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Pelvic Floor
Strengthening
The Role of Pelvic Floor Exercise and Physical Therapy in Prolapse and Incontinence Management

Pelvic floor muscle training is an established and effective component of management for pelvic organ prolapse and stress urinary incontinence. Done correctly — with proper technique, appropriate progression, and professional guidance — it produces meaningful improvement in symptoms for most women with mild to moderate pelvic floor dysfunction. Done incorrectly — as many women are doing their Kegel exercises — it produces little benefit and delays effective management.

Dr. Ramona D. Andrei, MD, PhD, FACOG integrates pelvic floor physical therapy referral into the management of pelvic floor disorders at both our Lapeer and Rochester Hills offices.

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Board-certified gynecology & minimally invasive surgery  ·  Most major insurances accepted
Serving Lapeer County & Oakland County

Pelvic Floor Muscle Training — What It Does and What It Does Not Do

The pelvic floor is a group of muscles — primarily the levator ani complex — that form the base of the pelvis and provide dynamic support for the pelvic organs. These muscles contribute to urethral closure during increases in intra-abdominal pressure, provide a supportive platform that reinforces the ligamentous support of the pelvic organs, and are involved in bowel and bladder control and sexual function.

Pelvic floor muscle training (PFMT) — most commonly described as Kegel exercises — strengthens these muscles through repeated voluntary contraction and relaxation. When performed correctly, with attention to proper muscle identification, contraction technique, and progressive overload, PFMT produces measurable improvements in pelvic floor muscle strength, coordination, and endurance that translate into reduced urinary leakage and reduced prolapse symptom severity.

The critical distinction that the gynecologic and physical therapy literature consistently emphasizes is that supervised PFMT — directed by a trained pelvic floor physical therapist who confirms correct muscle activation and progresses the exercise program systematically — is significantly more effective than unsupervised self-directed exercise. The majority of women who attempt Kegel exercises on their own are not contracting the correct muscles, are not achieving adequate intensity or progression, or have pelvic floor dysfunction that requires assessment before exercise is appropriate. A referral to pelvic floor physical therapy is not simply a recommendation to do exercises — it is a referral to a clinical intervention with a professional.

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What Pelvic Floor Strengthening Can and Cannot Achieve

Setting realistic expectations is an essential part of pelvic floor exercise counseling. The following reflects the evidence-based scope of what pelvic floor muscle training can achieve for different pelvic floor conditions.

For Stress Urinary Incontinence — Strong Evidence of Benefit

Pelvic floor muscle training is the first-line treatment recommended for stress urinary incontinence by all major gynecologic and urology professional societies, with the strongest evidence base of any conservative intervention. Supervised PFMT reduces stress leakage episodes by 50 percent or more in the majority of women with mild to moderate SUI. Complete resolution is achievable for some women, particularly those with predominantly muscular weakness. Improvement is typically apparent within 6 to 12 weeks of consistent supervised training and continues to accumulate with ongoing practice.

For Pelvic Organ Prolapse — Symptom Reduction, Not Structural Repair

Pelvic floor muscle training for prolapse reduces the symptomatic burden of prolapse — pelvic pressure, bulge awareness, and urinary symptoms associated with prolapse — by improving the dynamic muscular support that reinforces ligamentous pelvic floor support. It does not repair the structural fascial defects that allow prolapse. Women with mild to moderate prolapse who complete a supervised PFMT program typically report meaningful reduction in symptoms and may experience slowed or halted prolapse progression. PFMT alone is unlikely to provide adequate symptom relief for severe prolapse, but it improves outcomes when combined with pessary management and prepares the pelvic floor for better surgical recovery when surgery is ultimately performed.

For Urge Incontinence and Overactive Bladder — Behavioral and Muscle Components

Pelvic floor muscle training for urge incontinence and overactive bladder incorporates a behavioral component — urge suppression technique using pelvic floor contraction at the moment of urgency — alongside strength training. This combined approach reduces urge leakage episodes and bladder urgency by training both the muscular contraction reflex and the central nervous system suppression of the void reflex. Evidence supports supervised PFMT with behavioral training as effective first-line management for urge incontinence.

Postoperative Pelvic Floor Rehabilitation

Pelvic floor physical therapy after prolapse or incontinence surgery is increasingly recognized as an important component of optimizing surgical outcomes and reducing recurrence risk. Postoperative PFMT rebuilds muscle strength that may have been affected by surgery, addresses scar tissue mobility, and re-establishes functional pelvic floor coordination that supports the anatomic repair. Dr. Andrei routinely recommends postoperative pelvic floor physical therapy as part of the postoperative care plan for pelvic reconstructive surgery patients at Lapeer Women’s Health.

When Pelvic Floor Exercises Should Not Be Started Without Assessment

Not all pelvic floor dysfunction responds to strengthening exercises. Pelvic floor physical therapy assessment first — before starting any exercise program — is important when:

  • Pelvic pain is present — a hypertonic (overactive) pelvic floor requires relaxation therapy, not strengthening
  • Pelvic floor exercises are making symptoms worse rather than better — this may indicate pelvic floor hypertension
  • There is uncertainty about whether the correct muscles are being contracted — as is the case for the majority of women attempting self-directed Kegel exercises
Lapeer: (810) 969-4670  ·  Rochester Hills: (248) 923-3522
Pelvic Floor Physical Therapy — What the Referral Process Looks Like

Pelvic floor physical therapy referrals at Lapeer Women’s Health are coordinated by Dr. Ramona D. Andrei, MD, PhD, FACOG as part of the comprehensive pelvic floor management plan.

Gynecologic Evaluation First

Before a PFMT referral is made, a gynecologic evaluation establishes the specific pelvic floor diagnosis — which compartments are prolapsed, the degree of descent, the type of incontinence, and whether concurrent pelvic pain or hypertonic pelvic floor dysfunction is present. This information guides the physical therapy referral and ensures the physical therapist understands the clinical context.

What to Expect From Physical Therapy

A pelvic floor physical therapist performs an internal pelvic floor muscle assessment to evaluate strength, coordination, and tone. A personalized exercise program is designed based on the specific findings. Sessions typically occur weekly or biweekly for 6 to 12 weeks. Home exercise between sessions is an essential component. Most insurance plans cover pelvic floor physical therapy with appropriate diagnosis codes, which the referral from Lapeer Women’s Health provides.

Ongoing Pelvic Floor Maintenance

Pelvic floor muscle training is not a one-time intervention — maintenance exercise is required to preserve gains and prevent regression. After completing a supervised program, women are provided with a home maintenance protocol. Annual check-ins with the physical therapist or at Lapeer Women’s Health assess whether progression or modification of the home program is needed, particularly as postmenopausal tissue changes accumulate over time.

Are You Doing Kegels and Not Getting Results? There Is a Reason for That.

The vast majority of women who attempt pelvic floor exercises on their own — after being told to “just do Kegels” — are not doing them correctly. They are contracting accessory muscles instead of the pelvic floor, they are not achieving adequate contraction intensity, or they have pelvic floor dysfunction that requires assessment before exercise is appropriate. Unsurprisingly, they do not get results.

Supervised pelvic floor physical therapy, preceded by a gynecologic evaluation that establishes the clinical diagnosis and guides the referral, is a fundamentally different intervention than self-directed home exercises. It is a clinical treatment, not advice to exercise. And it works — for most women with mild to moderate pelvic floor dysfunction — when delivered correctly.

The evaluation that starts this process begins at Lapeer Women’s Health — at both our Lapeer and Rochester Hills offices, without a referral required.

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Frequently Asked Questions About
Pelvic Floor Strengthening
The most reliable way to confirm correct Kegel technique is an assessment by a pelvic floor physical therapist who can directly evaluate muscle activation during contraction. Research consistently shows that a significant proportion of women — some studies report more than half — contract the wrong muscles when attempting Kegel exercises without instruction, most commonly contracting the gluteal, thigh, or abdominal muscles instead of the pelvic floor. A physical therapist can teach correct technique, confirm muscle activation, and ensure that the exercise program is targeting the actual muscles it is intended to target.
Most women doing supervised PFMT begin to notice improvement in urinary leakage and pelvic floor function within 6 to 12 weeks of consistent practice. Maximum benefit typically accumulates over 3 to 6 months of regular training. Women who expect immediate results and discontinue the program when improvement is not apparent within a few weeks miss the window in which the program produces its most significant benefits. Consistency and correct technique over the full training period are the primary determinants of outcome.
Regular pelvic floor muscle training may reduce the risk of developing significant prolapse or delay its onset, though the evidence for primary prevention is less robust than for treatment of established prolapse or incontinence. Maintaining pelvic floor muscle strength throughout life — including during and after pregnancy, and in the postmenopausal years as tissue support diminishes — is a reasonable preventive strategy. The postpartum period is an important window for initiating supervised pelvic floor rehabilitation to address the muscle injury that occurs with vaginal delivery before it becomes symptomatic prolapse years later.
Pelvic floor-specific exercises — Kegels and pelvic floor physical therapy — do not worsen prolapse. High-impact and heavy resistance exercise can worsen prolapse symptoms by increasing intra-abdominal pressure during activity, but the solution is not to avoid exercise entirely. It is to modify the exercise program with guidance from a pelvic floor physical therapist who understands the specific prolapse anatomy. Many women with prolapse can continue an active exercise program with appropriate modification, breathing technique, and pelvic floor engagement strategies that reduce the prolapse-worsening effect of high-load activities.
Most major insurance plans cover pelvic floor physical therapy when it is ordered for an established clinical diagnosis — such as pelvic organ prolapse or stress urinary incontinence. A referral from Lapeer Women’s Health with the appropriate diagnosis codes is provided at your clinical visit. Coverage terms including copays, visit limits, and prior authorization requirements vary by plan. Our office staff can assist with insurance questions, and checking your specific plan’s physical therapy benefits before starting is recommended.
Yes. Pelvic floor physical therapy referrals are provided as part of comprehensive pelvic floor evaluation at both the Lapeer office (1245 N Main St, Lapeer, MI — (810) 969-4670) and the Rochester Hills office (2710 S Rochester Rd, Suite 2, Rochester Hills, MI — (248) 923-3522). No referral is required to schedule your initial evaluation at Lapeer Women’s Health.
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Related Pages
Board-certified gynecology & minimally invasive surgery  ·  Most major insurances accepted  ·  Convenient locations in Lapeer & Rochester Hills
Pelvic Floor Therapy Works — When It’s Done Right.

Our team at Lapeer Women’s Health provides the clinical evaluation and referral that makes pelvic floor physical therapy an effective intervention at both our Lapeer and Rochester Hills offices. No referral required.

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The information on this page is intended for educational purposes only and does not constitute medical advice. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.

Gynecologic care for women of every age

Lapeer Women’s Health — Lapeer
1245 N Main St
Lapeer, MI 48446
Lapeer: (810) 969-4670
Rochester Hills: (248) 923-3522

Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307

Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.