Pelvic Floor Therapy: Pregnancy, Postpartum, and Children

What is Pelvic Floor Therapy?

The pelvic floor is a group of muscles at the bottom of the pelvis. It holds in pee and poop, relaxes to let them out, supports the bladder, bowel, and uterus, and plays a part in sex. Pelvic floor therapy is done by a licensed physical therapist (PT), or sometimes an occupational therapist (OT), with extra training in pelvic health. It looks quite different for adults and for children.

Pregnancy and after birth. Pregnancy and birth put heavy demands on these muscles. About one in three women has some urine leaking after childbirth, and up to one in ten has some leaking of stool or gas. Other common problems include pain in the pelvis, pubic bone, tailbone, or low back; pain or tightness from a tear, stitches, or a C-section scar; painful sex; a feeling of heaviness or bulging (prolapse); and a gap between the belly muscles (diastasis recti). A therapist takes a detailed history, looks at posture, breathing, and core and hip strength, and often, with your permission, does an internal vaginal exam to check how the muscles squeeze and relax. Treatment usually includes pelvic floor muscle training (often called Kegels, but taught and checked so you do them correctly), breathing and core work, bladder and bowel habits, scar and tissue care, and a plan to return safely to lifting, running, and exercise. During pregnancy, some people also go for birth preparation, such as positions and breathing for pushing. Guidance from the American College of Obstetricians and Gynecologists (ACOG) says pelvic floor exercises can begin right after birth, and that a postpartum check should ask about leaking and refer to physical therapy or a urogynecologist when needed.

Children. Pediatric pelvic floor therapy treats bladder and bowel problems such as daytime accidents, urgency, repeat urinary tract infections, hard or painful poops, stool leaking into underwear, and bedwetting that comes with daytime symptoms. Doctors often call this mix "bladder and bowel dysfunction" (BBD). Many of these children squeeze their pelvic muscles when they should relax them, or hold on too long. Care starts with bladder and bowel diaries and "urotherapy": timed bathroom trips, good fluid intake, a footstool for toilet posture, and a constipation plan made with the child's doctor. The therapist adds belly breathing, gentle belly massage, movement and core exercises, and often biofeedback, where small stickers on the skin near the bottom turn muscle signals into a video game. Sessions are play-based and external. Children with autism, spina bifida, cerebral palsy, Down syndrome, or other conditions may also work on sensory needs, routines, visual schedules, or catheterization skills.

For both groups, a course of care is often a handful of visits spread over several weeks to a few months, plus daily practice at home. Length varies a lot from person to person.

Who is it for?

Who provides it?

A licensed physical therapist (PT), or sometimes an occupational therapist (OT), with added pelvic health training. Some work in hospital women's health, urogynecology, pediatric urology, or GI programs; others work in private clinics. In Illinois, the only legal requirement is a PT or OT license from the Illinois Department of Financial and Professional Regulation (IDFPR), which you can check on the IDFPR License Look Up. There is no separate state license for pelvic floor therapy, so extra training matters.

Common credentials include the APTA Academy of Pelvic Health Physical Therapy's CAPP-Pelvic (Certificate of Advanced Practice in Pelvic Health) and CAPP-OB (Obstetric Health), the board certification PWCS (Pelvic and Women's Health Clinical Specialist, formerly WCS), and the Herman & Wallace PRPC (Pelvic Rehabilitation Practitioner Certification), which is open to PTs, OTs, nurses, and other licensed clinicians. The Academy's online PT Locator lets you filter by pregnancy and postpartum care, ages treated, and insurance.

Most pelvic health therapists mainly treat adults. None of the main credentials is pediatric-specific; CAPP-Pelvic offers pediatrics only as an optional track. For a child, ask about pediatric courses, such as the Academy's Level 3 Pediatrics course or Herman & Wallace's Pediatrics Level 1 and Level 2 bowel and bladder courses, and how many children the therapist treats each week. A background in pediatric PT or OT is a plus, especially for children with developmental or sensory needs.

What do families and practitioners report?

Supporters say many pelvic floor problems are muscle-coordination and habit problems, so teaching people to use and relax these muscles on purpose treats the cause instead of only the symptoms. For pregnancy and after birth, therapists point out that leaking, pain with sex, and prolapse symptoms are common but not something you just have to live with, and that a checked, personal program works better than trying Kegels from a pamphlet. They also say postpartum care in the U.S. often stops at one visit, and a PT can guide the return to lifting, running, and daily life. For children, therapists and parents report fewer accidents, less painful pooping, fewer infections, and more confidence at school and sleepovers, and say biofeedback games make an embarrassing topic feel manageable. Many OB-GYNs, midwives, and pediatric urologists refer patients for this care.

Does it work? What the research says

Pregnancy and after birth. The best summary is a 2020 Cochrane review (Woodley and colleagues) of 46 trials with 10,832 women. For women without leaking, structured pelvic floor muscle training started early in pregnancy probably lowers the chance of leaking urine in late pregnancy (about 62% less; moderate-quality evidence) and slightly lowers it 3 to 6 months after birth (about 29% less; high-quality evidence). For women who already leak during pregnancy or after birth, the review found no clear evidence that training cures it in this period, though the trials were small and varied. Evidence on leaking stool was limited. Trials reported almost no side effects. NICE guideline NG210 (2021) advises encouraging all pregnant and postpartum women to do pelvic floor training, considering a supervised 3-month program for higher-risk women (for example, after a forceps or vacuum birth or an anal sphincter tear), and offering at least 3 months of supervised training for stress or mixed urinary incontinence, including in pregnancy. For mild prolapse, a 2011 Cochrane review (Hagen and Stark) found some evidence that supervised training improves symptoms and prolapse stage, and NICE suggests at least 4 months of supervised training for mild prolapse with symptoms. For diastasis recti, the picture is weak. ACOG's 2020 exercise guidance says abdominal exercises have been shown to reduce the gap, but a 2021 review (Gluppe and colleagues) rated the evidence very low quality, and a 2026 update (Lyons and colleagues) found no clear evidence that exercise alone closes the gap, though it may still help function and symptoms. Research on birth preparation and on pelvic pain and painful sex after birth is more limited.

Children. The International Children's Continence Society (ICCS) sets the shared language for this field in its 2014 terminology update (Austin and colleagues) and its 2021 urotherapy document (Nieuwhof-Leppink and colleagues), which describes standard urotherapy as the first step for daytime wetting, with pelvic floor training and biofeedback added when needed, and notes that much of this rests on expert consensus. A 2018 meta-analysis (Schäfer and colleagues) found standard urotherapy clearly beats waiting, with roughly half of children with daytime wetting becoming dry within a year. For dysfunctional voiding, a 2024 meta-analysis (Li and colleagues) found biofeedback improves urine flow, reduces leftover urine, and lowers infections, but had little effect on daytime wetting, bedwetting, or constipation. For constipation, results are mixed: the 2014 ESPGHAN/NASPGHAN guideline recommended against biofeedback as an add-on, a 2020 primary-care trial (van Summeren and colleagues) found no added benefit from pelvic physiotherapy, and a 2025 meta-analysis (Hao and colleagues) concluded it may be a useful add-on but many studies were small and uneven. For children with neurologic conditions or autism, research is limited and care relies mostly on clinical experience.

Is it covered by insurance in Illinois?

Pelvic floor therapy is usually billed as regular outpatient physical or occupational therapy, using standard evaluation and treatment codes (for example, therapeutic exercise and neuromuscular re-education), plus pelvic floor biofeedback codes 90912 and 90913 when biofeedback is used. It is not a separate "pelvic floor" benefit, so coverage depends on your plan's PT or OT visit limits, deductibles, and whether the therapist is in network. Most insurers want a diagnosis such as urinary incontinence, pelvic pain, prolapse, constipation, or encopresis. Illinois law lets physical therapists see patients without a referral in many cases, but many plans still require a doctor's referral or prior authorization.

Illinois Medicaid's therapy rules require a signed, written order from a doctor, advanced practice nurse, or physician assistant, and some services need prior approval; HealthChoice Illinois managed care plans set their own approval rules, so call your plan first. Illinois Medicaid covers pregnant women for up to 12 months after the pregnancy ends, so postpartum pelvic floor therapy can often be covered during that year. Some private pelvic health practices are out of network and give you paperwork to seek reimbursement yourself. Hospital-based programs may bill a separate facility fee.

What to consider and ask

• Ask your OB, midwife, pediatrician, or urologist to check for medical causes first, such as infection, a healing problem after birth, constipation that needs a clean-out, diabetes, or spine problems.
• Match the therapist to the person: ask how much of their caseload is pregnancy and postpartum, or how many children they treat, since most pelvic health training is adult-focused.
• Ask up front how the therapist handles internal exams, consent, privacy, and who can be in the room, and know that adults can choose external-only care.
• If you leak or have prolapse symptoms, a supervised program of about 3 to 4 months is what guidelines suggest; one or two visits may not be enough.
• Expect daily home practice, such as pelvic floor exercises, breathing, bathroom routines, and diaries; results depend heavily on follow-through.
• For children, treat constipation at the same time, and for children with autism or other disabilities, look for a therapist who can adapt to sensory and communication needs and coordinate with other therapists or school.
• For parents with a new baby, ask whether you can bring the baby to sessions or use telehealth for some follow-up visits.