Pelvic floor physical therapy can be a little mysterious and nerve-racking to first time patients. What will it involve? What do I wear? Will there be internal exams? Will this help me?

Jade Integrated Health is the leading pelvic floor physical therapy clinic in the greater Portland and Brunswick area. Our pelvic floor physical therapist are experienced and have received extra training beyond their standard physical therapy schooling. Jade Integrated Health prides itself on getting the expert in front the patient to provide the best possible care. That being said, who better to answer all your pelvic floor therapy questions than the experts themselves. Nancy Charlebois MSPT, LMT , Karie Wik DPT, LMT CYT and Amanda Delorme MSOT, CYT are here for you!

1. How long will an appointment be?

   Typically your appointments will be 50-55 minutes for both the initial evaluation and follow up sessions.

2. I have other conditions that could be related (i.e. interstitial cysts endometriosis, IBS); how will that affect my therapy?

   Other medical conditions are frequently interplaying with pelvic floor conditions. We will always review medical history with our patients and make a plan of care that works well for the individual, and this plan might involve seeking care from other professionals for the diagnoses that physical therapy can not address. We want the whole patient to be healthy! Your physical therapist will communicate with you and with other providers to help you meet your goals. You may also find that PT treatment helps your other conditions become less symptomatic.

3. I am pregnant; how will this affect my physical therapy?

   There are physical therapists that specialize in treating pregnant and postpartum women as well as pelvic health. Your physical therapist will still perform a full evaluation of the condition that brings you in. However, there may be some additional factors that they will assess in order to accommodate your rapidly changing body. For example, using different positioning strategies, considering exercise modification and appropriate modalities.

4. What can I expect at my first appointment? Follow-up appointments?

   If you have had physical therapy for another part of the body you can expect similar events at your pelvic floor physical therapy appointments such as an interview, muscle/sensation and/or performance testing followed by some basic education and development of goals and a treatment plan. Some of the differences during a pelvic floor exam and evaluation might include more time spent on talking about your history, depending on how long you have been having symptoms and what factors might be involved. For example, if you have had some pelvic pain for the past 20 years we might have some investigating to do before jumping into an exam or treatment plan. Another thing that patients notice in my first visit with them is usually a lot more education on anatomy and physiology (how the pelvic floor looks, works and what can go wrong) since, unlike the shoulder or knee, we typically don't arrive with as much knowledge of this region of the body. This may be due to the pelvic floor being mostly inside the pelvic bowl out of plain sight. We are also trained experts in muscle testing of these deep and inside muscles. Unlike other medical providers who specialize in diagnosing disease or dysfunction, physical therapists are the experts in muscle performance, coordination and functional use of the pelvic floor. For this reason, sometimes an internal sterile glove exam is optimal for forming a treatment plan and helping you succeed in meeting your physical therapy goals.

5. Will I need an internal exam and why is it necessary?

   An internal exam is performed at the patient's comfort level, and while it is not at all mandatory, it is a helpful part of gathering information about your case so we can make the most effective treatment plan for you. An internal exam can help us figure out the difference between someone with weak hypertonic muscles and someone with strong low endurance muscles, both of whom may present with urinary incontinence but require different styles of physical therapy treatment. For someone with pelvic pain, an internal exam may be the only way to identify scar tissue or trigger points so we can make the most helpful treatment recommendations.

6. Can I come to pelvic floor physical therapy is I am on my period?

   You can still come to pelvic health PT if you have your period. If any internal examination or treatment is needed that day, you and your provider can discuss whether to go ahead with internal work. If you decide to defer internal work to your next treatment, there are other treatment strategies, exercises and techniques that you can participate in PT while still having your period.

7. What conditions can a pelvic floor physical therapist treat?

   Pelvic floor therapists are trained to work on any part of the body. We have taken specialized courses and hands on training in order to be knowledgeable about impairments related to the pelvis. This typically may include musculoskeletal or neuromuscular impairments which contribute to, or arise from bladder, bowel, or sexual dysfunction. For example, leaking urine involuntarily, increased bladder urge, or frequency during the day or night, constipation, painful urination or defecation, involuntary loss of stool with or without strong urge, injuries involving the tailbone, groin, or pelvis, pelvic pain of any kind including unwanted pain related to sexual activity. We also treat patients with changes related to aging, cancer/cancer treatments, post-surgery, pregnancy and sports related conditions.

8. How long will I be coming to physical therapy?

   It depends on your diagnosis. Someone with muscle weakness and can expect to start having decreased symptoms in about 6 weeks with strengthening, someone with urge leaks may have decreased symptoms after some training in just a couple of visits, and someone with long term pelvic pain can expect the length of their recovery to be much longer as we work to change the body's patterns. I like to start with a once or twice a week frequency with most patients and then progress to less frequent visits over time as the patient is feeling more independent with their homework.

9. Can I bring my baby with me?

   At Jade, we welcome the younger crowd in diapers! New parents are welcome to bring their pre-crawling babies. It is ok if they cry, we know this happens. If they need a diaper change or anything that will help them be more content during your appointment, we will flow with the needs of you and you baby.

10. I have a history of trauma that may affect my physical therapy treatment; what should I do?

    First of all, everyone deserves to feel safe and have choices about the types of treatment, exam and therapeutic relationship that is developed during their medical care. It is always helpful for providers to know if certain actions, touch or language might be avoided in order to help us support you in the best way possible. Because pelvic health sometimes involves examination of vulnerable parts of the body, I put a couple extra measures in place in order to provide all patients with choices. One option is to offer a chaperone in the room for any part of the exam or treatment session per APTA (American Physical Therapy Association guidelines). Another option is to provide whatever communication is needed prior to administering an exam or treatment in order to gain consent from my patient. For example asking permission to palpate (touch with purpose of assessing tissues/joints) and allowing patients to decide when/if an internal vaginal or rectal exam is performed during the course of treatment (if medically appropriate). If you have strategies developed with a mental health or trauma counselor, we can work these into our sessions. Communication and consent are always key.

Jade Integrated Health treats male, female and pediatric pelvic floor health. We foster an environment of understanding and openness for all patients in our clinic. We want our patients to leave feeling more knowledgable and empowered about their medical care and their bodies.

Don’t see your questions here? We would love to talk to you!