I’m Dr. Hope Cunningham, owner of Restore Hope Physical Therapy in Washington, DC, and I specialize in pelvic floor dysfunction using a whole-body approach.
If you’ve been to physical therapy before, you probably expect a combination of education, exercises, and hands-on work. Pelvic floor physical therapy is no different in that sense.
But the specific treatments often look and feel quite different from what you might have experienced in other physical therapy settings.
Many of my patients ask about the specific techniques I use because they’re often unfamiliar to them or used in ways they haven’t encountered before. This post walks you through the main pelvic floor therapy techniques I use at Restore Hope and explains how they work together to address pelvic pain, bladder and bowel dysfunction, and other pelvic floor conditions.
Manual Therapy: Listening Through Touch
When a new patient comes in for their initial evaluation, I start with an assessment. Based on the results, I choose which techniques will be most effective for that individual. Often I get a sense of this right away after listening to their story and observing their body. Sometimes it’s a process of gentle exploration.
One of the primary techniques I use is manual therapy.
Manual therapy in pelvic floor PT uses hands-on techniques to work with the muscles, connective tissues, and organs that support pelvic function. The goal is to reduce pain, restore movement, and improve how the bladder, bowel, and reproductive organs work together.
I often describe it as therapeutic massage because most people understand what that looks like: you’re on a table receiving hands-on work that has health benefits and feels relaxing. But there are key differences in how and why these techniques are applied.
Before becoming a pelvic floor physical therapist, I spent eight years as a massage therapist. That background gave me time to develop hands-on skills and intuitive touch. My physical therapy training then exponentially expanded my understanding of how the body works together to function and dysfunction.
Now I apply these techniques specifically to address bladder, bowel, and sexual dysfunction, as well as complex chronic pain.
I specialize in several forms of manual therapy. These pelvic floor therapy techniques each have their own specialized training in anatomy and hands-on application. While these techniques often overlap in practice, each brings something unique to treatment. Here’s what they are and how they work.
The Pelvic Floor Therapy Techniques I Specialize In
Myofascial Release
Fascia is connective tissue that creates a web throughout your entire body, connecting your skin, muscles, joints, and internal organs. When there’s inflammation or injury, fascia can become sticky and restrict movement.
Myofascial release uses gentle, sustained pressure to help these tissues move freely again.
Visceral Manipulation
This technique applies fascial work specifically to internal organs. The organs move and respond to touch differently than muscles or joints, and they can refer pain to seemingly unrelated areas.
A common example: kidney tension can feel like low back pain.
By addressing the fascial layers around organs with gentle stretching and breathing, we can often relieve pain that hasn’t responded to traditional treatments.
Trigger Point Release
Trigger points are tight bands within muscles where metabolic waste has built up. They cause pain and can cause discomfort to other parts of your body.
Releasing trigger points in hip muscles might relieve bladder pain. Releasing points in the abdomen might ease pelvic floor tension.
Craniosacral Therapy
This technique uses extremely light touch to release restrictions around the brain and spinal cord. It helps restore natural fluid movement throughout the body.
One of the most valuable skills I learned from this training: how to listen with my hands using the lightest possible touch.
How These Techniques Work Together
I often find these techniques overlapping in practice. Here’s what that looks like:
Someone with urinary urgency might have fascial adhesions between the bladder and hip muscles from endometriosis or Crohn’s disease. Or between the bladder and an abdominal scar from a C-section or hysterectomy.
Sometimes I’m working with pelvic floor muscles and find connections to the dura (the protective lining around your spinal cord that runs from skull to tailbone). After releasing fascial tension from the base of the skull down the spine, pelvic floor tightness and pain often diminish significantly or disappear altogether.
The body is deeply interconnected. These pelvic floor therapy techniques work together to address those connections.
Biofeedback: Retraining Your Pelvic Floor
Biofeedback helps you reconnect with your pelvic floor muscles and restore healthy function.
EMG Biofeedback Devices
Sometimes I recommend in-home biofeedback devices for pelvic floor muscle training. Examples are the Perifit or the Elvie. These devices provide real-time feedback on muscle engagement, helping you strengthen more effectively between sessions.They can be purchased directly, however I recommend seeing a Pelvic PT for an assessment first to determine if they are in fact are the right kind of strengthening for you. I do not receive any compensation for recommending these devices.
Rectal Balloon Biofeedback
Rectal balloons are the gold standard for treating outlet dysfunction constipation (constipation caused by pelvic floor dysfunction).
This is a treatment we do together in session. The balloon is inserted rectally and inflated to the size of a bowel movement. It helps you practice coordinating muscles and breathing for more effective, comfortable bowel movements. It can also be used to train sensation if your body is giving you either too much or too little notification of the presence of stool in your rectum.
Other Forms of Feedback
Tactile feedback: I use my hands to guide your attention to specific areas, helping you reconnect with muscles your brain has “forgotten.”
Visual feedback: Using a mirror to watch your muscles engage during movement can retrain patterns that aren’t working well.
Whole-Body Assessments: Looking Beyond the Pain
Many patients seek me out in Washington, DC specifically because they want a treatment approach that looks at how the entire body works together.
This is especially helpful for people with chronic pain that other therapies haven’t resolved.
What This Looks Like in Practice
I check pelvic and hip alignment in different positions: standing, squatting, sitting.
If you have pain while sitting (coccydynia, pudendal neuralgia, low back pain, hip pain), I need to see how your pelvis and hips relate in those positions. Sometimes the issue isn’t in the pelvis itself. It’s tight or weak tissue in the ribs, spine, shoulders, neck, or head creating a pull on the painful area.
A Recent Example
A patient came to me with vaginal pain specifically when walking. This is unusual.
I watched her walk and saw that one hip was significantly weaker, not supporting her pelvis well on that side. During the internal exam, her pelvic floor muscles were also much tighter on that same side.
After a month of daily hip strengthening combined with pelvic floor relaxation stretches, breathing techniques, and manual therapy to both areas, she improved dramatically.
The Education and Exercise Behind Pelvic Floor Techniques
Education
Education is a big part of pelvic floor physical therapy. We might discuss:
- Workspace ergonomics
- Child-carrying and breastfeeding positions
- Diet for bladder and bowel health
- How your body works to encourage healing
My goal is to give you a framework for understanding your body so healing can continue long after our sessions end.
Exercise
My philosophy: if it’s not enjoyable (or at least interesting) and takes too long, it won’t get done. This is true even for my own exercise routine.
I keep initial exercises to 3-4 that take about 10-15 minutes total and I work them into routines you already have whenever possible.
I borrow from:
- Yoga
- Weight lifting
- Functional strength training
- Tai chi and qigong
- Dance
Everything is tailored to what makes sense for your body and your life.
Your Body Tells a Story
Your body holds experiences, stress, injuries, and resilience. My work is about listening to that story through movement and touch.
If you’re struggling with pelvic pain, incontinence, constipation, painful sex, or a sense that something just isn’t right, you don’t have to figure it out alone.
Get Personalized Support
These pelvic floor therapy techniques give you a sense of what treatment at Restore Hope looks like in practice. But every body heals differently and has unique needs.
If you have questions about your specific symptoms or want to learn whether pelvic floor PT could help you, a personalized assessment provides clarity.
At Restore Hope Physical Therapy in Washington, DC, I use this holistic, whole-body approach to treat pelvic floor dysfunction. From manual therapy to biofeedback to individualized exercise programs, I create treatment plans that fit your body and your life.
Ready to take the next step? Schedule a new patient pelvic PT assessment to discuss your concerns and learn how pelvic floor physical therapy can help you feel more comfortable in your body again.
Other Pelvic Floor Physical Therapy Services at Restore Hope PT
I specialize in a wide range of pelvic health-related issues for all genders. Services include:
- Support for sexual dysfunction for people assigned female at birth
- Management of constipation and abdominal pain for people assigned male and female at birth
- Pregnancy and postpartum pelvic pain relief
- Treatment of pelvic pain and urinary incontinence for people assigned male and female at birth