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Pelvic Floor Dysfunction: How Physical Therapy in Brooklyn Can Help

By Dr. Jack Engelberg, PT, DPT · · 4 min read

Leaking a little when you cough, sneeze or jump. Rushing to the bathroom and not always making it in time. Pelvic pain, pain with intimacy, or a sense of heaviness after having a baby. These problems are very common and very treatable, yet many people never mention them to anyone, assuming they're just part of having children or getting older. Pelvic floor physical therapy is a specialized area of PT that addresses these concerns directly, for women and men.

What Is the Pelvic Floor?

The pelvic floor is a group of muscles, ligaments and connective tissue that stretches like a hammock across the bottom of the pelvis, from the pubic bone in front to the tailbone in back. These muscles:

  • Support the bladder, bowel and, in women, the uterus
  • Help control urination and bowel movements
  • Contribute to sexual function
  • Work with the deep abdominal muscles, diaphragm and back muscles to stabilize the trunk

What Is Pelvic Floor Dysfunction?

Pelvic floor dysfunction happens when these muscles are too weak, too tight, poorly coordinated, or a combination. Both "too weak" and "too tense" can cause symptoms, which is why a proper evaluation matters.

Common Symptoms

  • Stress urinary incontinence — leaking with coughing, sneezing, laughing, lifting or exercise
  • Urge incontinence — a sudden, strong urge to urinate with difficulty holding it
  • Frequent urination or getting up often at night
  • Pelvic organ prolapse symptoms — heaviness, pressure or a bulge in the vaginal area
  • Pelvic pain — in the pelvis, genitals, tailbone or low back
  • Pain with intercourse
  • Constipation or difficulty emptying the bowels
  • Bowel leakage

What Causes Pelvic Floor Problems?

  • Pregnancy and childbirth — including vaginal delivery and C-section
  • Menopause — hormonal changes affect pelvic tissues
  • Chronic straining — from constipation or heavy lifting
  • Chronic coughing
  • High-impact exercise
  • Prostate surgery — in men, leakage after prostatectomy is common
  • Pelvic surgery
  • Holding tension — stress and habitually tightening the pelvic floor can lead to pain
  • Low back and hip problems — which often interact with pelvic floor function (see low back pain)

How Pelvic Floor Physical Therapy Helps

Pelvic floor muscle training is a well-supported first-line treatment for stress urinary incontinence in women, and pelvic floor therapy can help with a range of other bladder, bowel and pain conditions.

Evaluation

Your therapist will take a detailed and private history covering bladder and bowel habits, pregnancy and birth history, pain and your goals. They'll assess posture, breathing, the abdominal wall, hips and low back. With your consent, an internal assessment may be offered to evaluate pelvic floor muscle strength, coordination and tension. It's always your choice, and external approaches are available.

Treatment May Include

  • Pelvic floor muscle training — learning to contract and, just as importantly, fully relax these muscles
  • Coordination with breathing and core — so the pelvic floor works well during lifting and exercise
  • Bladder training — gradually extending time between bathroom trips for urgency and frequency
  • Bowel habits and positioning — such as using a footstool on the toilet
  • Manual therapy — for tight or painful tissues
  • Postpartum recovery — including abdominal separation (diastasis recti) and safe return to exercise
  • Pre- and post-prostatectomy rehab for men

What You Can Do at Home

  • Don't strain on the toilet. Raise your feet on a small stool and breathe out gently.
  • Stay hydrated. Cutting fluids often makes urine more concentrated and irritating to the bladder.
  • Limit bladder irritants like caffeine, alcohol and carbonated drinks if urgency is a problem.
  • Avoid "just in case" bathroom trips, which can train the bladder to signal more often.
  • Exhale on effort. Breathe out when lifting, standing or pushing.
  • Get evaluated before doing endless Kegels. If your muscles are already tight, more squeezing may make symptoms worse.

When to See a Pelvic Floor Physical Therapist

Consider an evaluation if you have:

  • Leaking with activity or urgency
  • Pelvic pain or pain with intercourse
  • Pelvic heaviness or pressure
  • Ongoing postpartum concerns, whether your baby is 6 weeks or 6 years old
  • Bladder or bowel issues after prostate or pelvic surgery

See a physician promptly for blood in the urine or stool, signs of a urinary tract infection, sudden loss of bladder or bowel control (especially with back pain or numbness in the groin), unexplained weight loss, or new severe pelvic pain.

Frequently Asked Questions

Is leaking after childbirth normal?

It's common, but it's not something you have to live with. Pelvic floor therapy often helps.

Do men have pelvic floor problems?

Yes. Men can have incontinence, pelvic pain and other pelvic floor issues, particularly after prostate surgery.

Is pelvic floor therapy offered at every Refuah office?

Pelvic floor therapy is a specialized service. Please call the office nearest you to ask whether it's available there and with whom.

Ready to get started? Call the Refuah office nearest you

Pelvic floor therapy is a specialized service, so call the office nearest you to ask whether it’s available there. You can also book online at refuahpt.com.

Book at refuahpt.com

About the author. Dr. Jack Engelberg, PT, DPT is a Doctor of Physical Therapy and owner of Refuah Physical & Occupational Therapy, with offices in Midwood and Boro Park, Brooklyn, and on Staten Island.

Medical disclaimer: This article is for general education only and is not medical advice, diagnosis or treatment. Everyone’s situation is different. Talk with your physician or a licensed physical therapist about your symptoms. If you think you have a medical emergency, call 911.

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