‘I Tried Pelvic Floor Physical Therapy—And It Was Nothing Like What I Expected’
Before I get into my experience, let's start with a little background: Pelvic floor physical therapy rehabilitates the muscles in a person’s pelvic floor, which run from the pubic bone to the tailbone. These muscles are important because, among other things, they play a role in supporting the pelvic organs, controlling the bladder and bowels, and allowing for healthy sexual function. Research suggests that pelvic floor physical therapy helps with symptoms and conditions including (but not limited to):
- Urinary issues, like incontinence, urgency and frequency, and painful bladder syndrome
- Bowel problems, like chronic constipation and fecal incontinence
- Sexual and vulvar dysfunction, like pain during intercourse or tampon insertion
I don't personally experience any urinary issues, bowel problems, or vulvar dysfunction, so I wasn't expecting Dr. Jeffcoat to "find" anything during my visit. I thought she'd say everything was fine and then send me on my way. (For the record, I was wrong.)
- Heather Jeffcoat, DPT, doctor of physical therapy, owner of Femina Physical Therapy, and author of Sex Without Pain
Here's what trying pelvic floor physical therapy was like
I filled out eight pages of paperwork before I saw Dr. Jeffcoat, including a “Pelvic Floor Impact Questionnaire,” designed to determine how pelvic floor pain might impede my ability to live life normally. The impact questionnaire is broken down into three categories—bladder or urine, bowel or rectum, and vagina or pelvis. Why? Dr. Jeffcoat says your pelvic floor therapist should take a three-pronged approach that includes the bladder, the bowels, and the vulva or sexual organs because the pelvic floor impacts each of these.
Additionally, she points out that most people (and medical forms) might use "sexual health" and "vaginal and vulvar health" interchangeably; however, pelvic floor issues extend beyond painful sex, she says. Someone might also experience vulvar or vaginal pain during tampon insertion or a pap test.
Once I completed the paperwork, Dr. Jeffcoat's receptionist walked me to a super-relaxing, dimly lit exam room. Once Dr. Jeffcoat entered the room to begin the exam, she first reviewed the patient forms with me, noting some less-than-ideal responses I'd given—it turned out that I misread the forms. Then she explained what I would experience throughout the session, which helped me prepare for it accordingly. Even though I was here to explore my pelvic floor, she explained that part of this exam would feel like any other physical therapy appointment.
"A pelvic floor physical therapist should also be a really good orthopedic physical therapist, because a lot of our patients will have multiple overlapping issues." —Heather Jeffcoat, DPT
“A pelvic floor physical therapist should also be a really good orthopedic physical therapist because a lot of our patients will have multiple overlapping issues,” says Dr. Jeffcoat. “You cannot fully resolve urinary incontinence if someone also has severe hip pain and you're not treating that concurrently—because there's probably something in the hip that's driving the pelvic floor dysfunction.”
To that end, Dr. Jeffcoat started by checking my overall mobility. For instance, she applied pressure to my lower back and asked me if there was any tenderness. Then she asked me to lift my right knee halfway to my chest as if I was marching in slow motion. “As you bring that right knee down, there’s a little bit of popping," she said. Dr. Jeffcoat said it was expected, considering I didn’t experience any lower back pain, which could indicate bladder issues.
Many of Dr. Jeffcoat's clients do experience pain, which might indicate other problems. “Pain is often associated with a high tone, or overactive pelvic floor,” says Dr. Jeffcoat. What might that pain indicate? Possible diagnoses include vulvodynia, which is chronic pain or discomfort around the opening of your vagina. Dr. Jeffcoat adds that it might also indicate vaginismus, an involuntary tensing or contracting of muscles around the vagina, as well as urinary incontinence or exacerbated symptoms of endometriosis.
After she finished checking my back, Dr. Jeffcoat stretched me out on the exam table and felt for any tension or tightness around my hips and abdomen. She could tell that my abdominal muscles weren’t doing what they were supposed to. She also noticed that, instead of being able to hold my leg up and resist her pressure, she was able to push it down with relative ease each time. For each of the mobility issues that Dr. Jeffcoat noticed, she recommended a stretch for me to try at home.
After addressing mobility concerns, it was time for the pelvic floor examination. During this part of the therapy, patients can typically expect providers to examine them internally—meaning if you have a vulva, your therapist will place a finger inside you to feel for any vaginal tension or pain. I was not expecting this—I thought pelvic floor physical therapy would be like Pilates.
Some folks might be uncomfortable or experience pain with the internal part of the exam.
Dr. Jeffcoat says she would clearly communicate what she's doing and how it's beneficial for anyone caught off guard by the internal exam. If someone is having a tough time with the vaginal wall examination, which Dr. Jeffcoat says is not an infrequent occurrence, she might reschedule the internal exam. "Since we are looking at them as a whole person, if they are uncomfortable in any way, we can delay the intravaginal exam to a later date," says Dr. Jeffcoat. In the meantime, she'd work on orthopedic findings. "This helps build trust between the provider and the patient, and it's still working towards meeting their goals," she adds.
All that said, Dr. Jeffcoat walked me through the entire process, letting me know before she inserted her finger into my vagina, and she also explained what she was doing throughout the exam. This helped make everything a little less awkward.
Ultimately, Dr. Jeffcoat noticed that I had a bit of pain as she examined the deepest vaginal wall. She prescribed an exercise to help with that discomfort, and she gave me a form detailing how to perform that exercise at home. I felt more empowered to take care of my physical health because I had an easy-to-follow step-by-step guide.
However, patients dealing with a more severe issue might have different treatments. A patient might need to come into the office once or twice a week if they have complaints about pain, bladder urgency or frequency. Or maybe every other week if they're experiencing isolated muscle weakness, says Dr. Jeffcoat. "Regardless of in-office frequency, all patients should be given a home program to reinforce the techniques learned in their sessions," she says. "Coming to physical therapy once a week, without any follow-through at home, may not give the patient the results they desire."
A few tips for your first pelvic floor physical therapy session
Some folks might be uncomfortable or experience pain with the internal part of the exam, says Dr. Jeffcoat. “One way to reduce this is to make sure your provider is communicating with you throughout—that they tell you when they will be moving from one spot to the next, and what they are going to be assessing at each spot,” she says. “Clear communication is the best way to proceed with ... any type of physical exam.”
Suppose you’re considering going to pelvic floor physical therapy and aren’t sure what to expect. In that case, Dr. Jeffcoat has some helpful advice for your first visit: “When calling to find out more, ask them how much experience they have treating your particular diagnosis or symptoms,” she says. “A passion, clear communication during the evaluation, and laying out your treatment plan should all be demonstrated in the first visit.”
It's worth noting that pelvic floor therapy can be prohibitively expensive. For instance, a two-hour evaluation (first visit) with Dr. Jeffcoat costs $525, and 55-minute follow-ups are $250. There is also a chance that your insurance provider might not cover care. If you're interested in accessing care, call your insurance company to explore your options.
Pelvic floor physical therapy may not have been what I was expecting, but it can help folks who experience some pain and other symptoms. Dr. Jeffcoat suggests using the Academy of Pelvic Health Physical Therapy’s provider locater to find a therapist.
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