What Is Pelvic Floor Physical Therapy?
A Beginner’s Guide to Anatomy, Function, and Who Pelvic Floor PT Helps
Dr. Allea Francis, PT, DPT
Pelvic floor physical therapy is a specialized branch of physical therapy focused on restoring healthy function to the muscles, connective tissues, and nerves within the pelvic region. These muscles influence nearly every essential system—bladder, bowel, sexual health, core stability, circulation, and even aspects of reproductive and menstrual function.
Yet for many people, the pelvic floor feels like a mysterious or “hidden” part of the body. Without a clear understanding of where these muscles are or what they do, it becomes difficult to make sense of symptoms like leakage, pain, pressure, or sexual dysfunction; and knowing where to turn when these symptoms arise can be equally difficult.
So, What Exactly is Pelvic Floor Physical Therapy?
Pelvic floor physical therapy (PFPT) is a specialty within the broader scope of physical therapy. While general physical therapy focuses on restoring mobility, reducing pain, and improving movement, Pelvic floor PT focuses specifically on the muscles and structures at the base of the pelvis and all of the muscles and systems surrounding it. These muscles must contract, relax, lengthen; respond to pressure, support organs, regulate fluid movement, and coordinate with the breath. When they are overactive, underactive, weak, tight, uncoordinated, or overwhelmed by stress or injury, symptoms can arise throughout the entire body, not just in the pelvis.
Pelvic Floor PT evaluates not only the pelvic floor itself, but the whole system that influences it, which includes:
Spine + ribcage
Hips + glutes
Core + diaphragm
Nervous system regulation
Hormonal and reproductive health
Lifestyle, stress, and movement patterns
So, why might you need to see a Pelvic Floor Physical Therapist?
Basic Pelvic Floor Anatomy
To understand pelvic floor function, it helps to first visualize where these muscles live. The pelvic floor sits at the very bottom of the pelvis like a supportive hammock or bowl. Importantly: the pelvic floor is not one muscle—it is many muscles that make up a group.
Below, we have broken down the differing layers of the pelvic floor depending on anatomy at birth.
For people born with female anatomy:
13 muscles make up your pelvic floor:
Superficial Layer (closest to the outside):
Bulbospongiosus
Ischiocavernosus
Superficial transverse perineal
Perineal body
Urogenital Diaphragm (middle layer):
Deep transverse perineal
External urethral sphincter
External anal sphincter
Deep Pelvic Floor (levator ani + coccygeus):
Puborectalis
Pubococcygeus
Iliococcygeus
Coccygeus
Important supporting muscles inside the pelvic bowl:
Obturator internus (O.I.)
Piriformis (outside the bowl, but deeply connected)
Superficial muscles can be evaluated by a Physical Therapist externally. Uncomfortable sensations like burning, ripping, and tightness in the vulvar area suggests dysfunction with these muscles. As the Pelvic Floor muscles move further inward, sensations like deep burning, hitting a wall, and even abdominal pain may be experienced. These deeper layers can only be assessed internally, according to patient needs and explicit consent.
For people born with male anatomy:
11 muscles are housed in your pelvis:
Superficial / Urogenital Layer:
Bulbospongiosus
Ischiocavernosus
Superficial transverse perineal
Perineal body
External Anal Sphincter
Deep Pelvic Floor (similar to female anatomy):
Puborectalis
Pubococcygeus
Iliococcygeus
Coccygeus
Accessory Muscles:
Obturator internus
Piriformis
All of these structures work together to regulate pressure, maintain continence, support sexual function, and stabilize the spine and pelvis.
Is Your Pelvic Floor the Missing Link in Your Pain? Here’s What You Need to Know
What Do the Pelvic Floor Muscles Do?
Regardless of anatomy at birth, we can understand pelvic floor function using a simple method: the Five S’s and Two R’s.
First S: Support
The pelvic floor muscles provide internal support for:
The bladder
The uterus or prostate
The rectum
The intestines
Symptoms of dysfunction with support may look like:
Pelvic organ prolapse
Pressure or heaviness in the pelvis
Difficulty standing or walking without discomfort
Second S: Sphincteric Control
Pelvic floor muscles open and close the urethral and anal sphincters for healthy bladder and bowel function.
Dysfunction here may include:
Urinary leakage
Fecal or gas leakage
Urgency or hesitancy
Constipation
Incomplete bowel emptying
Third S: Sexual Function
Pelvic floor muscles play a key role in arousal, sensation, lubrication, engorgement, orgasm, and erectile function.
Dysfunction may look like:
Pain with intercourse
Erectile dysfunction
Pain with insertion
Difficulty or delayed reaching orgasm
Fourth S: Stability
The pelvic floor is part of the deep core, working with the diaphragm, transverse abdominis, and back muscles to provide stability within our abdomen.
Dysfunction may look like:
Low back pain
Hip or SI joint pain
Feeling unstable during exercise
Pressure with lifting or coughing
Fifth S: Sump-Pump (Circulation + Lymph Flow)
The pelvic floor helps circulate blood and lymph out of the pelvis, as the pelvis houses many lymph nodes.
Dysfunction may look like:
Pelvic congestion
Swelling or heaviness
Poor fluid movement or edema
Pelvic Pain
First R: Reproductive Function
The pelvic floor supports:
Menstrual flow
Pregnancy
Labor and delivery
Postpartum recovery
Dysfunction may look like:
Painful periods
Difficulty using menstrual products
Postpartum pressure or pain
Difficulty opening the pelvic floor with labor and delivery
Second R: Respiratory Function
The pelvic floor and diaphragm move together with every breath. When this rhythm is disrupted, pressure problems develop.
Dysfunction may look like:
Breath holding during exercise
Core instability
Pelvic pressure
With these functions in mind: Support, Sphincteric Control, Sexual Function, Stability, and Sump-Pump; alongside Reproductive and Respiratory function, let’s discuss when it might be time to see a Pelvic Floor PT.
Who Is Pelvic Floor Physical Therapy For?
Pelvic floor PT can help anyone experiencing symptoms in the areas discussed above. Common reasons people seek PFPT include:
Bladder Symptoms
Leakage with coughing, sneezing, running
Urgency or frequency
Hesitancy or retention
Interstitial cystitis-like symptoms
Bowel Symptoms
Constipation
Incomplete emptying
Painful bowel movements
Fecal or gas leakage
Sexual Pain + Dysfunction
Pain with intercourse or penetration
Vaginismus
Erectile dysfunction
Difficulty achieving orgasm
Pain + Pressure
Pelvic pain
Tailbone pain
Low back, hip, or groin pain
Pelvic heaviness or prolapse symptoms
Pregnancy + Postpartum
FAQ: I just had a baby, when should I see a Pelvic Floor Physical Therapist?
Nervous System + Stress-Related Symptoms
Chronic pelvic tension
High-tone pelvic floor
Pain flares connected to stress
Tonic & Phasic’s Holistic Approach to Pelvic Floor Care
At Tonic & Phasic, treatment is always individualized and grounded in whole-body healing. In treating any one of the symptoms above, chronic or unexplained; our sessions may include:
Internal and external pelvic floor assessment
Manual therapy
Nervous system regulation + breathwork
Vagus nerve stimulation
Herbal and nutrition strategies
Functional movement retraining
Core + hip stabilization
Education that builds lifelong body literacy
Our goal is not just to reduce symptoms—it’s to help individuals understand their bodies, reconnect to their inner balance, and build sustainable healing over time.
If you’re interested in learning how Pelvic Floor Therapy may support your health, give us a call at (949) 612-7695 and our care coordinator will be happy to help you.
You can also book with ease through our online portal. Click Book Now to see your options.
Dr. Allea Francis, PT, DPT is a Doctor of Physical Therapy who began her journey into pelvic health after being diagnosed with interstitial cystitis, an experience that fueled her passion for understanding and treating chronic pelvic pain. She has extensive expertise in managing complex conditions such as pudendal neuralgia, PGAD (persistent genital arousal disorder), rectal spasms, endometriosis, and interstitial cystitis.
In addition to her work with chronic pelvic pain, Dr. Allea has a special interest in the rehabilitation of pelvic organ prolapse and preventive care to prepare the body for labor and delivery. Her holistic, patient-centered approach integrates physical therapy with nutrition, mindfulness, and other complementary therapies to provide comprehensive and compassionate care.
