How pelvic floor PT works — and what the first visit looks like
How pelvic floor PT works — and what the first visit looks like.
If you have been referred to pelvic floor physical therapy — or are considering scheduling an appointment on your own — you might feel uncertain about what actually happens in the room. That is completely normal. Pelvic floor PT is one of the most effective and least understood areas of physical therapy, and the uncertainty itself is often the biggest barrier to getting care that can make a meaningful difference.
This post walks through exactly what a pelvic floor evaluation looks like at Root Physical Therapy — from the moment you arrive through the end of your first session. Nothing is left vague. If you have been putting off scheduling because you were not sure what to expect, this is for you.
Before we begin: Everything that happens during a pelvic floor evaluation is explained to you before it happens. Nothing is performed without your explicit consent. You can decline any part of the assessment at any time, for any reason, and you will still receive excellent care. Your comfort sets the pace — always.
What pelvic floor PT actually treats
The pelvic floor is a group of muscles, ligaments, and connective tissue at the base of the pelvis. It supports the bladder, uterus, and rectum; maintains urinary and bowel continence; contributes to sexual function; and plays a role in lumbopelvic stability during movement. When these muscles are too weak, too tight, poorly coordinated, or damaged, the result is pelvic floor dysfunction — a broad category that includes conditions most people do not associate with physical therapy.
Pelvic floor PT can help with:
- Urinary incontinence — leaking when you cough, sneeze, laugh, jump, or exercise
- Urinary urgency — the sudden, intense need to urinate
- Pelvic organ prolapse — a sensation of heaviness, pressure, or bulging in the pelvis
- Pelvic pain — including pain during intercourse, chronic pelvic pain, vulvodynia, and coccydynia
- Postpartum recovery — diastasis recti, perineal tearing, C-section scar management, return to activity
- Pregnancy-related pain — pelvic girdle pain, pubic symphysis dysfunction, low back pain during pregnancy
- Constipation and bowel dysfunction
- Pre- and post-surgical pelvic rehabilitation
A 2019 review published in Current Opinion in Obstetrics and Gynecology found that pelvic floor physical therapy is an effective first-line treatment for stress urinary incontinence, pelvic organ prolapse, and pelvic pain — with outcomes comparable to or exceeding surgical intervention for many patients (Wallace et al., 2019). Yet the majority of women with pelvic floor symptoms never receive a referral or seek evaluation.
Your first visit: step by step
A first visit at Root Physical Therapy lasts approximately 60 minutes. It takes place in a private treatment room — not an open gym space. Here is what each part involves.
The conversation
Your evaluation begins with a detailed discussion of your symptoms, medical history, and goals. Dr. Dizon will ask about your urinary and bowel habits, menstrual history, pregnancy and delivery history (if applicable), sexual health, pain patterns, and exercise or training activities. These questions may feel personal — they are asked because pelvic floor function intersects with all of these areas, and understanding the full picture is what allows treatment to be effective rather than generic.
Approximately 15–20 minutes
The external physical assessment
While you remain fully clothed, your therapist will assess your posture, breathing mechanics, hip mobility, lumbar spine movement, core stability, and lower extremity strength. The pelvic floor does not function in isolation — it is part of a larger system that includes the diaphragm, deep core muscles, and hip musculature. Dysfunction in any of these areas can contribute to or mimic pelvic floor symptoms. This portion of the evaluation looks and feels similar to any standard orthopedic PT assessment.
Approximately 15 minutes
The internal pelvic floor assessment (with your consent)
If clinically appropriate and with your explicit consent, Dr. Dizon will perform an internal assessment of the pelvic floor muscles. This involves the insertion of one gloved, lubricated finger — vaginally or rectally — to evaluate muscle tone (is the pelvic floor too tight or too lax?), strength (can you generate a contraction?), coordination (can you contract and fully relax on command?), and the presence of tender points or trigger points.
This is not a gynecological exam. There are no stirrups, no speculum, and no instruments. It is a manual muscle assessment — the same kind of hands-on evaluation a PT would perform on any other muscle group in the body, adapted for the pelvic floor. The assessment is described to you in detail before it begins, and your therapist checks in with you throughout.
If you prefer not to have an internal assessment, that is completely fine. Treatment can proceed based on external findings, symptom history, and functional testing. Many patients choose to defer the internal assessment to a second or third visit once they feel more comfortable — and that is a perfectly valid approach.
Approximately 10 minutes
Assessment findings and treatment plan
After the evaluation, Dr. Dizon will explain what she found — in clear, straightforward language. You will learn whether your pelvic floor is presenting with hypotonicity (weakness), hypertonicity (excessive tension), coordination deficits, or a combination. She will explain how these findings connect to your symptoms and outline a treatment plan with specific goals, expected frequency (typically weekly for 6 to 12 weeks), and what you will be working on between sessions.
Approximately 10 minutes
Initial treatment and home program
Most first visits include the beginning of treatment. Depending on your findings, this may include manual therapy to release hypertonic muscles, pelvic floor muscle re-education (learning to correctly contract and relax — which is not the same as doing Kegels), breathing and coordination exercises, and an initial home exercise program. You will leave your first visit with a clear understanding of what is happening, why it is happening, and what you can start doing today.
Approximately 10 minutes
Common concerns addressed
"Will it be painful?"
The internal assessment should not be painful. You may feel pressure or mild discomfort if there are areas of tension or tenderness — which is clinically useful information — but the goal is never to cause pain. Your therapist adjusts pressure based on your feedback throughout, and you can stop at any point.
"I am on my period — should I reschedule?"
No. Menstruation does not affect the quality of the assessment. However, if you would prefer to reschedule for comfort reasons, that is entirely your choice.
"I have never had anyone examine me there — is this normal PT?"
Yes. Internal pelvic floor assessment is a standard, evidence-supported component of pelvic health physical therapy, performed by physical therapists with specialized training. It is the most direct way to evaluate whether the pelvic floor muscles are functioning correctly. Just as an orthopedic PT would palpate your rotator cuff to assess shoulder function, a pelvic health PT palpates the pelvic floor muscles to assess pelvic function. The setting, the draping, and the consent process are designed to make this as comfortable as possible.
"I was told to just do Kegels — is that wrong?"
Not necessarily wrong, but often incomplete. Kegels — pelvic floor contractions — are appropriate for some presentations and contraindicated for others. If your pelvic floor is hypertonic (too tight), Kegels will make the problem worse. Research has shown that up to 30% of women perform Kegels incorrectly even after instruction, and many women who have been told their pelvic floor is "weak" have never had an internal assessment to confirm whether weakness is actually the issue (APTA Pelvic Health, 2025). An assessment determines what you actually need — not what a generic recommendation assumes.
"Do I need a referral from my OB-GYN?"
No. Washington State has unrestricted direct access to physical therapy. You can schedule a pelvic floor evaluation directly without a referral from your OB-GYN, midwife, or primary care physician. If you do have a referral, that is helpful for care coordination — but it is not required.
What treatment looks like after the first visit
Follow-up sessions are typically 45 to 60 minutes, one to two times per week, for a course of care lasting 6 to 12 weeks depending on the condition. Treatment may include:
- Manual therapy — soft tissue mobilization, trigger point release, and scar tissue mobilization (for perineal tears and C-section scars)
- Pelvic floor muscle training — progressive strengthening, endurance work, and coordination training tailored to your specific findings
- Neuromuscular re-education — retraining the connection between your brain and your pelvic floor muscles, particularly for patients who have difficulty isolating or controlling these muscles
- Breathing and pressure management — coordinating the diaphragm, pelvic floor, and core to manage intra-abdominal pressure during daily activities and exercise
- Progressive loading and return to activity — structured reintroduction of exercise, running, lifting, or sport based on clinical criteria
- Behavioral modification — bladder retraining, fluid and dietary recommendations, and habit adjustments that complement the physical rehabilitation
The goal is not indefinite PT. It is to resolve your symptoms, build your understanding of how your body works, and give you the tools to manage your pelvic health independently going forward.
Who should consider pelvic floor PT
Pelvic floor dysfunction is common. It is not a normal part of aging, postpartum recovery, or being a woman. If any of the following apply to you, a pelvic floor evaluation is appropriate:
- You leak urine when you cough, sneeze, laugh, run, or lift — even a small amount
- You experience urgency or frequency that disrupts your daily routine
- You feel heaviness, pressure, or a sensation of something falling in the pelvis
- You have pain during intercourse that has not been explained by a medical evaluation
- You are pregnant and experiencing pelvic girdle pain, pubic symphysis pain, or low back pain
- You are postpartum — at any point, whether six weeks or six years — and have unresolved symptoms
- You are returning to strength training or combat sports after pregnancy and want to ensure your pelvic floor is ready
- You have been told your symptoms are "normal" but they are interfering with your quality of life
Ready to schedule your first visit?
Dr. Lorrainne Dizon sees patients in a private treatment room at Root Physical Therapy, Georgetown. No referral required. Most major insurance accepted. We will verify your benefits before your first appointment.
Request an appointmentSources
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology. 2019;31(6):485–493. doi:10.1097/GCO.0000000000000584
- APTA Pelvic Health Division. What to expect during pelvic health physical therapy. 2025. Available at: aptapelvichealth.org
- Beamish NF, Davenport MH, Ali MU, et al. Impact of postpartum exercise on pelvic floor disorders and diastasis recti abdominis: a systematic review and meta-analysis. British Journal of Sports Medicine. 2025;59(8):562–575. doi:10.1136/bjsports-2024-108619
- Dufour S, Vandyken B, Forget MJ, Bhatt K. Association between lumbopelvic pain and pelvic floor dysfunction in women: a cross sectional study. Musculoskeletal Science and Practice. 2018;34:47–53. doi:10.1016/j.msksp.2017.12.001
- Bø K, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction. International Urogynecology Journal. 2017;28(2):191–213.