, heaviness, and more).
Diastasis recti (abdominal separation): sometimes there can be a separation between the two sides of the abdominal muscles, known as diastasis recti. With a pelvic evaluation and treatment, the separation can be decreased, allowing for both aesthetic and functional improvements.
Core stability and performance: the pelvic floor is a key component of core stability and pressurization. With treatment related to your specific sport (we like to approximate the demand at Renegade.. Aka if you’re lifting heavy at the gym, we’re lifting heavy in the clinic), we’re able to improve your core stability strategy (and increase your PR’s too).

Here’s a specific list of diagnoses that we see at Renegade:

Pelvic Organ Prolapse (POP)
Incontinence (fecal or urinary)
Pelvic pain
Pain associated with the low back, pelvic girdle, sacroiliac joint (SIJ), public symphysis, or tailbone
Pregnancy-related aches and pains
Preparation for birth and recovery after birth
Pain with intercourse
Pain associated with endometriosis, interstitial cystitis, cramping during menstruation
Diastasis recti
Gut and bowel issues

The list below is full of things that we’ve heard from our patients at Renegade and might be what you’re thinking (or what you have told your friends!) too:

“I pee my pants when I laugh, cough, and sneeze!”
“I'm leaking while I'm pregnant and after baby.”
“I can't go to the trampoline park with my kids.”
“How can I exercise safely while I'm pregnant?”
“I want to get back to lifting and running after baby, but I'm not sure how to safely do that.”
“I have pain with intercourse/intimacy.”
“I skip heavy lifting days because I'm afraid I'm going to leak.”
“I used to run, but I feel a lot of heaviness and pain in my pelvis when I try to run now.”
“I want to make sure I don't have a diastasis or a hernia and if I do, how can I heal it?”
“I had a baby years ago and I just haven't felt normal since.”
“I have to pee every time I hear water running!”
“When will my mommy tummy go away?”
“I don't leave the house without a pad or liner.”
“I want to do whatever I can to have the best birth outcomes.”
“How can I rehab from a c-section safely?”
“I really want to strengthen the correct way after I give birth.”
“I need to make sure everything is okay "down there".”
“I feel a lot of heaviness in my pelvis, especially after sitting and standing for long periods.”

What are the results that someone can expect from pelvic PT?

While results are, of course, specific to the person and their specific dysfunction, it’s common for folks to:

Stop leaking with activity
Have decreased pain in the pelvis
Have sex without pain
Experience decreased heaviness in the pelvic region
C-Section scar mobility improvements and pain reduction
Improved birth outcomes and birth preparedness
A true visual improvement in their diastasis/ab separation
Lift heavier/feel like lifting is easier in general
Improved back, hip, knee, and tailbone pain
Improved mobility overall and less feeling of “tightness” in the pelvic region

What to expect at your pelvic health physical therapy session

Dr Kyle Brunelle of Renegade Movement and Performance

Pelvic health sessions differ between different clinics, but at Renegade, we have 90-minute evaluations with your physical therapist and 60-minute follow-up appointments (all 1:1, of course).

When you come in for your initial examination, your PT will start with an extensive interview of your health history and experience. We know that a lot of providers our patients have seen before don’t listen to their whole story… we want to know all of it, because it all matters.

From there, an external examination will be performed. Your back, hips, abdomen, and pelvis will be assessed. Things that will be looked at include mobility, stability, and strength. After an external examination, an internal examination may be indicated to also look at the same things for the internal muscles of the pelvic floor.

An internal examination is never mandatory and your PT will discuss the results of the external exam with you as well as the indications for an internal examination. The benefits of an internal examination include being able to visualize and truly understand the muscles inside the pelvis, which provide a lot of information about what’s going on in that area (this allows more specificity for treatment).

Consent is of the utmost importance and your PT will continually ask for consent before and during the examination (and you are able to withdraw consent at any time).

This exam is very gentle in nature and your PT inserts one or two gloved fingers into your vagina or one finger in your rectum. This allows the therapist to directly palpate the muscles inside the pelvis and note any tension or weakness of the muscles. It also allows the therapist to determine the exact coordination of the musculature during movement, coughing, laughing, and breathing, which can assist with the overall treatment.

A speculum is not used and inserted into the vagina or rectum. (We don’t even have a speculum in the clinic.)

While the internal pelvic examination is the gold standard for examination and treatment of pelvic floor musculature, it is never a mandatory procedure and if you choose to forego the internal examination, you will be able to receive treatment from your physical therapist based on the external examination.

The examination is much different and more supported than a typical gynecological office visit exam.

weightlifting in pelvic health physical therapy at renegade movement and performance

Pelvic health follow-up sessions look a lot like our orthopedic sessions in most ways. The whole body is considered during these examinations and treatments.

One thing that sets us apart at Renegade is that we will help you get back to what you want to do.

For example: if you want to get back to jump roping without leaking, then we will be working on that during sessions. Pelvic health physical therapy is much more than just working the muscles around the pelvis.

And you may be wondering about pelvic exercises, like Kegels and vaginal weight use. Pelvic floor PT is way more than just Kegel exercises. While Kegels are definitely the “most focused on” exercise publicly, there are many other exercises that are used for and during pelvic physical therapy.

How long is treatment for pelvic health physical therapy?

Treatment length can be very much so dependent on what is found during the examination, but typically 5-8 sessions is recommended by your PT. We find that patients who have pelvic pain may need more sessions to fully address the symptoms they are experiencing.

Renegade Movement and Performance’s approach to pelvic health

While you’ve already heard this in previous sections of this blog, we want to make sure we outline how we set ourselves apart.

It’s not uncommon for folks to come to our clinic having been told before that all of the conditions listed above, and whatever they are experiencing, are things that women just need to accept as their “new normal”.

Even though something may be very common, it doesn’t mean that there isn’t a solution for it. We’re here to tell you that “just deal with it” and “it is what it is” and “just use a pad” is bad advice, and if you’re looking for an actual long-term solution, we’re your people.

As physical therapists, we blend our knowledge of orthopedics and pelvic health in order to give you the best solutions for your symptoms and condition. We strongly believe that spending your entire session on the table is not the answer, so you’ll find that a lot of movement will happen during your sessions!

A testimonal from a pelvic health patient of Dr. Kyle’s
"Working with Kyle has changed my life. I have been seeing him for pelvic floor physical therapy for the past 5 months. I have had very limiting pelvic pain for the last 8 years and have worked with many other PTs over the years. Other PTs gave me exercises that didn’t fix my pain and told me I needed to limit my physical movements and life to avoid pain. In 5 months, Kyle had me pain free, lifting weights, running, and living my life without flare ups. He knows and understands pain science and epitomizes what a PT dealing with chronic pain should be. I cannot recommend him highly enough and can’t thank him enough for changing my life."
—Katherine S.

What does pelvic floor PT cost?

Depending on where you go to pelvic PT, you may be able to utilize your insurance benefits. At Renegade, we are out of network with insurance companies, because insurance companies limit the level of care we can provide to our patients and we only want to give you the best. Plus, we’ve found that more often than not, pelvic PT is not covered by insurance benefits because it is not medically necessary, per the insurance company.

We are also out of network because we do not like hidden costs. You will always know the exact cost of your sessions and if you would like to submit for out-of-network reimbursement from your insurance company, we will provide you with the paperwork necessary to do so.

Athletic performance and pelvic health

Let’s talk performance and the pelvic floor.

When we look at something like core stability, most of us probably envision creating tension in our abs to pull on bones and help hold them in place. What we don’t think about as often is that a majority of how we create core stability actually comes from the pressure inside of our abdomen that’s created by these ‘core’ muscles contracting.

Think of your abdomen as a soda (or beer if you prefer) can. If we start to crush that can from the side walls it’ll create more pressure inside of the can. This is your abdominal muscles. However, there’s also a top and a bottom of that can! The top would be portrayed as your diaphragm and the bottom would be your pelvic floor. These areas can also (ideally) be used to create/ manage pressure inside your abdomen and create core stability.

If our main scaffolding for movement, the trunk/core, isn’t functioning optimally, then we will have to overwork the areas that are connected to it (these would be your limbs). Consider the performance indications of limbs, however strong they may be, bolted onto a wet noodle of a trunk. (oh no…)

One of the common strategies we see used to create pressure for core stability is breath holding (next time you exercise check in to see what your breathing is like). This crushes the top of the can with our diaphragm to create the pressure/ stability, which is great, but this means two things: 1. That pressure has to go somewhere- our abs and/or pelvic floor are forced to work harder than what’s ideal and 2. WE’RE NOT BREATHING! What does that mean for our performance?

The other part here is our pelvic health. When we have suboptimal breathing and pressurization strategies it can result in pelvic floor dysfunction. This may look like: urinary, fecal, or gas leakage; pain in the penis, vagina, rectum, SI joint, hip, or low back; difficulty starting or continuing to empty our bladder or rectum; pain during intercourse, orgasm, or ability to have/maintain an erection; any mix of the above and more, unfortunately.

If you’re looking to improve your athletic performance, it’s crucial to look at your pelvic floor and core function.

How to get started

Looking to get started with a pelvic floor PT? Make sure you check out the provider registries that we mentioned prior if you need to find a pelvic floor PT in your area.

If you’d like to learn more about Renegade and see if we can help you, feel free to read more about us here.

Learn more about pelvic floor physical therapy

We have other resources that you can use to learn more about pelvic health PT.

Providers locally that we recommend for women’s health care:

Precision Chiropractic owned by Dr. Alissa Dimos
Amy Morrisette, MSN, APRN — Urogynecology Department of Dartmouth Hitchcock in Bedford

Do you have pelvic floor dysfunction?!

Reading this blog post and wondering if you are a good fit for pelvic PT or if you have pelvic floor dysfunction (which is just a fancy word for saying pelvic floor symptoms)?

Check out our Cozean Screening Tool, developed by Nicole Cozean, PT, DPT, WCS, CSCS of Pelvic Sanity. You can use this screening tool and determine if, based on the symptoms you have and your medical history, if pelvic floor PT could help you.

Click Here to download the screening tool

About Renegade Movement and Performance

Renegade Movement and Performance is a pelvic health and orthopedic sports performance clinic in Bedford, NH that focuses on finding and treating the root cause so you can get back to doing what you love and continue doing it for life.

At Renegade, we know that the healthcare system can be intimidating, frustrating, and leave you guessing and wishing someone would just listen to your story, believe you, and give you legitimate answers.

Our goal is to be the hope dealers, giving you the space and time to tell us your whole story so that we can fully understand both you as a human and the symptoms that you are having so that we can best help you.

We are very strong in our belief that the advice “just stop doing it” is BS and is not helpful for folks we work with.

If you’re dealing with nagging aches and pains, pelvic floor symptoms, any orthopedic injuries, or are feeling frustrated with progress after trying everything else, we’d love to help you. Feel free to text or call us at (603)267-0432, book a free 15-minute discovery call here, or fill out the form below to submit an inquiry to work with us.

About the Author

Dr. Kyle Brunelle, PT, DPT, CIDN is a pelvic health physical therapist and a compassionate, trauma-informed provider trained by the Herman and Wallace Institute as well as an orthopedic/sports performance physical therapist with a passion for heavy lifting and movement assessment.

Kyle is the “no stones will remain unturned” type of provider who will look deeper than you thought possible to find answers for your concerns. As the Co-Owner of Renegade, Kyle is steadfast when it comes to providing excellent care and unmatched results for his patients.

His motto is: “If you only look where everyone else has always looked, you’ll get the results that everyone else has always got.”

Dr. Kyle’s Education

Doctor of Physical Therapy, Utica College, Utica, NY (GPA 3.94/4.0) May 2019
Recipient, Research Award

Bachelor of Science in Health Studies, Utica College, Utica, NY (GPA 3.88/4.0) December 2015
Graduated Summa Cum Laude
Recipient, Presidential Scholarship of Utica College
Recipient, Burger Scholarship of Utica College

Certifications

Mechanical Diagnosis & Treatment, McKenzie Part A June 2018
FMT Certified: Basic/Advanced/Blades June 2018
Integrated Kinetic Neurology (IKN) August 2020
Herman & Wallace Level 1: Women’s Pelvic Health August 2020
Herman & Wallace 2B: Men’s Pelvic Health December 2020
Certified in Integrative Dry Needling (CIDN) by the American Dry Needling Institute, Dr. Yun-Tao Ma November 2021
Integrative Dry Needling Foundation Course June 2021
Integrative Dry Needling Advanced Course November 2021
Integrative Dry Needling Pelvic Course April 2022

Pelvic Health Physical Therapy: The Ultimate Guide For Women Who Want to Know if Pelvic Floor PT is for Them