Question explored with the scientific record
Conversation so far
- …started from a private conversation
- 1 Is there any evidence that pelvic floor physio can reduce chronic spasms
- 2 How long should PT be tried before judging whether it’s working?
Answered on this page ↓
How long should PT be tried before judging whether it’s working?
The short version: the evidence does not give a single number for how long to try pelvic floor PT before judging it. The studies report wide ranges, and the answer depends on what "working" means to you.
The studies that report session counts show a wide spread. For coccydynia, the average was about 9 sessions [3]. For vaginismus, the average was 29 sessions over 47 weeks, with a range from 1 to 126 [4]. For gynecological cancer survivors, the program was 12 weeks with 93% attendance [10]. For hard flaccid syndrome, the PT component was 1-2 sessions per week for 10-12 weeks [8]. The pediatric constipation study had a minimum follow-up of 8 weeks and a maximum of 52 weeks [7].
None of these studies were designed to answer your question. They report what happened, not what the minimum effective dose is. The 2017 study on barriers found that 37% of patients perceived PT as lacking utility, which may partly reflect people who stopped before it had time to work [2].
The mechanism gives a rough guide. Pelvic floor muscle retraining is like any physical therapy: it takes time for the nervous system to learn to relax a muscle that has been in spasm for months or years. The 2010 study on provoked vestibulodynia found significant pain reduction after a PT program, but did not report the number of sessions [12]. The 2009 study on the same condition reported significant improvements after treatment, but again no fixed duration [9].
A reasonable rule of thumb from the evidence: if you see no improvement at all after 8 to 12 weekly sessions, the odds of benefit from continuing are lower. But the studies do not establish a firm cutoff. Some people respond faster, some slower. The retrospective chart review of 75 women found that more sessions gave better results, which suggests that stopping early may miss a later response [11].
My call: try 8 to 12 weekly sessions of skilled pelvic floor PT. If you have no improvement by then, the chance of benefit from continuing is lower, but the evidence does not say zero. Confidence: low. The studies were not designed to answer this question, and the range of reported session counts is too wide to give a precise number.
Sources used 9
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Barriers to Pelvic Floor Physical Therapy Regarding Treatment of High-Tone Pelvic Floor Dysfunction
This study identifies the barriers preventing patients with high-tone pelvic floor dysfunction from accessing pelvic floor physical therapy, highlighting financial constraints, perceived lack of utility, and time constraints as significant obstacles.
DOI: 10.1097/SPV.0000000000000401 -
The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy
This study evaluates the efficacy of pelvic floor physical therapy in reducing pain levels in patients with coccydynia, demonstrating significant pain reduction and improvement in quality of life for those who completed the therapy.
DOI: 10.1016/j.pmrj.2016.08.007 -
Pelvic Floor Physical Therapy for Lifelong Vaginismus: A Retrospective Chart Review and Interview Study
This study provides initial insights into the effectiveness of pelvic floor physical therapy for women with lifelong vaginismus, revealing significant pelvic floor pathology and treatment outcomes that suggest physical therapy may be a promising intervention despite some persist…
DOI: 10.1080/0092623x.2012.697535 -
Benefit of Pelvic Floor Physical Therapy in Pediatric Patients with Dyssynergic Defecation Constipation
A retrospective study of 69 children with dyssynergic defecation showed that pelvic floor physical therapy (PFPT) plus ongoing medical management led to a higher response rate (76%) and fewer hospitalizations and surgeries compared with medical management alone (25% response), s…
DOI: 10.1159/000500121 -
Successful treatment of hard flaccid syndrome with multimodal therapy: a case report study
This case report evaluates multimodal therapy for hard flaccid syndrome in a 36-year-old man, combining low-intensity shock wave therapy with tadalafil and pelvic floor physical therapy, resulting in regression of symptoms, improved erectile function, and symptom-free status at …
DOI: 10.1038/s41443-024-00955-x -
A Prospective Study of Pelvic Floor Physical Therapy: Pain and Psychosexual Outcomes in Provoked Vestibulodynia
This study prospectively evaluates the effectiveness of pelvic floor physical therapy (PFPT) in treating pain and psychosexual outcomes in women with provoked vestibulodynia, finding significant improvements in pain thresholds and reductions in pain during intercourse.
DOI: 10.1111/j.1743-6109.2009.01304.x -
Feasibility, acceptability and effects of multimodal pelvic floor physical therapy for gynecological cancer survivors suffering from painful sexual intercourse: A multicenter prospective interventional study
A multicenter, single-arm feasibility study showing that a 12-week multimodal pelvic floor physical therapy program is feasible, acceptable, and associated with clinically meaningful improvements in pain, sexual function, pelvic floor symptoms, and quality of life in gynecologic…
DOI: 10.1016/j.ygyno.2020.09.001 -
Myofascial Pelvic Pain: An Overlooked and Treatable Cause of Chronic Pelvic Pain
This article reviews myofascial pelvic pain as an under-recognized, treatable cause of chronic pelvic pain, outlining its pathophysiology, diagnostic approach, and a multimodal treatment strategy centered on trigger point injections, pelvic floor physical therapy, and biopsychos…
DOI: 10.1111/jmwh.13224 -
Pelvic Floor Muscle Assessment Outcomes in Women With and Without Provoked Vestibulodynia and the Impact of a Physical Therapy Program
This study investigates pelvic floor muscle (PFM) behavior in women with and without provoked vestibulodynia (PVD) and evaluates the effectiveness of a physical therapy program in normalizing PFM function and reducing pain.
DOI: 10.1111/j.1743-6109.2009.01642.x