Often dismissed or misunderstood, pelvic floor dysfunction affects millions, limiting daily life and well-being. pelvic floor therapy offers holistic, personalized solutions, empowering individuals to regain strength, mobility, and confidence.
Pelvic floor physical therapy is an emerging field in the US, though in many European countries, pelvic floor rehabilitation is a standard part of women’s healthcare—widely practiced, culturally accepted, and integral to overall well-being. Here, pelvic floor dysfunction and its debilitating effects have long been shrouded in stigma and relegated to whispered conversations. Yet, the pelvic floor—a crucial network of muscles supporting the bladder, uterus, and rectum—is central to a wide range of health issues that affect people at various stages of life. When compromised, pelvic floor dysfunction can be profoundly debilitating, affecting everything from movement and sexual health to basic physical autonomy. Whether due to postpartum recovery or the natural changes of aging, this often-overlooked condition can severely limit daily life, causing people to avoid exercise, social activities, or even leave their homes. It’s time to break the silence, and acknowledge that these are not only conversations we can have—but conversations we must have.
Pelvic Floor Issues Affect Everyone
Pelvic floor issues can affect anyone—men, women, transgender individuals, and people of all ages. As Tylene Lizardi, a pelvic floor therapist at Monarch Physical Therapy in New Paltz, explains, it can be the new mom dealing with changes from pregnancy and vaginal delivery, someone recovering from a cesarean section or hysterectomy, an individual who has undergone gender reassignment surgery, a man with penile or testicular pain, the older gentleman who underwent a prostate procedure, a person trying to conceive but unable to have penetrative intercourse, or someone with endometriosis who finds themselves with abdominal and pelvic pain interfering with daily life.
However, pelvic floor dysfunction is most common among women, particularly as they age. Nearly 24 percent of women in the US experience pelvic floor disorders, such as urinary or fecal incontinence, constipation, painful intercourse, sexual dysfunction (including difficulty reaching orgasm), pelvic floor prolapse, and diastasis recti (the separation of abdominal muscles), according to the National Institutes of Health. These issues become even more prevalent with age, affecting over 40 percent of women aged 60 to 79, and nearly half of women aged 80 and older. Hormonal changes and the natural loss of muscle mass (known as sarcopenia) weaken the pelvic floor, often requiring extra effort to maintain strength through targeted exercises and proper nutrition.
The stigma surrounding pelvic floor dysfunction is a significant barrier. Many women are told incontinence or pelvic pain is simply a “normal” part of aging, childbirth, or surgery. As Lizardi points out, society often dismisses these issues with humor. “How many times have you heard a joke on TV or in conversations of, ‘Don’t make me laugh or I’ll pee myself?'” she asks. “While these problems are common, they’re not normal. I hear so many patients say, ‘I wish I had known about pelvic rehab sooner.'” For many, the first time they hear about pelvic floor therapy is years after they began experiencing symptoms. Even if a woman raises pelvic floor issues with her primary care doctor, many doctors are unfamiliar with pelvic floor physical therapy and may offer generic advice, such as doing more Kegels—an approach that can, in some cases, worsen the problem.
Luba Starostiak of Lotus Physical Therapy in New Paltz and Rockland highlights that women’s health issues in general have been historically under-researched, contributing to the dismissal of pelvic health concerns. “When women complain about pain or dysfunction, their concerns are not always taken seriously,” she says. “This has led to a lack of proper care and understanding.” However, as awareness grows, pelvic floor physical therapy has emerged as a valuable treatment for many pelvic health concerns, empowering individuals to regain control over their bodies and live without the limitations these issues often impose.
Pelvic Floor Physical Therapy
Pelvic floor physical therapy begins with a thorough assessment, often involving vaginal or rectal assessments, to identify the muscles or systems contributing to the dysfunction. Based on this evaluation, therapists may use targeted exercises, biofeedback, electrical stimulation, and manual techniques like myofascial release and vaginal dilation to help retrain the muscles. In addition to physical treatments, therapists provide guidance on diet, relaxation techniques, breathing exercises, and other lifestyle factors, and create a personalized, progressive program incorporating orthopedic, neurological, and manual therapy techniques. At-home exercises, such as stretching, stress management, core stability work, and vaginal weights, may be included as part of the comprehensive treatment plan. While therapy in the office is important, much of the healing happens through self-care and consistent at-home practice.
Diet and Lifestyle Factors
Diet can play a key role in pelvic floor health, with certain foods and beverages exacerbating both urinary and bowel incontinence. Starostiak explains that acidic foods like coffee, black tea, citrus, and tomato-based products can irritate the bladder lining, leading to increased contractions and leakage. Similarly, inadequate hydration can lead to concentrated urine, which further irritates the bladder lining. Starostiak also notes inadequate fiber intake or foods that cause gas or bloating can contribute to constipation, putting pressure on the bowel and bladder. She also highlights the importance of addressing food sensitivities, such as those related to irritable bowel syndrome, suggesting to see a nutritionist or gastroenterologist.
However, Lizardi is quick to emphasize the importance of a tailored approach to diet: “This is very individual. There is a lot of fear-based information to avoid specific foods and beverages or follow restrictive dieting plans, which can be harmful,” she says. “It is important to work with a multidisciplinary team to identify potential food triggers and the safest way to address them.”
Beyond diet, other lifestyle factors are essential for maintaining pelvic health. Staying hydrated by drinking four to six ounces of water per hour, emptying your bladder every two to four hours, and practicing mindful elimination (taking time and relaxing when using the bathroom) can help support pelvic function. Moving your body in ways that bring you joy, getting out in nature and enjoying morning sunlight, and finding ways to manage stress like meditation or meaningful social interactions are also important for overall well-being.
A Holistic, Individualized Approach
Although Kegel exercises (or pelvic floor contractions) are commonly recommended for pelvic floor dysfunction, they are not always the solution. Dr. Kegel, who developed these exercises, believed they could strengthen pelvic muscles, but the approach has evolved. As Starostiak notes, Kegels are not appropriate for everyone—especially for those with tight, high-toned pelvic floors where relaxation and stretching are more beneficial. Similarly, Lizardi emphasizes that pelvic floor dysfunction can stem from a variety of causes, including weak, overactive, or uncoordinated muscles, or even issues outside the pelvis, like hip or foot problems. Therefore, a personalized, comprehensive approach is essential, targeting the root cause rather than relying on a one-size-fits-all method like Kegels.
Each person’s care is tailored to their specific issues and goals. “There is no one-size-fits-all approach,” Lizardi says. “A good physical therapist will understand the patient’s story. We look at the whole person. Pelvic floor issues tend to encompass multiple systems—nervous, musculoskeletal, immune, gastrointestinal, and urinary. We must wear many hats and understand how various body systems interact to impact the patient’s symptoms and how to best address them.”
“Each individual is unique,” Starostiak agrees. “There is no cookie-cutter recipe for treating pelvic floor dysfunction.”
When seeking treatment, be sure to find a physical therapist with specialized training in pelvic floor rehabilitation to ensure the best care for your needs. You can get a referral from your primary care doctor, OB/GYN, or midwife, or reach out directly to a physical therapist with expertise in pelvic health. Some therapists accept insurance, while others may not, so it’s important to confirm coverage beforehand. In the Hudson Valley, there are pelvic floor specialists working in both private practices and larger medical groups, including Nuvance at Northern Dutchess Hospital and Vassar Brothers Medical Center. Through personalized, non-invasive therapy and lifestyle adjustments, individuals can effectively address pelvic issues and regain control, improving overall quality of life.
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This article appears in December 2024.
