The State of Pelvic Floor Physical Therapy 2024

2024 Women's Health Report

Introduction

The pelvic floor has come a long way since our 2023 report - and there's a lot to celebrate, starting with some high-profile headlines. The New York Times featured a pelvic floor workout in its Well column. Urologist Dr. Rena Malik introduced the pelvic floor to the 5.2 million subscribers of the Huberman Lab. Sara Reardon, PT, DPT, who has half a million followers on Instagram, was profiled in Time Magazine. And Google searches for "pelvic floor" hit the roof after Brittany Mahomes, a former pro soccer player and member of Taylor Swift's social circle, advised fellow moms to "take care of your pelvic floor."

In policy, the APTA's Academy of Pelvic Health played a primary role in bringing the Improving Postpartum Outcomes Act to Congress. The bill calls for pelvic floor PT to become a covered benefit for postpartum Medicaid patients and could positively impact 41% of birthing people.

Investment banks and consultants are seeing an exciting opportunity in pelvic health, and companies that prioritize women's health are including pelvic floor PT in their benefits offerings. "I'm hearing major insurance plans mention women's health and MSK in one breath when listing top priorities," says Kelsey Maguire, Managing Director of the Blue Venture Fund investment firm (an Origin investor).

With all this momentum, the timing couldn't have been better to release the Origin Pelvic Health Study (featured in Vogue). Conducted by Ipsos, the study reveals the overwhelming prevalence of pelvic floor-related symptoms among U.S. women ages 18 to 59, driving home the need for solutions, from clinical care to products by companies like Elvie, Perifit, and The Pelvic People.

"Our once lofty goal of making pelvic floor PT available to women and all people with vaginal anatomy, across the U.S., feels increasingly inevitable," said Carine Carmy, CEO and Co-Founder of Origin. "The pressure cooker for this change is happening outside in, with rising consumer demand, and inside out, as health systems, payers, and providers aim for a higher standard of care."

In this year's report, we're diving into the story behind our study data and highlighting the people, products, and ideas that are paving the way for a feel-good future for pelvic health.

Pelvic Floor Dysfunction: A Women's Health Epidemic Hiding in Plain Sight

According to our study, 75% of U.S. women ages 18 to 59 report two or more pelvic health symptoms in the past year, ranging from bladder leaks and bowel issues to sexual dysfunction. This far exceeds data from previous studies, which show 32% of women have one or more symptoms of pelvic floor dysfunction (PFD).

The average number of symptoms reported was five, which isn't likely to surprise pelvic floor PTs. "When the pelvic floor isn't functioning properly due to muscle tightness, weakness, lack of coordination, or some combination of all three, it can lead to a constellation of symptoms," said Liz Miracle, PT, MSPT, WCS, Head of Clinical Quality & Education at Origin. "These symptoms are typically viewed and treated in isolation, when the pelvic floor can be an underlying link that few patients or other providers are aware of."

• 75% of U.S. women ages 18-59 report 2 or more pelvic health symptoms in the past year
• 5 - the average number of pelvic symptoms reported

Millennial Pelvic Health in Crisis

What's more surprising is how many younger women are dealing with pelvic health issues. Half of Millennial women ages 28 to 43 report having bladder leaks in the past year, which is right up there with Gen X women (ages 44 to 59), 61% of whom report bladder leaks in the past year.

Inability to orgasm was higher among Millennial women — 43% reported this symptom (compared to 24% of Gen X women). Overall, Millennials were more likely to report multiple pelvic symptoms in the past year than Gen Xers.

Childbirth may be one of the biggest risk factors for women in their 30s and early 40s, but it isn't the only one. "By this point in their lives, many Millennial women have been engaging in high-impact exercise or dealing with chronic cough or constipation for decades," said Miracle. "These small things can add up over time, creating intra-abdominal pressure that can cause tissue creep and lead to symptoms like incontinence."

The high prevalence across age groups makes it clear that pelvic health is anything but a "niche" issue — a dismissal that Carmy has had heard too many times. "A few short years ago, I was told that pelvic floor PT was too specialized, despite the fact that most women are living with life-disrupting symptoms that pelvic floor PT can treat or prevent," said Carmy. "Our study adds to a growing body of literature that demands more action."

Bladder Leaks in Past Year

• 50% Millennial women
• 61% Gen X women

The Prevalence of Pelvic Health Symptoms

Data from the 2024 Origin Pelvic Health Study, conducted by Ipsos, with funding organized by Rise Together Ventures. Find full results and methodology at theoriginway.com/research.

• 83% of U.S. women ages 18-59 experienced at least one pelvic health symptom in the past year
• 64% said that their pelvic health symptoms negatively impacted their lives
• 96% of women with pelvic symptoms said they hadn't been diagnosed with a related medical condition

Millennials were more likely to report a host of pelvic symptoms

The Most Common Symptoms

• 1 in 3 women reported at least one sex-related symptom in the last year
• 1 in 2 women reported at least one bladder and bowel symptom in the last year

Gaps in Postpartum Care

• 23% of women who had a baby within 5 years said they felt "not at all supported" by their medical providers during their postpartum physical recovery.
• 44% of women who had a baby within 5 years said providers did not help them understand what is and isn't normal in terms of symptoms.

Women who have given birth within 5 years report that they were dissatisfied with medical care related to:

• 42% Healing and strengthening their pelvic floor after vaginal childbirth
• 37% Managing bladder and bowel symptoms
• 32% Returning to sexual activity
• 31% Returning to exercise and physical activity
• 29% Managing postpartum pain and discomfort
• 29% Caring for their baby without straining their body
• 23% Returning to work

Women who have given birth within 5 years report that they received no guidance on:

• 86% Healing their pelvic floor after childbirth
• 71% Exercising safely before or after childbirth
• 85% Reducing their risk of tearing during childbirth
• 68% Effectively pushing out a baby
• 83% Healing their abdominals after pregnancy and childbirth
• 50% Managing pregnancy pain

The top barriers to getting more care for symptoms

• 33% aren't sure what is or isn't normal
• 30% aren't sure that anything could help
• 21% aren't sure which provider to see
• 32% lacked time / energy to get care

It's Time to Get Loud About Pelvic PT

The medical system may seem like a mountain of bureaucracy, but just as with fertility and menopause, women have moved that mountain in the past — and can do it again.

"In 2016, Progyny launched with its first five clients, mostly big tech companies who were open to what were then considered 'nice-to-have' benefits," said Janet Choi, MD, Chief Medical Officer of the fertility and women's health benefits company Progyny. "In the 8 years since, we have grown to partner with over 460 employer clients across 45 different industries, and fertility and family building is now considered a 'must-have' benefit."

Dr. Choi said several factors contributed to this incredible growth, but that none was more powerful than public awareness. "As more women have open conversations about specific health struggles that are impacting their lives, they become impossible to ignore."

When it comes to talking to a doctor about symptoms, Joanna Strober, CEO of midlife care clinic Midi Health, believes that people have to know that a fix is out there. "I think it's hard to talk about things when you don't know if there's a solution to it," she pointed out. "Why would I complain about my brain fog to a doctor if there was nothing that could change it? When there's a clear path to feeling better, that's often when people are driven to take action."

The pelvic floor may be trending, but the power of pelvic floor PT has yet to reach the masses. According to our study, only 8% of women who have had a baby in the past year saw a pelvic floor PT to support their recovery. When asked why they hadn't sought additional care, the top barriers weren't cost, transportation, or convenience — it was that they weren't sure what was normal and they didn't know that anything could help.

While we continue to reach more and more women outside of the doctor's office, we need the healthcare system to back us up — and that means educating patients about their pelvic health in every relevant care setting, from annual check-ups to specialist visits.

Partners in Pelvic Health: Connecting with Providers Across a Fragmented System

As it stands, most women are not being screened by providers for symptoms related to PFD or referred to pelvic floor PT when those symptoms come up. Among the women included in our study, 64% said that their pelvic health symptoms negatively impacted their lives, yet only 4% said they had received a related medical diagnosis.

Even with urinary incontinence, the most well-known symptom of PFD, prior research shows that only 3% of symptomatic patients are referred to a pelvic floor PT by primary care physicians (17% are referred to urologists who may ultimately refer to pelvic floor PT).

"There are so many instances when pelvic floor PT can be game-changing in women's lives," said Kimberlee Sullivan, PT, DPT, WCS, Head of Clinics at Origin. "From the athlete or patient with COPD who has incontinence to the person recovering from a hysterectomy or gender-affirming surgery. We're hearing more patients say 'I found pelvic floor PT online,' which is a wonderful thing, but we have to keep pushing until every provider who works with women knows when to refer them to pelvic floor PT."

That list starts with primary care providers and OBGYNs but extends far beyond to orthopedic PTs, sex therapists, menopause specialists, oncologists, GI specialists, cardiologists, and many more.

"Because of its unique position in the body, the pelvic floor impacts and is impacted by multiple systems, from the digestive and circulatory systems to the reproductive and nervous systems," said Sullivan. "Right now, the majority of providers are ignoring the pelvic floor and, as a result, the majority of women have pelvic health symptoms."

Empowering Providers with Tools & Education

"Ideally, it would be standard for women's health practitioners to screen for pelvic pain as well as bladder, bowel, and sexual symptoms during the annual well-woman visit," said Ingrid Harm-Ernandes, PT, WCS, the former Co-Director of Duke's PT Residency Program who has written a book on PFD for patients and published research on how best to teach clinicians to assess for PFD. "This does not necessarily have to involve an internal pelvic exam — there are a number of verbal assessment tools and even self-assessment tools that take less than 5 minutes."

We've seen how simple screening tools, like those used for postpartum depression can improve patient outcomes by ensuring that providers follow up with patients as needed — and the same is likely to be true for pelvic floor dysfunction.

At Origin, part of provider outreach involves sharing customized referral kits that include self-assessment tools and other resources geared toward each provider's unique patient population, as well as state-specific physical therapy Rx pads. The goal is to make passing pelvic health information onto patients — and passing patients on to pelvic floor PT — a streamlined and positive experience.

"Providers are inundated with flyers and handouts that read like pharmaceutical ads or offer trendy interventions rather than providing useful tools and immediate resources," said Bridget McMillion, PT, DPT, a physical therapist at Origin who markets to local providers in Salt Lake City. "Patient-facing content that's easy to read and includes detailed tips and howtos specific to their populations' concerns is much more likely to make it into their patients' hands."

For the first time ever, there's also a community of women's health startups to collaborate with. "We've focused on scaling our network of referring providers by partnering with other women's health startups like HerMD, Midi Health, Millie, Gennev, and many more," said Allison Grant, Head of Brand & Growth at Origin. "They educate their patients on pelvic floor PT, and we provide education to our patients about how they can benefit from specialized maternity, menopause, and sexual health care."

A Wide Network of Referring Providers

It takes a village to get women with pelvic health symptoms the care they need.

Mental Health

• Postpartum mental health specialists
• Sex therapists

Heart & Lungs

• Cardiologists
• Pulminologists

Cancer

• Oncologists

Maternity & Gyn

• Doulas
• Gynecologists
• Menopause specialists
• Midwives
• Obstetricians

Bladder & Bowel

• Gastroenterologists
• Urogynecologists
• Urologists

Bone & Joint

• Orthopedic doctors
• Orthopedic PTs

Providers as Organizational Change Agents

While it takes time and care to establish every new provider relationship — at Origin, we've found that it can take an average of five touchpoints with a provider before they start referring to pelvic floor PT — reaching just one influential provider at a clinic has the potential to drive organization-wide change.

"Despite having completed a residency and fellowship in Women's Health, the pelvic floor was not brought up at any point during my medical education," said Navya Mysore, MD, the National Program Director for Sexual and Reproductive Health at One Medical, who sees patients in Brooklyn, NY. "But then I ended up seeing a pelvic floor PT myself after my first pregnancy and was later connected to Origin's CEO, Carine Carmy."

Mysore is now working to promote education on pelvic floor dysfunction at One Medical. "We're not expecting every PCP to become an expert of the pelvic floor," said Mysore. "But we do want them to be able to identify when potentially there could be a problem and then know who to refer to, so that patients are accurately cared for."

Once patients have been referred, the quality of care is what keeps the relationship going. "It's only because I've connected with local pelvic floor PTs that I know to end patients for pregnancy and postpartum care, as well as for bladder, bowel, or sexual symptoms," said Daniel Niku, MD, MS, an OBGYN in private practice in Beverly Hills. "And I keep sending patients to pelvic floor PT because they come back happy, and that's what I care about most."

The type of provider most likely to fully understand the application of pelvic floor PT are urologists and urogynecologist. "I've been in practice for over a decade and I've realized that I can't treat my patients without a good pelvic floor physical therapist," said Benjamin Dillon, MD, Associate Chief of Urology and Medical Director of Specialty Care at Kelsey-Seybold in Houston, TX. "It's a no-brainer. Pelvic floor PT should be incorporated much like behavioral therapy and diet modification is discussed as a first-line therapy for conditions including incontinence and urgency." Dillon recently made it easier for Kelsey-Seybold providers to refer to pelvic floor PT through their EHR.

Larissa Rodriguez, MD, a Urogynecology and Reconstructive Pelvic Surgery Specialist, and founder of the Center for Female Pelvic Health at Weill Cornell Medicine (WCM) in New York, is removing barriers to pelvic floor PT by bringing a diverse group of pelvic health experts under one roof.

"After working in this field for over 20 years, I've seen the fragmented care some women receive," said Dr. Rodriguez, Chair of the Department of Urology at WCM. "Given all the organs and physiological functions involved with the female pelvis and pelvic floor, combining the expertise of urogynecologists, colorectal surgeons, physical therapists, and rehabilitation medicine specialists ensures excellent quality of care for women suffering from pelvic floor disorders. Having pelvic floor PT integrated into the center also brings together expert minds to address research questions and help advance the field."

Raising the Standard of Care for Birthing People: PT in the Hospital & at Home

Based on our study data, patients who suffer most from the lack of access to pelvic floor PT are those who are pregnant and postpartum. "There is no current standard of care for treating the postpartum population in the United States," said Kristi Lynn Kliebert, PT, Director Director of Communications at the Academy of Pelvic Health Physical Therapy and former Director of the Academy's Pregnancy and Postpartum Special Interest Group. "Without a standard of care, there is no established framework to guide providers, payors, or patients in maneuvering the postpartum journey. Although a shift is slowly happening, change is slow."

Of the 23 pelvic health symptoms included in our study, about half were more prevalent among recently postpartum women. Some of the most distressing statistics revealed how incredibly unsupported study respondents felt while recovering from childbirth.

Twenty-three percent of study respondents who gave birth within the past 5 years said they felt "not at all supported" by medical providers during their physical postpartum recovery. Forty-four percent said providers did not help them understand what is and isn't normal in terms of their symptoms.

The fact that 17% of women who had given birth within the past 5 years indicated that their interactions with the healthcare system during their most recent birth made them less likely to have another child speaks to the degree to which we are failing women at one of the most physically and emotionally vulnerable points in their lives.

A Clinical Pathway to Support Postpartum Patients

Pelvic health educator Rebeca Segraves, PT, DPT, WCS, believes that training hospital-based PTs to deliver critical postpartum care will save lives and set new mothers up for success at home.

"The reality is that we don't have enough pelvic floor PTs to deliver this care," says Segraves, who has documented a training program published in the Journal of Women's & Pelvic Health Physical Therapy last January and featured in The Atlantic this past November. "So we need to think about training OBGYNs, midwives, and nurse practitioners to work with PTs who are already in hospitals to deliver a thorough in-patient evaluation and handoff to outpatient PT for ongoing recovery care."

Segraves' intervention, known as Enhanced Recovery After Delivery or ERAD, is already being implemented by a trailblazing few obstetric PTs. It involves evaluating a patient's cardiopulmonary, musculoskeletal (MSK), and pelvic health function, as well as instructing them on a home therapy program, and providing handoffs to outpatient providers for ongoing recovery care. With as many as 40% of patients skipping their postpartum check-up, having this kind of assessment before they leave the hospital is likely to have a massive impact.

How do we bring this kind of intervention to hospitals across the country?

That's a question that researchers are digging into now. "PT researchers are working to determine what the barriers are to integrating postpartum hospital care, so that we can knock some of them down," said Lori Tuttle, PT, PhD, a professor at San Diego State University's Doctor of Physical Therapy Program and Director of The Pelvic Health and Rehabilitation Laboratory. "Because, even if you show that a treatment is effective and establish new standards of care, if it doesn't fit within a hospital flow, it's not going to happen. It's not that hospitals don't want to give patients good care; it's that they may not have the space, the resources, the personnel, or the knowledge."

Viewing Birthing Bodies Holistically

Jessica Swartz, PT, DPT, a physical therapist at Origin and PhD student working in Tuttle's lab, is leading an APTA-funded study to identify those barriers. "Acute-care physical therapists are already in hospitals, treating patients in burn units, orthopedics, cardiac care, pulmonary care, neurological care, etc.," said Swartz. "Yet women and birthing people are overlooked. This obviously needs to change. So we're asking: What exactly is getting in the way?"

Swartz hypothesizes that the lack of PT care for new mothers is rooted in how medical providers have been trained to think about the birthing body. "Right now, providers think of obstetrics as very much related to the reproductive system, which is not a focus of physical therapy. But, in pregnancy, all of your bodily systems — including the nervous system, cardiovascular system, and musculoskeletal system — change and adapt in order to grow a fetus, and the same goes for recovering from childbirth and caring for a newborn. PTs who work with pregnant and postpartum patients know this, firsthand. But we need to get everyone else thinking this way."

Integrating in-patient postpartum care would be monumental, but it is also just the beginning in terms of supporting birthing people throughout their healing journey. As our data shows, the lack of guidance starts early on in pregnancy, with 51% of women who gave birth within the past 5 years reporting they received no guidance on managing pregnancy pain, 68% saying they received no guidance on how to push out a baby, and 71% saying they received no guidance on safe exercise before or after childbirth.

"The ideal time for patients to be handed off to a physical therapist is before they even enter the hospital system to give birth," said Segraves. "A pelvic floor therapist who is familiar with the entire journey through pregnancy and postpartum is going to be their best educator."

The Pelvic Marketplace: Seeking Solutions Outside of Traditional Healthcare

When dealing with pelvic health symptoms, women are used to looking outside the medical system to find relief. They spend an average of $900 annually on incontinence supplies like pads and adult diapers, buy lubes and dilators for painful sex, take laxatives for constipation, or turn to TikTok for advice on how to calm their overactive bladders.

As consumers learn more about how their pelvic floors can contribute to these symptoms, they're looking for related solutions, and the marketplace is stepping up to meet them with online classes, app-enabled pelvic floor devices, and even specialized sex toys. These options can fill gaps for people who don't have access to pelvic floor PT or act as a stepping stone to getting evidence-based care.

Reardon, who offers pelvic floor workout programs to people who join her online V-Hive community, is happy to see more innovation. "I view it as very similar to mental health," she said. "Not everyone has the resources or commitment to meet weekly with a licensed therapist, but they may be able to afford a few sessions with a life coach, read a book about anxiety, take a mindfulness course, or use a relaxation app," she said. "These days people expect and need a menu of options when it comes to taking care of themselves, and pelvic health is no different."

Miracle, who helped bring the kGoal, a pelvic floor strengthening device, to market is also optimistic. "Having more ways to engage and educate people is a good thing, and the dialogue around these products can normalize pelvic issues," she said. "The downside is that following guidance or using a device that isn't backed by research — or that is backed by research but isn't right for you — can either do nothing or, in some cases, make your symptoms worse. So, education on topics like hypertonic vs. hypotonic pelvic floor is more important than ever."

Getting Care Through Employers

A growing number of women's first exposure to pelvic health is via an email from their benefits team, inviting them to sign up for a program offered by digital MSK companies like Hinge and Bloom. Because these offerings are focused on coaching versus one-on-one clinical care, the conditions that can be treated and level of support varies by program, but you can't beat the price — eligible employees participate for free.

"Many women have pelvic health disorders, but barriers including accessibility, cost, and convenience stop them from getting care," said Marta Cardeano, General Manager of Bloom, the digital pelvic health program by Sword Health. "For the women we help, they are excited and motivated when they learn they can work one-on-one with a Pelvic Health Specialist with a Doctor of Physical Therapy degree. Sword's technology allows women to do their Bloom sessions from home, any time of day. And, the cost is covered by their employer or health plan."

For employees at companies that don't yet offer pelvic health benefits, they can reach out to their HR teams and request it. Input from employees can help guide their benefits spending. "What we've found with our data is that demand for women's health solutions is ranking higher than both mental health or weight loss, but awareness around solutions like pelvic floor PT remains low," said Ed Liebowiz, EVP and Chief Product Officer at benefits management platform Solera, which includes Origin in its women's health offering. "We chose to include Origin because they specialize in women's health, they understand the unique challenges involved in this care, and they've built their entire clinical model to address those challenges."

New Classes, Tools & Feel-Good Toys

Consumers looking for general info can find how-to videos on YouTube, pelvic floor-focused classes on platforms like Motherly, Every Mother, and The Pelvic Gym, or pay a membership or subscription fee to get content created by licensed pelvic floor PTs, fitness instructors, or other pelvic floor influencers.

"I'm happy to see more pelvic floor PTs creating educational content," said Harm-Ernandes, who published her book The Musculoskeletal Mystery in 2021, just as women stuck at home during the pandemic started to tune into their pelvic health issues. "There are so many influencers who don't have a clinical background. Pelvic floor PTs need to get our voices out there and establish ourselves as the public authority on pelvic health."

Anyone engaging with influencer posts about pelvic health is likely to see a flood of ads from high-end, app-supported kegel trainers like Elvie, kGoal, and Perifit. Other highly visible products include the myofascial tension-releasing Cooch Ball, the vaginismus vibrator known as the Kiwi, and the external vibration and musclestimulation devices offered by INNOVO and ELITONE.

"People are finding us sooner, taking their pelvic health seriously sooner, and starting with clinically trusted, at-home options that help them feel capable and connected," said Emily Sauer, CEO and Founder of the Pelvic People, makers of the Kiwi and Ohnut.

The sooner folks take charge of their pelvic health, the better. Pelvic health impacts individuals through every stage of life, and — as our study data shows — you can't be too young or too old for pelvic floor PT.

Are you part of the pelvic health revolution? We want to hear from you! Email us at hello@theoriginway.com.