Biofeedback: This is the most common treatment, done with the help of a physical therapist. Biofeedback is not painful, and helps over 75% of people with pelvic floor dysfunction. Your physical therapist might use biofeedback in different ways to retrain your muscles. For example, they may use special sensors and video to monitor the pelvic floor muscles as you try to relax or clench them. Your therapist then gives you feedback and works with you to improve your muscle coordination.
The pelvic floor is a combination of multiple muscles with ligamentous attachments creating a dome-shaped diaphragm across the boney pelvic outlet. This complex of muscles spans from the pubis (anterior) to the sacrum/coccyx (posterior) and bilateral to the ischial tuberosities. The bulk of the pelvic musculature is the levator ani, composed of the puborectalis, pubococcygeus, and iliococcygeus. The puborectalis wraps as a sling around the anorectal junction accentuating the anorectal angle during contraction and is a primary contributor to fecal continence. Elevation and support of the pelvic organs are associated with the pubococcygeus and the iliococcygeus. The pubococcygeus is the most medial component which separates, fashioning the levator hiatus with openings for the urethra, vagina (females), and anus. The bulbospongiosus and ischiocavernosus muscles are the primary contributors to the superficial portion of the anterior pelvic floor. The more superficial musculature of the posterior pelvic floor constitutes the external anal sphincter. The transverse perineal muscles cross the mid-portion of the superficial aspect of the pelvic floor and coalesce with the bulbospongiosus muscles and external anal sphincter as the perineal body.
Kegels: American gynecologist Arnold Kegel created this seminal pelvic floor exercise. To do a Kegel, contract your muscles that stop the flow of urine, hold for five seconds, then release for five seconds. Repeat this exercise 10–15 times, up to three times per day. Avoid doing Kegel exercises when urinating since stopping the flow midstream can cause some urine to remain in your bladder, putting you at a higher risk of urinary tract infections (UTIs).
Building and maintaining a strong pelvic floor is crucial for women of all ages. The pelvic floor is a group of muscles at the bottom of your pelvis that supports the womb, bladder, and bowels. So if these muscles become weak—whether it's due to childbirth, pregnancy, aging, or weight gain—it may be challenging to control your bladder and bowel activity. This is referred to as incontinence, a condition that affects nearly 25 million Americans, 75% to 80% of which are women.
If an internal examination is too uncomfortable for you, your doctor or physical therapist may use externally placed electrodes, placed on the perineum (area between the vagina and rectum in women/testicles and rectum in men) and/or sacrum (a triangular bone at the base of your spine) to measure whether you are able to effectively contract and relax your pelvic floor muscles.
Pelvic floor dysfunction can be diagnosed by history and physical exam, though it is more accurately graded by imaging. Historically, fluoroscopy with defecography and cystography were used, though modern imaging allows the usage of MRI to complement and sometimes replace fluoroscopic assessment of the disorder, allowing for less radiation exposure and increased patient comfort, though an enema is required the evening before the procedure. Instead of contrast, ultrasound gel is used during the procedure with MRI. Both methods assess the pelvic floor at rest and maximum strain using coronal and sagittal views. When grading individual organ prolapse, the rectum, bladder and uterus are individually assessed, with prolapse of the rectum referred to as a rectocele, bladder prolapse through the anterior vaginal wall a cystocele, and small bowel an enterocele.[10]
Your pelvic floor is the group of muscles and ligaments in your pelvic region. The pelvic floor acts like a sling to support the organs in your pelvis — including the bladder, rectum, and uterus or prostate. Contracting and relaxing these muscles allows you to control your bowel movements, urination, and, for women particularly, sexual intercourse.
Patients may meet individually with a dedicated nurse educator who provides a focused session on bowel management techniques. Central to the process is a daily regimen that combines an evening dose of fiber supplement with a morning routine of mild physical activity; a hot, preferably caffeinated beverage; and, possibly, a fiber cereal followed by another cup of a hot beverage — all within 45 minutes of waking. This routine augments early morning high-amplitude peristaltic contractions by incorporating multiple colon stimulators.
Medications: Daily medications that help to keep your bowel movements soft and regular are a very important part of treating pelvic floor dysfunction. Some of these medications are available over-the-counter at the drugstore and include stool softeners such as MiraLAX®, Colace®, Senna or generic stool softeners. Your primary care doctor or a gastroenterologist can help to advise you which medications are most helpful in keeping your stools soft.
If an internal examination is too uncomfortable for you, your doctor or physical therapist may use externally placed electrodes, placed on the perineum (area between the vagina and rectum in women/testicles and rectum in men) and/or sacrum (a triangular bone at the base of your spine) to measure whether you are able to effectively contract and relax your pelvic floor muscles.
Biofeedback: This is the most common treatment, done with the help of a physical therapist. Biofeedback is not painful, and helps over 75% of people with pelvic floor dysfunction. Your physical therapist might use biofeedback in different ways to retrain your muscles. For example, they may use special sensors and video to monitor the pelvic floor muscles as you try to relax or clench them. Your therapist then gives you feedback and works with you to improve your muscle coordination.
Biofeedback uses electrodes placed on your body (on the perineum and/or the area around the anus) or probes inserted in the vagina or rectum to sense the degree of tenseness in your pelvic floor muscles. Results displayed on a computer or other device provide cues to help you learn to relax those muscles. Usually, patients feel relief after six to eight weeks of therapy. You may be able to buy or rent a unit to use at home.
There is not a surgery to treat pelvic floor dysfunction because it is a problem with your muscles. In rare circumstances, when physical therapy and biofeedback fail to work, your provider might recommend you see a pain injection specialist. These doctors specialize in localizing the specific muscles that are too tense or causing pain, and they can use a small needle to inject the muscle with numbing medication and relaxing medication. This is called trigger point injection.
There is not a surgery to treat pelvic floor dysfunction because it is a problem with your muscles. In rare circumstances, when physical therapy and biofeedback fail to work, your provider might recommend you see a pain injection specialist. These doctors specialize in localizing the specific muscles that are too tense or causing pain, and they can use a small needle to inject the muscle with numbing medication and relaxing medication. This is called trigger point injection.

For internal massage, your PT may insert a finger into the vagina or rectum and massage the muscles and connective tissue directly. A frequently used technique is “Thiele stripping,” in which your therapist finds a trigger point by feeling a twitch in the muscle underneath, exercising it using a circular motion, and then putting pressure on it to help relax it, repeating the process until the muscle starts to release. Internal massage can also help release nerves. Sometimes, anesthetics can be injected into these trigger points. PTs may do this in a few states, but in most states, a doctor or nurse must administer injections.


Squats: Squats are a great holistic exercise because they engage many muscles at once. To do a body-weight squat, stand with your feet shoulder-width apart, then slowly bend your knees, dropping your hips and glutes down and back, keeping your back straight, as if you’re sitting down on a chair. (You can place your hands on your hips or stretch them out in front of you for balance.) Bend your knees until your thighs are parallel with the floor, then return to an upright position. Repeat 10 times, up to three times per day.
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