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Physical therapist helping a woman with exercises

What to expect at a pelvic floor PT appointment

Physical therapist helping a woman with exercises4

February 18, 2020

By Carolyn Yates, PT, DPT

Pelvic floor physical therapy is a specialty of PT that focuses on the pelvis and the different pains and dysfunctions that can arise. The pelvic floor is made up of muscles, ligaments, tendons, and joints just like your shoulder or knee. As musculoskeletal experts, pelvic floor physical therapists treat the dysfunctions and pains that can arise as a result of injuries to those muscles, tendons, ligaments and joints. These things can include incontinence, pain with penetrative intercourse, prolapse, or abdominal pain. Many times your OB/Gyn or midwife will refer you to pelvic floor PT if you express you are experiencing symptoms that are related to muscular dysfunction. Sometimes your symptoms might not be completely understood by your doctor as something that a physical therapist can help. Rest assured, you can make a difference in your symptoms by seeing a pelvic floor PT!

What happens at the appointment?

Your first session will consist of a verbal history taken by the physical therapist. You will spend a good amount of time answering questions about your injury history, your current symptoms, what makes them worse, what makes them better. You will be asked about your bowel and bladder health. If you have intercourse, you will be asked if it is painful and for how long you have had pain with it. The questions asked during the verbal history all depend on what your symptoms are that you’re coming in for but expect to be asked a lot of personal questions. It is important for the PT to get a thorough history and understanding of where you are.

Once the verbal history is done, the PT will move on to the physical exam. You will most likely go through a general movement and mobility screen. Again, depending on what you are there for, you will be asked to do different things. For example, balancing on one leg, bending forward to touch your toes, strength tests of your leg and core muscles. You will then (most likely) have an internal exam done. The PT needs to do an internal exam to determine the mobility and strength of the pelvic floor muscles, as well as to assess for trigger points or other pain-producing points internally. This might seem scary or awkward, but rest assured, everything will be explained ahead of time and the PT will go at the pace that you feel comfortable with. It can be physically uncomfortable at times (just like deep tissue massages and going to general PT can be physically uncomfortable as well). Just know that you can ask to stop or take a break at any point. Your comfort level is of utmost importance.

Once the physical exam is completed, the PT will talk with you about your plan of care. The plan of care is to set expectations and goals for you to achieve as you work with the PT as well as what the PT expects to do manually to help you work through your pain or dysfunction. Manual work may include dry needling, deep tissue massage, trigger point release, stretching, muscle activation for strengthening, and desensitization work to name a few. You will also likely be instructed in exercises to start doing until you return to PT. Sometimes you will just be given simple stretches to start implementing or you may be given a number of strengthening exercises; it just depends on what you are seeing the PT for specifically.

How is PT different than a lot of the fitness programs out there?

PT is different than fitness programs because it is focused on treating a specific pain or dysfunction as well as finding the source of that pain/dysfunction and working to prevent it from happening again. You will do strengthening exercises but they will be prehab/rehab focused as opposed to fitness-focused. Fitness is a component of injury prevention/recovery from injury, but a PT is focused on reducing the dysfunction and finding the source of it.

How many appointments can I expect until things are better?

This is a question that comes up all the time and is very difficult to answer. Every body is different and predicting how many appointments a patient will need without even talking to them/knowing anything about them is impossible. Some pains or dysfunctions can be resolved quickly with education and a couple of simple exercises, and some need more hands-on manual treatment with tailored, progressive exercises. This question can only be answered after some information is gathered by the PT. But in general, 4-6 visits over the span of two months can act as a good estimate. Education and understanding the progression of your symptoms over this amount of time is important and will give the PT better insight into how to best help you.

How much should I expect to spend?

Pelvic floor physical therapy is a specialty and also requires a lot more hands-on, personal work. Therefore, it can be more expensive and most pelvic floor PTs are out-of-network with all insurance carriers. Being out-of-network allows the PTs to have freedom to treat for longer amounts of time; which is very necessary in pelvic floor PT due to the nature of the work.
Some PTs will provide you with a “super-bill” after you pay for your appointment which you will then submit to your insurance if you have out-of-network coverage and what you paid will go towards your out-of-network deductible or you will be reimbursed some or all of what you paid if your out-of-network deductible has been satisfied.

Average cost of pelvic floor PT depends on if the PT takes insurance and if they are in- or out-of-network and your geographical location. You can expect to pay anywhere from $50 to $200 per session. Insurance can lessen this but again, it depends on what your coverage is like.

How do I find the right PT?

The most important thing to look for if you are in need of pelvic floor PT is that the PT actually dues internal work. It is imperative that you have a thorough evaluation done of the internal muscles. Find a PT who can do a 15-minute phone consultation with you ahead of time. This way you can get questions and concerns answered and feel like you have a little more of a connection with the PT before you go in. This will help calm nerves and make the first session easier.

Carolyn Yates, PT, DPT is a Colorado State licensed Physical Therapist with a pelvic floor rehabilitation specialty. She received a Doctorate of Physical Therapy (DPT) from Belmont University School of Physical Therapy and is the owner and head physical therapist of Verity Physical Therapy & Wellness in Boulder, CO.

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