Pelvic Health FAQ

Pelvic rehabilitation is a non-surgical approach used to improve pelvic (floor) dysfunction.
Pelvic floor dysfunction may lead to urinary, reproductive, gastrointestinal, sexual health issues, as well as pain.

Interventions in pelvic rehabilitation may include:
behavioral strategies, manual therapy, biofeedback, therapeutic modalities, exercise training, education, and functional retraining.

During the initial assessment, I will explain whether evaluating your pelvic floor function is necessary.
Assessment may include pelvic floor muscle strength, mobility, coordination, and whether there is overactivity or signs of irritation.

An internal exam is one method of assessment and can provide valuable information about pelvic floor muscle condition.
However — you are never required to undergo an internal exam.
If you prefer not to, we can focus on external assessment, movement testing, and discussing symptoms to understand your condition and develop a treatment plan.

Internal examinations are recommended only when appropriate and with your full consent. Many individuals choose to proceed after some time, once they feel informed and comfortable.

No, they are different.

A pelvic rehabilitation internal exam does not use a speculum.
Its purpose is to evaluate pelvic floor muscle function.

An OB-GYN internal exam focuses on medical diagnosis, such as checking structural abnormalities, infections, or other medical issues.

A pelvic rehabilitation internal exam evaluates how your pelvic floor muscles work — including contraction, relaxation, coordination, and muscle tension.
This information helps determine the most appropriate rehabilitation approach.

During rehabilitation, when pain or symptoms improve and pelvic floor muscle function becomes clearer, some individuals may feel ready to proceed with an internal exam.
Others may rely on external assessment and functional evaluation. Both are acceptable.

If a medical condition is suspected (e.g., infection, bleeding, structural concern), we will recommend seeing an OB-GYN instead, as pelvic rehabilitation cannot replace medical diagnosis.

Not necessarily.

Most women receive a vaginal internal exam, but if symptoms are primarily related to the rectum or anal area — such as rectal/anal muscle discoordination — the assessment may be performed rectally instead.

For men, pelvic floor evaluation is done rectally, as this is the appropriate way to assess pelvic floor muscle function.

A large part of the first visit is education.
If an internal pelvic floor exam is appropriate and you feel comfortable, we may perform it to assess pelvic floor muscle function.

Many people have never seen or sensed their pelvic floor muscles before, and learning to understand and feel your pelvic floor is often the first and most important step of rehabilitation.

After discussing your medical history and understanding your goals and expectations, we will decide together whether an internal exam is necessary.
If your condition is clear and the initial findings do not require an internal exam, we may begin with external assessment and functional evaluation instead.

As patients gain a better understanding of their body and pelvic floor, treatment often progresses more smoothly.
Knowledge is empowering.

Internal pelvic floor examination is generally not recommended under the following conditions:

• Pregnancy

• Within 6 weeks postpartum

• Within 6 to 12 weeks after abdominal or pelvic surgery

• Active urinary tract infection (UTI)

• Pelvic or vaginal infection

• Any acute condition where internal examination may worsen symptoms or delay healing

During pelvic rehabilitation, one of our goals is to help patients gradually sense the presence and movement of their pelvic floor muscles, and learn how to control them. This process is called pelvic floor awareness.

Many people have never consciously paid attention to their pelvic floor—just like we rarely think about how we walk or breathe, even though these muscles work constantly in daily life. The pelvic floor is located deep within the body, making it harder to visualize or feel without guidance.

Through proper education or rehabilitation training, individuals can learn to better sense, coordinate, and intentionally activate or relax their pelvic floor muscles. Improved awareness not only enhances exercise performance and posture, but also plays a critical role in preventing and treating pelvic floor dysfunction.

Developing pelvic floor awareness is an essential first step in pelvic rehabilitation.

Pelvic rehabilitation is helpful for anyone experiencing symptoms related to pelvic floor dysfunction or pelvic-related conditions.

For people who want to stay active without pain or limitations, pelvic rehabilitation can be especially important.
For example, individuals with hip muscle weakness may find activities like walking or climbing stairs more difficult. Strengthening the pelvic and hip muscles can improve daily function and reduce discomfort.

Other examples include people with:

• Lower back, hip, or pelvic pain

• Discomfort related to posture or prolonged sitting

• Pelvic symptoms that worsen during exercise or certain movements

• Pain or tightness after long periods of stress

• Symptoms that influence daily quality of life

Some individuals prefer conservative treatment first, while others seek rehabilitation before or after surgery to optimize recovery.

Whenever symptoms arise, it is helpful to undergo an evaluation to understand the cause and determine whether pelvic rehabilitation is appropriate.

Kegel exercises, introduced in 1948 by American gynecologist Dr. Arnold H. Kegel, are designed to strengthen the pelvic floor muscles. When performed correctly, Kegel exercises can help improve pelvic floor function and are often used to prevent or treat urinary incontinence after childbirth.
Over the years, they have become widely known and promoted in both women and men. However, Kegel exercises are not suitable for everyone, and doing them incorrectly may worsen certain symptoms.

Here are situations where Kegel exercises may be harmful or ineffective:

1. Over-tightened pelvic floor muscles
   If your pelvic floor is already tense or overactive, performing Kegels may increase this tightness and worsen symptoms such as pelvic pain, painful sex, constipation, or difficulty emptying the bladder.

2. Incorrect muscle activation
   Many people mistakenly contract their abdominal muscles, buttocks, or inner thighs instead of the pelvic floor. Without proper activation, Kegels become ineffective.

3. Not appropriate for your condition
   In some people—especially those with pelvic pain, prolapse symptoms, or difficulty relaxing—the repeated squeezing of Kegels may increase downward pressure or worsen discomfort.

4. Lack of guidance or overtraining
   Performing excessive or poorly guided Kegels can fatigue the pelvic floor or create imbalances, leading to worsening symptoms over time.

To know whether Kegel exercises are right for you, it's best to receive an assessment and proper instruction from a pelvic health professional.

Pelvic rehabilitation can benefit anyone whose quality of life is affected by urinary issues, bowel dysfunction, pelvic pain, sexual discomfort, or core stability problems. Common reasons for seeking pelvic rehab include urinary incontinence, frequency, urgency, nocturia, difficulty emptying, and sensations of incomplete voiding. Individuals with pelvic pain—such as chronic pelvic pain, perineal pain, vulvar pain, or prostatitis-like discomfort—may also benefit greatly.

Many women seek pelvic rehabilitation for dyspareunia, postpartum pelvic instability, diastasis recti, or symptoms related to pelvic organ prolapse. Men frequently visit due to pelvic floor dysfunction, ejaculatory pain, or urinary incontinence following prostate surgery. Bowel-related issues such as chronic constipation, obstructed defecation, and anorectal muscle dysfunction are also closely linked to pelvic floor health and respond well to targeted rehabilitation.

Pelvic rehab is likewise helpful for individuals recovering from pelvic, gynecologic, urologic, or prostate surgeries, supporting the restoration of normal urinary, bowel, and pelvic floor function. Those aiming to improve deep core stability, posture, or athletic performance will also find pelvic rehabilitation beneficial.

Pelvic rehabilitation begins with a thorough medical history and a detailed physical examination. When appropriate, this includes an internal pelvic floor assessment to evaluate muscle tone, strength, coordination, pain sources, and pressure management. All treatment plans are individualized—no single device or technique is used for everyone.

One of the most valuable clinical tools is ultrasound, which provides real-time visualization of the deep core (diaphragm, transversus abdominis, multifidus, and pelvic floor), pelvic organ support, and post-void residual. Seeing their own pelvic floor move on screen often helps patients learn correct activation and relaxation more effectively.

EMG biofeedback converts pelvic floor muscle activity into visual waveforms, helping patients understand patterns of over-recruitment or under-recruitment. For individuals who struggle with initiating pelvic floor contraction, neuromuscular electrical stimulation (NMES) may support early activation.

For urgency, frequency, or overactive bladder symptoms, tibial nerve stimulation (TTNS/PTNS) may be used. This neuromodulation technique adjusts bladder signaling rather than strengthening muscles.

When muscle tightness, myofascial restrictions, postoperative scar discomfort, or chronic pelvic pain are present, manual myofascial release (MFR) is often incorporated. MFR uses gentle but targeted hands-on techniques to release tension and improve mobility. Depending on clinical findings and patient preference, it may be complemented by dry needling, extracorporeal shockwave therapy (ESWT), or guided use of a pelvic wand.

Some patients encounter equipment popularly referred to as a “pelvic electromagnetic chair” (commonly marketed as G-chair). Its mechanism is HIFEM (High-Intensity Focused Electromagnetic), a form of rPMS (repetitive Peripheral Magnetic Stimulation). This technology provides deep, non-invasive pelvic floor stimulation and is helpful for individuals with significant pelvic floor weakness, postpartum recovery needs, or impaired deep muscle activation.

Exercise tools such as yoga balls, resistance bands, and balance pads support strengthening, posture training, coordination, and translating clinic-based learning into daily routines.

Ultimately, all devices are adjuncts.

The foundation of pelvic rehabilitation remains: accurate assessment, individualized exercise prescription, breathing and pressure regulation, posture optimization, and meaningful lifestyle change.