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What to Expect from Pelvic Floor Therapy

Through visceral manipulation, pelvic physical therapy exists to treat conditions like incontinence, Irritable Bowel Syndrome (IBS), Pelvic Floor Dysfunction (PFD), painful sex, and other causes of pelvic pain or bowel/bladder dysfunction. Since the organs and muscles of the pelvis and abdomen are involved in these conditions, successful physical therapy treatments involves both internal and external work.

What do you mean by "internal work"?

Internal pelvic physical therapy is achieved by going through the rectum or vaginal cavity in women and through the rectum in men in order to reach the pelvic floor muscles, organs, or scar tissue. From the inside the therapist will manipulate the tissue with one hand, while also guiding, manipulating, and massaging from the outside with the other hand. While this type of therapy can seem intimidating, a good therapist will answer any questions before working on you and will not perform any therapies with which you do not feel comfortable.

What is "external work"?

The external work of pelvic physical therapy involves massage and visceral manipulation from the outside. When performing solely external work, the physical therapist will massage the intestines, stimulate the liver, and often do work on your lower back and buttocks. Sometimes pain and inflammation have caused misalignment of the coccyx or uterus, and the therapist can work from the outside to get these back into proper alignment. The therapist may also use essential oils or therapeutic creams on the abdomen or back in order to reduce inflammation.

What is the purpose of this type of therapy?

Visceral manipulation helps stimulate natural motility in organs such as the intestines when scar tissue or other blockages have caused issues of function. Blood flow is essential to healthy organ function, so visceral manipulation through internal pelvic floor physical therapy also increases blood flow to organs and musculature that are otherwise unreachable. The end goal in all physical therapy is the optimal functioning of organs and muscles.

I still have questions!

If you have more questions about pelvic physical therapy or about how we would treat your condition, please contact us by calling (714) 963-3322 or email us at


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Holly Horikawa PT, DPT, CLT

Owner and Founder

Dr. Horikawa received her Doctorate in physical therapy from Duke University in 2005 and founded Lokahi Physical Therapy & Wellness in 2013.

R.A. Sovilla

Patient Advocate

R.A. Sovilla suffered with pelvic pain due to endometriosis for over a decade. She is currently living pain-free post surgery and co-leads the OC Chronic Pelvic Pain Support Group with Dr. Horikawa.

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