Pelvic Floor Physical Therapy (or Pelvic PT) is a specialized type of physical therapy that treats bowel, bladder and sexual dysfunction through the musculoskeletal and neuromuscular system on the inside and outside of your body. Basically, there is a bowl of muscles between your hips, holding up your organs: your bladder, rectum and uterus, if you have one. Lots of things can go wrong with those muscles and the nerves that feed them, and when the muscles and nerves aren’t happy, everything else can go a bit haywire, too. Muscles can be too tight, too weak, in spasm, full of scar tissue, taking up the slack for other parts of the body that aren’t carrying their fair share, or not engaging fast enough — all things that make it hard for them to do their job properly. Instead of accepting these changes and dysfunction as people’s “normal”, we pelvic floor physical therapists use our hands to work on the muscles, tissues and nerves that need it, empowering you to heal yourself as we use our clinical expertise and work together with your body to resolve those “down there” problems. 

I like to remember that the pelvic floor is:

• the center of our weight-bearing system
• the center of our nervous system and the tail end of lots of thoracic and sacral nerves
• the bottom of the canister of air that is our respiratory system
• the bottom part of our body’s main stabilizers
• a huge part of our sexual, gastrointestinal and urinary systems
• one of 3 of our diaphragms. 
• part of our flight, fright, freeze systems

So while these muscles are intimate, together, we will be looking up and down the kinetic chain trying to help your body be more efficient throughout your daily movements to decrease the demand at the pelvic floor muscles. We will be addressing your feet all the way up to rib mobility, position of your cervical, thoracic, lumbar spine, pelvic position and TMJ, in addition to internal pelvic exams. It is all connected. You are fearfully and wonderfully made. 

No. You no longer need a referral from your medical doctor to see a physical therapist. Texas physical therapists have “direct access” and you can just call to make your appointment. It is easier if you have seen your medical provider and they are aware of these concerns and issues that you have as they will need to sign off on your PT plan of care within 10 business days of your initial evaluation, or we can no longer see you until a prescription is signed by a MD (gastroenterologist, gynecologist, urologist, primary care). If you did get a referral script, please bring it with you to your first appointment or you can upload it as part of your intake paperwork.

According to the TPTA (please visit their website for more questions):

Referral is no longer needed to evaluate and treat patients.

• Up to 10 business days for PTs with a doctoral degree, or PTs who have 30 hours of CCUs in Differential Diagnosis (*our pelvic health specialist qualifies under these qualifications) 
• Up to 15 business days for PTs with a doctoral degree who have completed a residency, fellowship training or board certification as recognized by the Texas Board of Physical Therapy Examiners
•  Must have at least one year of experience
• Must have liability insurance
• Will still need a referral if treatment is needed beyond the allowed days

A disclosure form must be given to patients who are treated by a physical therapist without a referral.  The form shall include language in which the patient acknowledges that physical therapy is not a substitute for a medical diagnosis by a physician, nor is it based on radiological imaging, that a physical therapist cannot diagnose illness or disease, and that such services might not be covered by a patient’s health plan or insurer.

NOTE: Although you can see your PT without a referral, some insurance companies will *only* reimburse you if you received a referral from your medical doctor. Please contact your insurance company prior to your first visit if this is a concern.

*The only exception to this rule is if you have never had a gynecological exam. In that case, we do ask that you visit your gynecologist before starting pelvic floor physical therapy as we will not be able to provide a patient’s first internal examination.

Honestly, most people have been doing the “kegels” and not making any progress in their daily life concerning pain or dysfunction. The pelvic floor was never intended to simply activate and rest on demand. It’s much more complicated than that. And that will be part of our job to allow the system to work together (resting and activating) while you’re moving and living your life. 

And, 30% of people do the kegels incorrectly and put them at risk of worsening their condition. Learning the correct form and providing you with a tailored training program will help you recover much faster.

We do offer an online option of learning some habits that may prepare you for pelvic floor PT. These are education topics that are usually brought up in treatment sessions if they pertain to your care. But as a working mom of 3 young kids, I understand that importance of learning what I can, when I can, so this online Teachable format was created (which is not covered by insurance):

https://communityphysicaltherapy.teachable.com/courses

There are several classes to choose from:

• Urinary Incontinence: Find YOUR Why
• Pelvic Pain: What is Driving YOUR Symptoms?
• Pelvic Organ Prolapse Management and Prevention
• Physical Therapy Concerning Bowel Health, Prolapse and Fecal or Gas Incontinence
• Urinary Urge Solutions: Day and Night

Dress in comfortable clothing that you can move in because there is a short orthopedic assessment where we will assess your range of motion and ask you to do a variety of motions (e.g. squat, lunge). If you did not complete the intake questionnaire(s) online, or emailed back the completed paperwork, then anticipate the initial paperwork taking 30 minutes to complete upon arrival, prior to your appointment time. There is a lot to unpack concerning these sensitive matters, and the paperwork must be able to accommodate people that have all types of pelvic dysfunction. You can print the forms out and bring in the completed forms to your evaluation. If you are printing them out, please also bring a form of payment, and a list of your medications, vitamins, supplements, as well any other types of treatments you may be taking undergoing at this time. Also bring the name and contact information of your medical provider (e.g. ob-gyn, urologist, proctologist, gastroenterologist, primary care physician), and a referral if you have one.

Internal pelvic floor muscle examinations are the gold standard for understanding pelvic dysfunction. Think about it: you wouldn’t go to a dermatologist and ask the doctor to assess your skin through your clothes, or a PT to address your hurt shoulder without letting them look and touch your shoulder. Pelvic floor physical therapists have specific, high-level training to assess the muscles, nerves and connective tissues that make up the pelvic floor, and we do this by performing an internal exam of the vagina and/or the rectum, depending on what area we need to assess. Stacy has extra certification of PRPC (Pelvic Rehabilitation Practitioner Certification) indicating many years of experience (beginning in 2013) and has passed a Herman and Wallace examination indicating competency of pelvic floor dysfunction. You’re in safe hands. However, not everyone is comfortable with an internal exam, and your job is to let us know what those boundaries are so we can determine if it’s appropriate to proceed. Discomfort, pain, fear, or simply not wanting it are all perfectly acceptable reasons. Again, “No” is a full sentence. Just let us know. There are several conditions that can be treated successfully using external techniques if you don’t wish to have an internal exam, but it is not gold standard treatment.

Before any external or internal exam, your therapist will show you on a model of the pelvis and the muscles and structures we will be assessing. You will be asked to provide consent before any assessment or treatment, and most importantly, you can change your mind at any time. Your PT will step behind a curtain for you to undress from the waist down and lie on the treatment table, covering yourself with the sheet provided. There are no stirrups or speculum involved in pelvic floor physical therapy. We use clean, non-latex gloves and first observe your pelvic floor muscles externally, assessing tissue quality and health, as well as muscle coordination. The internal exam involves inserting one gloved, lubricated finger into the vaginal canal or rectum, in order to access and assess the front and back portions of your pelvic floor muscles. I am examining the strength, endurance, muscle tone, coordination, connective tissue and tissue quality of these areas. While we talk you through the entire physical exam, you will provide feedback about any areas of discomfort, altered sensation, or limited mobility. We can stop at any time, and we may not even perform the internal exam on your first visit, depending on your comfort level or our time constraints.

NOTE: If you have never had a gynecological appointment (for women), you will be asked to get one before we do any internal work. Similarly, men who have never visited a urologist or proctologist may be asked to see one before we do any internal work. We ask this because it’s important to provide you with the best, most complete care possible

and there may be necessary tests or treatment to be completed by an MD before a physical therapist provides treatment. Please ask for a referral to a medical doctor should you need one.

ASAP. We will not perform internal assessments until cleared by physicians around your 6 weeks appointment after a birth or surgery, but there is so much we can work on in the meantime. What does your scar and pelvis position look like? How are you breathing, especially when moving? Do you have any orthopedic pains or difficulty with your everyday activities from feeding baby, lifting, bed mobility? Let’s help you address those things so that way when you see your doctor on your follow up visit, you can spend your precious time on other concerns that are best suited for that doctor (meds, hormones, birth control). 

Initial evaluations are 60 minutes with the therapist, after 30 minutes of paperwork for you to complete and followed with 10-15 minutes for scheduling subsequent sessions. Follow-up sessions are 60-75 minutes, with 15-30 minutes with the pelvic PT and the rest of the session with our talented team, working on your specific exercises/stretches for carryover into our daily exercises and movements. Our goal is for these first months with each other to increase ease of activating your correct muscle groups in the right order so when you are doing everyday activities, you don’t have to think about these muscles for the rest of your life. We use biofeedback, muscle energy techniques, manual therapy, tactile and verbal cues, neuromuscular re-education, home exercise programs, breathing patterns and TENS units to supplement your therapy sessions. 

Appointments always includes one-on-one time with a licensed Doctor of Physical Therapy for 15-30 minutes and then an additional 30-45 minutes in the gym (totaling about an hour) with our skilled team members who are trained in pelvic rehabilitation, following your specific treatment plan. Our sessions are movement based, so there is carryover from these sessions into healthy habits in your daily life, whether that be decreasing pain or increasing strength. These exercises are specific and individualized as there is no cookie cutter approach to pelvic health.

Yes. Menstruation does not affect pelvic floor muscle treatment in any way and can often decrease the discomfort you may normally experience during your period. If you do not wish to have any internal work done during this time, please let me know. Also, many sessions will not include internal treatments anyway. There are many other body parts that affect the pelvic floor and by helping them be more efficient, it can decrease the demand at the pelvic floor muscles, so they can respond naturally. 

Yes. If pelvic floor muscles are tight, in spasm, or uncoordinated, it can make it difficult for the body to welcome a pregnancy and allow for implantation. Pelvic floor PTs spend increased time with our patients and we can often pick up on muscular imbalances and circulatory or nervous system issues that may be a contributing factor to your current inability to conceive. Our treatment also often costs much less than current fertility options on the market while empowering you with a much deeper understanding of your personal anatomy and function. Once you no longer feel comfortable with internal treatments, usually due to pregnancy or implantation, then we respect your decision and will follow our treatment plan externally.