Pelvic health physical therapy--FAQ

At CorePhysio, our caring, educational approach sets the groundwork for optimal health and healing. Our priority is that you feel safe, comfortable and in control of your treatment options.

What will happen at my first appointment? 

It is common for clients to have questions about what to expect from pelvic health physical therapy. Pelvic health challenges are very personal by nature and it may not be clear how physical therapy can help your problem. We understand how challenging that first pelvic health PT appointment can be and we want to earn the trust of each client. We have heard many personal stories of the private struggle, embarrassment and frustration associated with pelvic pain, leaking and elimination challenges. CorePhysio pelvic health PT’s are good listeners who are experienced with the treatment of complex pelvic health conditions. Your therapist will explain what your options are and how PT can help you.

We will want to know the details of your problem, which can take some time as many clients may
have had quite a journey to get to a skilled pelvic health PT. We realize you have likely filled out many forms in the past, however it is very important to complete your client self-assessment before the visit. Your physical therapist will want to know what surgeries or procedures you have had, what medications you are on and what your general health is like, even if you don’t think it has anything to do with your pelvic health. They will want to know what makes your symptoms worse and how it affects your life. What may be ‘TMI’ for others is not for your pelvic health care. Sharing detailed information helps us help you heal.

The primary difference with having a problem in your pelvis, compared to having a problem in your shoulder for example, is that it affects some of life’s most important functions. Your CorePhysio PT will ask you about how often you go to the bathroom, whether it is painful to urinate or have a bowel movement, and if symptoms have affected your sexual function. After all, the aim of treatment is often things like being able to have intercourse again without pain, being able to sit through a movie without having to get up to go to the bathroom, being able to have a pain free bowel movement, or returning to hiking or working out without leaking.

Your CorePhysio PT will evaluate your posture, spine, pelvic joints and hips, as well as your internal pelvic floor. After giving you in-depth information about the drivers of your pain, you’ll learn what steps you can take right away to begin regaining freedom and control. Together, you and your therapist will develop a strategic plan for your healing.

Why assess the pelvic floor?

Pelvic health is complex and it is important to understand all factors that influence the pelvic floor. Because of the location of the pelvic floor muscles, the best way to evaluate and treat them is through direct internal assessment. The pelvis is just like any other area of the body, with many muscles, nerves, joints, ligaments and fascia. CorePhysio’s pelvic health clinicians are trained and licensed to treat this area of the body, just as they are licensed to treat your neck or back. Although you will never be pressured to have an internal assessment, it’s important to note that assessing the pelvic floor helps your physical therapist understand the complex factors driving your pain, and design a treatment program based on your body’s precise needs. (Internal assessments are only done with direct, informed consent, and are generally not performed on children, pregnant women or individuals who have not had a pelvic exam by a medical professional.)

How do PT exams differ from what a doctor does?

Physical Therapy pelvic assessments for women do not use a speculum. Direct assessment of the pelvic floor muscles can be performed intravaginally or intrarectally, depending on the needs of the client and always with the client’s clear consent. Our clients are given a map of the pelvic floor muscles to look at during the evaluation so they can learn about their anatomy, strength, referral patterns and how it connects to their symptoms. Evaluation of the skin, soft tissue structures, surrounding joints, ligaments, and fascia are performed and we are very sensitive to any pain or other issues that you may have. Our clinicians are aware that a light touch on a sensitive structure can feel like a lot of pressure in the pelvic floor. They are trained to gather information with careful contact to avoid or minimize discomfort so clients know exactly what to expect. The assessment allows the therapist to understand what areas are painful or sensitive, how much muscle spasm you have, whether you can contract your pelvic floor effectively with normal breathing, and also whether you can release it fully.

Are you just going to teach me kegels?

Kegels are the common term for contracting pelvic floor muscles and the first thing people think of when it comes to the pelvic floor, but pelvic floor muscles need to be able to do three things:

  1. Contract: Strengthening the pelvic floor muscles requires precision of muscle control, enabling the right intensity of contraction for the right task. The goal is a pain free contraction, in any posture with natural breathing patterns, without unnecessary hip or spinal movement. Spasming muscles are muscles that are stuck in a painful contraction pattern. Kegels focus on contracting alone, which increases pain in already short, spasmed pelvic floor muscles. Your CorePhysio PT will evaluate nerves, fascia and surrounding joints to understand why pelvic floor muscles may struggle to contract or relax.
  2. Relax: Your pelvic floor muscles need the ability to rapidly and fully relax after any intensity of contraction, with all surrounding joints in positions of comfort. If the hip, pelvis or spine joints are irritable, the pelvic floor muscles will react by splinting the region in a contraction. Clients may describe feeling like their muscles are ‘stuck’. Your CorePhysio PT will evaluate surrounding structures to understand why your pelvic floor muscles are unable to relax. It is not “in your head”.
  3. Lengthen: Pelvic floor muscles must lengthen and relax the right amount for the task. Muscles that are unable to lengthen and relax can result in straining during bowel movements, which can cause prolapse, hemorrhoids and pain.

Your CorePhysio PT is an expert on the ways the body is influenced by the colorectal, urologic, gynecologic, sexual, orthopedic, neurologic and biomechanical systems. After a detailed evaluation, your therapist will determine if you need to lengthen or strengthen your pelvic floor muscles. Your customized treatment will include extensive education about the drivers of your condition and address all systems influencing your pelvic floor.

How can physical therapy help with post-prostatectomy incontinence?

Following prostate surgery, the muscles of the pelvic floor are often weak, resulting in leakage of urine. Don’t wait to see if leaking will go away on it’s own—statistics show that in over half of men it won’t.

  • 31% of men post-prostatectomy experience enough leaking to need pads.
  • Without therapy, up to 63% of men will continue to need pads long term.

Specialized therapists at CorePhysio will evaluate the strength and control of your pelvic floor and core muscles and teach you how to locate and strengthen your muscles so they can function normally.

How often will I see my physical therapist?

We respect our clients’ time and financial resources and will provide the education, treatment and resources to get you better as quickly as possible. Your course of care is customized depending on the complexity of factors involved. Client readiness to make life changes and prioritize their self-care is critical for making progress. Just like with medication, the right dosage of care needs to fit the complexity of the condition. Short or infrequent visits are not successful in resolving complex, multifactorial needs. The most typical course of care is one time per week for 6-12 weeks, or for more complex scenarios, one to two times per week for 6-16 weeks. Foundational care plans of four visits can be designed for clients with limited insurance or financial resources to get their education and treatment plan underway.

© Core Performance LLC 2018