Bottom line, up front: Pelvic floor therapy is a specialized form of physical therapy that uses external and internal techniques—including manual therapy, biofeedback, electrical stimulation, and targeted exercises—to restore strength, coordination, and comfort to the pelvic floor muscles. Treatment plans are fully individualized, and therapy should never be painful.
Hi there. I’m Sherryl DeVries, owner and physical therapist at Relax Therapy in Seattle, Washington. If you’ve landed on this page, you’re probably dealing with something that’s been quietly affecting your daily life—maybe a little leaking when you sneeze, persistent pelvic pain, or discomfort during intimacy that you’ve been too embarrassed to bring up.
First, I want you to know: you are not alone, and you don’t have to keep suffering in silence.
According to Tufts Medicine, pelvic floor issues affect up to 1 in 3 women—and many men experience them too. Yet most people wait years before seeking help, often because they don’t know treatment is available or feel unsure about what it involves. That’s exactly why I’m writing this post. My goal is to walk you through the different types of pelvic floor therapy available, so you can feel informed, empowered, and ready to take that first step.
What Is Pelvic Floor Therapy?
Pelvic floor therapy is a collection of treatments designed to restore the function and strength of your pelvic floor muscles—the group of muscles, ligaments, and connective tissues that sit at the base of your pelvis. These muscles support your bladder, bowel, and reproductive organs. They play a role in bladder and bowel control, sexual function, posture, and core stability.
When these muscles are too weak, too tight, or not coordinating properly, a range of symptoms can follow: urinary or fecal incontinence, recurrent pelvic pain, pain during intercourse, or even lower back discomfort.
The most common form of treatment is Pelvic Floor Physical Therapy (PFPT). This involves physical exercises and hands-on manual therapy designed to improve coordination and control of these muscles. What makes pelvic floor therapy so effective is that it is fully individualized—no two treatment plans are the same, because no two bodies are the same.
Pelvic floor physical therapy falls into two main categories: external and internal therapy. Most patients benefit from a combination of both.
What Does External Pelvic Floor Therapy Involve?
External pelvic floor therapy targets the muscles of the lower body and core—without any internal contact. Think of it as similar to physical rehabilitation for other injuries, just with a specific focus on the pelvic floor and surrounding structures.
External therapy is often the first step in treatment. It helps reduce tightness, restrictions, and pain in the lower back, hips, and pelvic region. Common techniques include:
- Myofascial release – Gentle, sustained pressure applied to tight connective tissues and trigger points to reduce pain and restore flexibility
- Deep-tissue massage – Targeted work on deeper muscle layers to release tension
- Joint mobilization – Gentle stretching and manipulation of the pelvic and hip joints to improve range of motion
- Nerve release – Addressing restrictions along specific nerve pathways that may be contributing to pain
- Muscular cueing – Helping you identify and activate the right muscles at the right time
- Skin rolling and soft tissue work – Addressing superficial restrictions that affect deeper layers
These techniques are gentle and respectful of your body. My job during this phase is to help you understand your own muscles and build awareness of how they’re functioning—or not functioning.
What Does Internal Pelvic Floor Therapy Involve?
Internal pelvic floor therapy directly targets the pelvic floor muscles using internal techniques. This is where patients often have the most questions, and understandably so.
I want to be very clear: internal therapy is always performed with your full informed consent. Everything is explained before we begin, and you are in complete control. You can pause or stop at any time—no questions asked.
During an internal session, I use a gloved, lubricated finger to assess and treat the internal structures of the pelvic floor. This allows me to identify areas of tension, weakness, or trigger points that can’t be reached externally. Tools like dilators and wands may also be used to help hypersensitive or tight tissues safely accommodate stretch over time.
Internal treatment techniques may include:
- Trigger point release and internal massage – Targeting tender, knotted areas within the pelvic floor muscles
- Pelvic muscle retraining – Helping your muscles learn to contract and relax at the right times
- Kegel exercises and strengthening techniques – Building strength in weak or underactive muscles
- Manual activation – Hands-on guidance to help you feel and recruit specific muscle groups
- Internal muscular cueing – Teaching proper coordination from the inside out
- Myofascial release – Applied internally to address deeper tissue restrictions
- Ultrasound therapy – Using sound waves to support tissue healing and reduce pain
Internal therapy is most effective when combined with external work. Together, they provide a comprehensive approach to restoring pelvic floor function.
What Are the Additional Treatment Approaches Used in Pelvic Floor Therapy?
Beyond hands-on manual work, pelvic floor therapy includes several supportive techniques that can accelerate your progress and give you tools to use at home.
How Does Biofeedback Help with Pelvic Floor Control?
Biofeedback uses sensors—placed externally or internally—to track your muscle activity in real time on a screen. This gives you immediate, visual feedback on whether you’re contracting or relaxing your pelvic floor correctly. Many patients find this eye-opening. It removes the guesswork and helps you learn what proper muscle control actually feels like.
What Is Electrical Stimulation and When Is It Used?
Electrical stimulation (EMS) delivers low-level electrical currents to stimulate the nerves and deep muscle fibers of the pelvic floor. For muscles that are weak or unresponsive, this can help “wake them up.” For muscles that are overactive or spastic, it can help calm and normalize nerve activity. It sounds more intimidating than it is—most patients describe the sensation as mild and tolerable.
What Behavioral Changes Support Pelvic Floor Recovery?
Lifestyle and behavioral modifications are an often-overlooked but powerful part of pelvic floor therapy. Your treatment plan may include:
- Bladder and bowel education – Learning how fluid intake, diet, and voiding habits affect your symptoms
- Caffeine and bladder irritant reduction – Adjusting dietary choices that worsen urgency or leakage
- Fiber intake guidance – Supporting healthy bowel function to reduce straining
What Home Exercises Are Typically Prescribed?
Home practice is essential to lasting results. Common exercises include:
- Diaphragmatic breathing – Deep belly breathing that naturally coordinates with the pelvic floor to reduce tension and pressure
- Kegels and reverse Kegels – Depending on whether your muscles need strengthening or lengthening
- Targeted stretches – Such as child’s pose, happy baby, or hip-opener stretches prescribed for your specific condition
What Can You Expect During Your First Pelvic Floor Therapy Appointment?
Your first appointment at Relax Therapy is all about getting to know you—your history, your symptoms, and your goals. Here’s a general outline of what to expect:
- Medical history review – We’ll talk through your bladder, bowel, and sexual health symptoms, as well as any relevant medical history
- Postural and external assessment – I’ll assess your spine, hips, core strength, and movement patterns to identify any contributing factors
- Internal assessment (with full consent) – If appropriate, we’ll move to an internal evaluation to assess muscle tone, strength, and tender points
- Personalized treatment plan – Based on everything I find, I’ll create a tailored plan and walk you through it together
Your first appointment is typically 60 to 90 minutes. You set the pace—always.
You Deserve to Feel Better
Pelvic floor therapy should never be painful. If something doesn’t feel right, we slow down. Your comfort, dignity, and autonomy are at the center of every session I provide.
If pelvic floor symptoms are interfering with your daily life, your confidence, or your relationships, please don’t wait. Whether you’re dealing with leakage, pelvic pain, postpartum recovery, or discomfort during intimacy, there are real, effective, drug-free treatment options available to you.
I’d love to be part of your healing journey. Book an appointment with me at Relax Therapy and let’s figure out, together, how to get you back to feeling like yourself again.
Frequently Asked Questions About Pelvic Floor Therapy
Who is pelvic floor therapy for—is it only for women after childbirth?
Pelvic floor therapy is for people of all genders and ages. Anyone with a pelvis can benefit from therapy. While women commonly seek pelvic floor therapy related to pregnancy, childbirth, and menopause, men benefit from pelvic floor therapy following prostate surgery or with urinary, bowel, or pelvic pain concerns. Children with toileting issues (incontinence and/or constipation) may benefit from PFPT. GNC or trans* folks may need specialized care. Athletes and older adults can also benefit, depending on their symptoms.
How do I know whether I need external or internal pelvic floor therapy?
The type of treatment you need depends on your specific symptoms and the findings from your initial evaluation. Most patients benefit from both external and internal approaches. Your physical therapist will begin with a postural and external assessment before progressing to internal therapy, and only with your full consent.
Is pelvic floor therapy covered by insurance?
Coverage varies depending on your insurance plan. At Relax Therapy, insurance can be billed in some cases (excluding Medicare), and out-of-network patients may be able to submit a superbill for reimbursement. Self-pay packages are also available. Contact the clinic directly to verify your benefits.
How many pelvic floor therapy sessions will I need before seeing results?
Many patients notice improvement within a few visits, though this varies based on the condition and individual factors. A typical course of care ranges from 8 to 12 weeks, with one or two sessions per week. Your therapist will regularly reassess your progress and adjust the plan accordingly. My goal as a therapist is to have your issue resolved and for you to leave my practice empowered with at home exercises you can use to avoid seeing me again (though you are always welcome back if you have new issues!)
Can pelvic floor therapy help avoid surgery or medication?
In many cases, yes. Pelvic floor physical therapy is often recommended as a first-line treatment and can significantly reduce or resolve symptoms without the need for medication or surgery. For some patients, pelvic floor therapy helps delay or avoid more invasive interventions altogether.