What Does Pelvic Floor PT Entail?
- Nicole Cozean
- 3 days ago
- 5 min read
Pelvic floor physical therapy treats the issues most people wouldn’t want to discuss at a dinner party — problems with peeing, pooping, sex, or pelvic pain. A high-quality pelvic floor PT includes a thorough head-to-toe evaluation, internal and external assessment, hands-on treatment, and a clear action plan to resolve symptoms and prevent them from returning.
Introduction
When people first hear “pelvic floor physical therapy,” they often have no idea what it actually involves. Some imagine Kegels. Others picture awkward machines. Many assume it’s only for postpartum women.
In reality, pelvic floor PT addresses a wide range of symptoms — including urinary urgency or leakage, constipation, painful intercourse, erectile dysfunction, pelvic pain, tailbone pain, and more. Anything involving peeing, pooping, sex, or persistent pelvic discomfort can often be treated conservatively with specialized pelvic floor therapy.
Unfortunately, many people struggling with pelvic health issues feel alone. They may believe there’s no solution. Some have even been dismissed or told their symptoms are “normal.” But the truth is pelvic floor dysfunction is incredibly common — more than half of us will experience some form of pelvic floor issue in our lifetime.
The challenge isn’t that treatment doesn’t exist. It’s that many people don’t know what high-quality pelvic floor therapy should actually entail. In this article, we’ll walk through what gold-standard pelvic floor PT looks like — so you know what to expect and what you deserve.
Pelvic Floor Physical Therapy External Evaluation
A true pelvic floor therapist is first and foremost an orthopedic specialist who has pursued additional, advanced training in pelvic health.
Pelvic floor dysfunction rarely exists in isolation. Issues anywhere from the head and neck down through the spine, hips, knees, and even feet can contribute to pelvic symptoms. Your body works as one integrated system — and the pelvis sits at the center of it.
A high-quality pelvic floor PT should perform an extensive orthopedic evaluation. This may include:
Posture and breathing mechanics
Core and abdominal coordination
Hip and spinal mobility
Movement patterns during walking, squatting, or lifting
History of injuries, surgeries, or repetitive strain
This full workup sometimes takes more than one session. But it’s critical to identify both the proximate cause (what is triggering symptoms right now) and the underlying why (what allowed this problem to develop in the first place).
In many cases, the true root cause lies outside the pelvic floor itself.
Some providers focus almost exclusively on the pelvic floor muscles without this head-to-toe approach. While that may provide short-term relief, it often misses a significant part of the picture — which is one reason some patients plateau or see symptoms return later.
Pelvic Floor PT Internal Evaluation
One of the most common questions people ask is: “What happens at pelvic floor PT?”
A gold-standard pelvic floor therapist should be trained and skilled in performing an internal assessment — either vaginally, rectally, or both (depending on anatomy and symptoms).
The pelvic floor muscles can only be directly accessed internally. These muscles often play a major role in:
Urinary urgency or leakage
Constipation
Pain with sex
Erectile dysfunction
Tailbone or deep pelvic pain
An internal assessment allows the therapist to evaluate muscle tone, strength, coordination, nerve sensitivity, and pain triggers. In many cases, a therapist can reproduce a patient’s familiar symptoms simply by gently assessing a tight or irritated muscle — confirming the true source of the issue.
It’s important to know that internal evaluation is always done with informed consent, privacy, and patient comfort as top priorities.
Some providers who advertise pelvic floor therapy are not trained in internal assessment. While they may help with certain external or orthopedic factors, they’re often missing half of the clinical picture. This can limit their ability to fully resolve symptoms.
Ongoing Pelvic Floor Therapy Treatment
Once the evaluation identifies the driving factors, treatment begins.
In high-quality pelvic health settings, sessions are typically:
A full hour long
One-on-one
Hands-on
Conducted in a private treatment room
Specialized pelvic floor clinics generally do not double-book patients, rotate between multiple patients in one hour, or rely heavily on machines while stepping away. The value is in individualized, skilled care.
Treatment varies depending on the findings but may include:
Manual therapy to address muscle tension, nerve irritation, ligament restrictions, or fascial tightness
Guided strengthening or coordination exercises
Breathing retraining
Postural correction
Movement retraining
Most patients are seen once or twice per week, often for 8–12 weeks, depending on complexity. A skilled therapist should outline a clear progression plan so you understand where treatment is headed.
It’s also important to understand that progress isn’t always linear. Many patients experience early improvement, followed by a plateau, before working through more stubborn symptoms. This is normal — and part of comprehensive rehabilitation.
There is typically a home exercise component as well. True pelvic floor therapy is collaborative, with you actively participating in your recovery.
Additional Interventions in Pelvic Floor Therapy
Long-term success requires more than just treating irritated muscles.
A skilled pelvic floor therapist will also look at the lifestyle and behavioral factors contributing to symptoms. At PelvicSanity, we consider four core foundations of pelvic health:
Movement – How you sit, stand, lift, exercise, and breathe.
Sleep – Recovery and nervous system regulation.
Nutrition – Bladder and bowel health are directly influenced by diet.
Stress Management – The pelvic floor is highly sensitive to stress and nervous system activation.
If these foundations aren’t addressed, symptoms may improve temporarily but struggle to fully resolve.
High-quality pelvic floor PT is not just symptom management — it’s system optimization.
How to Find a Qualified Pelvic Floor Physical Therapist
Not all pelvic floor PT is created equal.
When searching for a provider, look for someone who:
Specializes exclusively in pelvic health — not a clinic where pelvic therapy is an occasional add-on
Is trained and comfortable performing both internal and external evaluation and treatment
Provides full hour-long, one-on-one sessions
Does not rely heavily on biofeedback machines, passive modalities, or simply watching you exercise
Creates a clear, structured action plan after the initial evaluation
You should leave your first visit understanding:
What’s driving your symptoms
What the treatment plan looks like
What kind of timeline to expect
If you’re local to Orange County, California, we would love to work with you. At PelvicSanity in Laguna Hills, our team specializes exclusively in pelvic health and provides gold-standard, one-on-one care to help you resolve symptoms and regain confidence in your body.
👉 Request an Appointment today to start your recovery with our pelvic health specialists.
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Who are We at PelvicSanity?
At PelvicSanity, it's our mission to support patients with pelvic pain and pelvic floor symptoms, regardless of where you live. We can help with:
In-person treatment for those in Southern California at the PelvicSanity clinic
Immersive Out-of-Town program for those able to travel
Remote Consultations to get you expert 1:1 help, advice and an action plan
Online patient courses on Interstitial Cystitis and Movement for Pelvic Health
A Facebook support group for patients called Finding Pelvic Sanity.
Dr. Nicole Cozean is the founder of PelvicSanity Physical Therapy in Orange County, CA. PelvicSanity treats patients from all over the world with remote consultations and the Immersive Out of Town Program. She also runs Pelvic PT Rising, training other pelvic PTs to better serve patients.
Named Physical Therapist of the Year, Dr. Nicole is author of the award-winning book The Interstitial Cystitis Solution and the first PT to serve on the ICA Board of Directors, Her passion is helping those with pelvic health issues - regardless of where they live - find lasting relief.
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