Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed May 15, 2026
What is pelvic floor physical therapy?
Pelvic floor physical therapy is specialized rehab for the muscles, connective tissue, and nerves that support your bladder, uterus, and rectum. A trained therapist checks how well these muscles work and builds a program around what they find. That might mean strengthening weak muscles, relaxing tight ones, improving coordination, or treating pain.
It is one of the treatments I talk about most with patients. The evidence behind it is strong, the risks are close to zero, and it works for a wide range of conditions.
What it treats
- Urinary leaking (stress, urge, and mixed types)
- Pelvic organ prolapse symptoms
- Overactive bladder
- Fecal (bowel) incontinence
- Pelvic pain and muscle tension
- Postpartum recovery
- Preparation for or recovery after surgery
It is more than Kegels
Most people associate pelvic floor therapy with Kegel exercises. Kegels are part of it, but a full program goes well beyond squeezing.
Your therapist may work on:
- Muscle strengthening, including endurance and power
- Relaxation and lengthening of tight or overactive muscles
- Coordination training, like learning to contract your pelvic floor right before a cough or sneeze (called “the Knack”)
- Surrounding muscles like your hips, inner thighs, core, and buttocks
- Breathing patterns and posture
- Biofeedback, where a sensor gives you visual or audio cues so you can see how your muscles are working
- Bladder and bowel habits, such as urge suppression or timed voiding
This matters because many women have pelvic floor muscles that are too tight rather than too weak. A therapist trained in pelvic floor rehab can tell the difference and adjust your program.
What to expect
First visit (about 60 minutes):
- A conversation about your symptoms, your history, and what matters to you
- An external and internal check of your pelvic floor muscles
- Education about your anatomy and how it connects to your symptoms
- A starting exercise plan
It is normal to feel nervous about the internal exam. Your therapist should explain every step before it happens. You are in control the whole time. If something is uncomfortable, you can say so or stop.
Follow-up sessions (30-60 minutes):
- Checking your progress
- Adjusting exercises as your strength or coordination improves
- Adding biofeedback, manual therapy, or electrical stimulation if needed
- Strategies for managing bladder and bowel symptoms day to day
What the research shows
The evidence for pelvic floor physical therapy is strong across several conditions.
For stress urinary incontinence, a large Cochrane review found that 74% of women who did supervised pelvic floor training for 3 to 6 months reported their leaking was cured or improved. That compared to 11% with no treatment. Programs with regular one-on-one supervision from a trained therapist produced better results than home exercises alone.
For prolapse, the POPPY trial studied 447 women with stage I to III prolapse. Women who did individualized pelvic floor training had more symptom relief at 6 and 12 months and were half as likely to need further treatment compared to controls.
For mixed incontinence, the ESTEEM trial showed that adding pelvic floor training and bladder strategies to surgery cut the need for additional treatment nearly in half (8.5% vs 15.7%).
Long-term success depends on sticking with your exercises. One study found that while 95% of women were still exercising at 3 months, only about 27% met the full program goals at 12 months. The most common barrier was simply forgetting. Building exercises into a daily routine, like linking them to brushing your teeth, can help.
Finding the right therapist
Not all physical therapists have training in pelvic floor rehab. I recommend looking for a therapist with a specialty certification. The two main credentials are CAPP (Certificate of Achievement in Pelvic Physical Therapy) and WCS (Women’s Health Clinical Specialist), which is the highest level and includes pelvic pain. Our practice has in-office pelvic floor physical therapists, so I can often get patients started quickly.
References
- Wallace SL, Miller LD, Mishra K. Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Curr Opin Obstet Gynecol. 2019. doi:10.1097/GCO.0000000000000584
- Wu JM. Stress incontinence in women. N Engl J Med. 2021. doi:10.1056/NEJMcp1914037
- Hagen S, Stark D, Glazener C, et al. Individualised pelvic floor muscle training in women with pelvic organ prolapse (POPPY): a multicentre randomised controlled trial. Lancet. 2014. doi:10.1016/S0140-6736(13)61977-7
- ACOG Committee on Practice Bulletins—Gynecology; AUGS. Urinary incontinence in women (Practice Bulletin No. 155). Obstet Gynecol. 2015. doi:10.1097/AOG.0000000000001148
- Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017. doi:10.1001/jama.2017.12137
- Carberry CL, Tulikangas PK, Ridgeway BM, et al. AUGS best practice statement: evaluation and counseling of patients with pelvic organ prolapse. Urogynecology. 2025. doi:10.1097/SPV.0000000000001641
- Richter HE, Burgio KL, Brubaker L, et al. Continence pessary compared with behavioral therapy or combined therapy for stress incontinence. Obstet Gynecol. 2010. doi:10.1097/AOG.0b013e3181d055d4
- Borello-France D, Burgio KL, Goode PS, et al. Adherence to behavioral interventions for stress incontinence: rates, barriers, and predictors. Phys Ther. 2013. doi:10.2522/ptj.20120072
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