What is a “Good” Pelvic Pain PT Session Like?

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Recently we received a question from a reader asking us to describe what a “typical good pelvic floor physical therapy session” is like.

It’s a question I’m sure every pelvic pain patient prescribed PT has thought about. Currently, there is no standard of care for pelvic pain PT. So unfortunately, patients get PT ranging from good to mediocre to inadequate to a complete waste of time. The hope is that when patients begin to push for the best standard of care, change will occur. The problem is that the majority of patients have no idea where the bar should be set when it comes to pelvic pain PT. Going into it they get very little, if any, information from their prescribing physicians, who themselves often have little knowledge of the treatment.

This brings us back to the original question: What is a “typical good pelvic floor PT session like?” With this post, we plan to answer that question by giving a play-by-play description of both an evaluation appointment at our clinic and a typical follow-up appointment.

Before we go any further, however, you’re likely wondering who the heck we are to presume to set the standard for pelvic pain PT? Well, for one thing, over the past decade we’ve focused solely on the treatment of patients with pelvic pain, both women and men. Plus, during that time, we’ve worked extremely hard to educate the PT community and the general medical community about pelvic pain PT (click here to get to know us better). But the most important claim we have is that we know what we do works because our patients get better!

Now, back to the question at hand. Below is the reader question that sparked this post.

Question:

I’m curious as to what a typical good pelvic floor PT session is like. I went to PT for a while to treat my pelvic pain, but I’m not sure it made a difference. The PT didn’t really explain anything—the only thing I heard was that I have some tight muscles, but that seems pretty vague to me. My PT sessions consisted of about 20 minutes of conversation, then I got up on the table, was guided through a leg stretching exercise, then my belly was massaged for a bit. From there I got undressed and had about 15 minutes of vaginal massaging. This never varied.

Answer:

Evaluation Appointment

At the evaluation appointment, the first thing we do is interview the patient. What we’re after is the patient’s full pelvic pain history. Among the questions we ask are:

When did your pain start? What does it feel like? Where is it located? What exacerbates your pain? What alleviates your pain? How does it affect these three functions: Urination? Bowel movements? Sex? What activities does your pain limit? What kind of work do you do? What doctors/other PTs have you seen? Have you had any diagnostic procedures done? What past treatments have you had? What medications are you taking?

It’s important that the interview not go over 15 minutes! That’s because we want to make sure we have enough time to get our hands on the patient. That’s how our time and their time is best spent. So after 15 minutes, whether we’ve gathered all of the info we need or not, we ask the patient to undress and hop up on the table. We leave the room to give the patient privacy and time to get situated and comfortable. If there is still info we need from the patient—and there always is—we will simply continue the conversation as we begin evaluation and treatment.

The evaluation  is the actual hands-on work that we do on the patient. The goal is to begin to uncover the contributing factors of each impaired area.

We choose where to begin based on what we’ve already learned from the patient. Because we’re limited by time—the evaluation appointment is a one-hour appointment—we must prioritize. So, we’ll pick selective things to work on during that first appointment. We want to tackle the areas causing the patient the most pain first.

While every patient’s pain is its own unique puzzle, there are two areas we will always check out on evaluation day. These are a patient’s connective tissue mobility and their internal pelvic floor muscles. We’ll access the latter either vaginally with our female patients or rectally with our male patients.

During the internal exam we are on the lookout for hypertonic (tight) muscles, trigger points, and a gauge of the patient’s pelvic floor motor control and function. Plus, we will palpate the peripheral nerves to identify irritability. As for the connective tissue, it’s a rare day that connective tissue is not involved in a patient’s pelvic pain. In fact, we go through the connective explanation every single time we have a new patient.

In case you’ve never gotten an explanation for how connective tissue contributes to pelvic pain or you need a refresher, this is our schpeal: “Connective tissue becomes tight as a result of underlying dysfunction in muscles, nerves, organs, or joints. As a result, there is reduced blood flow and the tissue becomes hyper-sensitive. Therefore, it becomes difficult and painful to manipulate. If we don’t fix it, it’s going to continue to contribute to the underlying impairments in corresponding muscles, nerves, organs, or joints, and the pain cycle will continue.”

So, in the evaluation appointment, we definitely examined the patient’s connective tissue mobility and their pelvic floor, plus other areas we were able to get to that we believed were contributing factors to their pain. Ultimately, between this first appointment and the next appointment or two, all areas on the patient will be evaluated from the ribs to the knees, back and front.

An Explanation

One of the things that bothered us in the reader’s question was this line, “They didn’t really explain anything—the only thing I have heard is that I have some tight muscles, but that seems pretty vague to me.”

We don’t ever want our patients not knowing why we’re doing what we’re doing! Throughout the treatment session, we explain to them what we’re doing and why.

If your PT is not giving you these kinds of explanations, it’s important that you ask for them. Asking her will not only bring you up to speed, it’ll force her to develop a plan, and not just treat you in a scattered, directionless way. And do not accept a half-hearted explanation that what she’s doing “decreases muscle tightness.” Your PT needs to be able to tell you why she thinks the tightness is there, what she thinks is causing it, and what she’s doing about it.

On top of explanations throughout, at the end of every appointment we give our patients a briefing on what we did, what we found, and what our expectations are. For instance, we’ll say something like, “So I worked on such and such trigger points today, they’re still there, so basically I don’t expect your pain to change until these start to change more. For the next four weeks, I’m only going to focus on this area and if I can’t get things under control I’m sending you for trigger point injections.”

A Typical Pelvic Pain PT Session

At the beginning of a typical PT session, we walk into the room with the patient dressed. We question the patient for two minutes at the most. Just as on evaluation day, time is precious. We only have one hour, so we want to begin manual therapy on the patient as soon as possible. If we don’t get all of the info we need  in two minutes, then we’ll just continue the conversation once we begin treatment.

One bit of info we want to get from the patient is a description of their symptoms after their last treatment. We especially want to know how those first two or three days were after treatment.

This is important for a few reasons. For one thing, oftentimes we will focus our treatment for the day based on what their response is and what is bothering them the most. For another thing, it allows us to educate our patients about reasonable expectations. For instance, based on their response to the question, we’ll explain why they were sore (if they were). Or why their pain was better or worse.

Also, from looking at the chart before the patient comes in, we’ll have a few very specific questions to ask. For instance, if it’s a patient who is having pain with sex, we’ll ask whether sex was possible since their last appointment.. If it was, we’ll want to know if anything was different about the experience. We’ll want to know whether the pain was less in intensity, less in duration, or in a different area.

After our two minute chat, we’ll leave the room so that the patient can change and get situated on the table. When we come back into the room, we’ll tell her or him what we’ll be doing during the appointment and why.

The first thing we’ll do during treatment is to treat the patient’s connective tissue. The reason we do the connective tissue manipulation first is that it makes it easier to treat underlying trigger points, it calms the nervous system down some; it increases blood flow to the area; and it relaxes the pelvic floor a bit.

For the most part, there are four rungs to the ladder of pelvic pain treatment. They are: working out external trigger points, working out internal trigger points and lengthening tight  muscles, connective tissue manipulation, and treating at structural abnormalities. However, the last, treating structural abnormalities, is only incorporated when it applies. So during a typical appointment, we are focused on these strategies.

Typically we spend about half the appointment on connective tissue manipulation and external trigger point release (external work), and half the appointment on internal trigger point release and muscle lengthening (internal work). An appointment lasts for one hour. And patients either see us twice a week or once a week.

So that’s what we do during a typical PT appointment. What we don’t do during an appointment is: We don’t ever leave our patients alone in the room hooked up to a tens unit or to a biofeedback machine or performing exercises with an aide. When it comes to the successful treatment of pelvic pain, what works is manual, hands-on treatment, so that’s what we do.

Also, we don’t use a cookie cutter, one-size-fits-all approach to pelvic pain PT. Not only will every patient’s treatment be different, but a specific patient’s treatment will change and evolve from appointment to appointment!

And, we don’t spend precious time cheer leading our patients through stretches and strengthening exercises. While we do arm patients with therapeutic home exercises from day one, like pelvic floor drops, we don’t spend more than a few minutes teaching patients how to do them. As for stretching and strengthening exercises, they do have their place; when pain is either completely gone or way down and when trigger points are gone, and the muscles are either tight or weak. That’s the time, and the place for them is when the patient is at home.

So, now that we’ve given you a rundown of what we believe is a good pelvic pain PT session, we’d love if you’d share your experiences with us and our readers! Do your PT sessions differ from what we’ve described? If so, in what way/ways?

Please either leave any questions or comments you might have in the comment box or email us at: blog@pelvicpainrehab.com.

If you’d like to leave an anonymous comment, just don’t fill in your name or email address and it will be posted as “anonymous”.

Be well,
Steph and Liz


137 thoughts on “What is a “Good” Pelvic Pain PT Session Like?

  1. I live in Wilmington, NC and really there is only 1 available practice in town for me delaing with pelvic pain. In the very beginning they suggested kegels which, I straight up said no to and they completely understood my reasoning and do no offer it anymore. My typical session consists of about 5 minutes talking, 15 minutes or so on e-stim by myself followed by manual therapy-almost always internal. How as a patient do I suggest that what I could benefit more from is strictly manual work…how do you approach your provider about these things? Also, would LOVE to know when you guys plan on making a DVD to go over your techniques so that those of us nowhere near the west coast can benefit!!! Thanks-

    • Dear Reader,

      Thank you so much for your comment and questions.

      Unfortunately, your dilemma is all too common: there are few providers, and even fewer with sufficient knowledge and training to successfully treat pelvic pain specifically. In defense of pelvic floor PTs, until fairly recently (last 5 years) there have been minimal opportunities for PTs seeking training for pelvic pain. The focus has been on treating incontinence, which is an entirely different animal than pelvic pain and needs to be treated very differently. Even today there are still few opportunities for PTs to get adequate training to treat pelvic pain, but it is improving!

      So, to answer your first question, what do you do when the only game in town does not have sufficient training or knowledge to successfully treat pelvic pain? This is a tough question, but extremely valid. Most medical practitioners respond to research. So I think a good place to start is presenting research or well-written journal articles that discusses the benefits of manual therapy for pelvic pain. Rhonda Kotarinos is an excellent pelvic floor PT who has co-written several articles and has been involved in exciting research in this specific area.

      Here’s a quick list of articles I would suggest. They are available on PubMed which your PT should be able to get access to.

      “Rehabilitation of the short pelvic floor. I: Background and patient evaluation.” FitzGerald MP, Kotarinos R.

      “Rehabilitation of the short pelvic floor. II: Treatment of the patient with the short pelvic floor.” FitzGerald MP, Kotarinos R.

      “Randomized multicenter clinical trial of myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness.”

      Other than presenting research or publications, I would try to talk to your PT about it. If you’re not progressing, meaning your symptoms are not changing, you should talk to your PT about why she/he thinks this is happening. I think it’s completely acceptable to ask questions about other treatment strategies that you’ve read about (i.e. on our blog), or discussed with other people that are successfully being treated for pelvic pain. A good PT should be open to discussing other treatment strategies if the strategy he/she is using isn’t working. If they’re not open to it, it may be time to look for another PT, even if that means traveling to another town. We see a lot of people from other cities, states, and countries on a very short-term basis, typically one week. Our goal is to get them on an effective treatment plan and then communicate with their local PT to continue that treatment plan.

      Again, this is an important issue, and we plan to devote an entire post to it in the coming weeks.

      To answer your second question, we have developed an excellent instructional DVD that teaches many of the manual techniques we use for both men and women with pelvic pain. This DVD is available to students who have taken our continuing education course, “De-Mystifying Pudendal Neuralgia as a Source of Pelvic Pain: A Physical Therapist’s Approach”. The reason it is only available to our students is in order to fully understand when and how to incorporate these techniques into a treatment plan, a PT really needs to understand the specifics of each technique which the DVD does not review. Our class is a comprehensive review of each technique and teaches how and when to apply them to a successful treatment plan for a person with pelvic pain.

      All the best,
      Liz

    • I saw your post and wanted to let you know that I am moving my practice to the Raleigh-Chappell Hill area this December 2014. I will have my own office that provides full body manual therapy. If you would like more information check out my website or send an email.

  2. Your treatments are right in line with my PT. The only difference is that my pain has reached the point that even a q-tip touching the external pelvic area is excrutiating. I always receive the injections or recently botox, first. This knocks out about 70% of the pain, which then allows the PT to work and stretch the pelvic floor muscles. Have had three episodes and am finally recognizing “early” symptoms. This will allow me to start with the PT before I need injections first. Thanks for your info. It encourages me that my specialist & PT are are staying current on this painful disorder.

  3. Hi Steph and Liz,

    Just wanted to say thank you for thr work that you do and all the people that you help with your treatment and knowlede. I have been reading about you guys on a yahoo support group called happypelvis. Although I’m Canadian, I do see a great provider in Ottawa Ontario who seems to subscribe to the same things you describe almost exactly. I was just wondering if you happened to know her since we only have one or two people doing this work in our city.

    Thanks!

  4. Fabulous article. Everything makes perfect sense and you did a good job at making the reader understand what a good PT session should go like. The thing I found interesting is the bit about the trigger point injections. In the Pittsburgh area, I can’t think of anyone that has experience doing these injections, and I know they would be beneficial to me and many others when flaring. Another goal to work towards on PM! Thanks Stephanie and Liz for your dedication to the CPP community.

  5. I clicked the box to be notified of comments here. I have enjoyed the conversation! However, I’m noticing quite a bit of spam in your comments. Some of them seem to have been deleted already. I commented on the post as well and I’m not seeing it now either, so you must have deleted it too. I’m sorry if anything I put in my comments was unacceptable. One never knows if it’s okay to offer additional treatments for pelvic pain on other people’s blogs.

    The reason I’m commenting now is to tell you about Askimet, which is a very low cost spam catcher and is great for catching the spam before it’s posted on your blog.

  6. I am currently a patient at Sarton Physical Therapy and see Julie and Nicole. They are fabulous and have already made a difference for me. My pelvic floor that started out as a tight hypotonic mess, is now completely trigger point free and now we are moving on to my rectal work to get that to simmer down! I see a pain free/symptom free future getting nearer and nearer. Although, my pain has never been dramatic or life ruining, it has been a mental and physical challenge to stay positive. If you are in southern california, I recommend these providers, they are awesome! They follow pretty much exactly what the blog says!

    • Hi Heather,

      I realize this post is several years old, but I just stumbled upon it and would be interested to hear about your healing process if you get this, as I just started at Sarton Physical Therapy a couple of months ago. I am still struggling with flare-ups and that gets me down emotionally–I would love to hear a success story!

  7. Do you have any PT recommendations for the Salt Lake City UT area?
    I have had bad experiences with many PT’s which made
    my pelvic pain, chronic urethritis worse.
    I am under care at a pain clinic since my doctor (yrs ago) told me nothing more could be done for me(urologist who took over my regular dr’s practice). At the time thre we no PT for my condition.
    Thanks.

    • Dear Miki,

      There is an excellent Ob/gyn in Utah, who treats pelvic pain, and he might have someone he can refer to you. His name is Dr. Howard Sharp, and his contact info is below. Best, Stephanie

      Sharp, Howard, MD, FACOG
      University of Utah School of Medicine
      Dept of OB/GYN
      50 N Medical Dr. Rm 2B-200
      howard.sharp@…
      (801) 581 – 7640
      (801) 585 – 5146

    • Miki-
      I am a pelvic floor PT who just recently moved to SLC and am building up a practice at the University of Utah for Women’s Health. I was trained at Duke and on the West Coast in Monterey, CA with a WH provider doing this for the last 15 years. Stephanie and Liz are amazing at what they do and I have been trained in this same way. Please feel free to contact me if you haven’t already found someone to help.
      (801) 587-7005

  8. I found pelvic floor therapy very helpful. I was working with Rhonda Kotarinos’ practice (my PT was Maureen) and it was a very good experience.

    I currently live in the Santa Monica area in Los Angeles and wonder if you could recommend any solid PTs here so I can continue therapy.

    • Hi Eric,

      Julie Guthrie at Synergie PT is good: 310-686-3926 as is Julie Sarton: 714 770 8228. Julie Sarton is a bit of a drive from Santa Monica, but she is very worth it, so perhaps you could visit both and see which is the better fit for you?

  9. I am having a lot of trouble and recently read an article on pelvic floor PT. I would like to try it so do you know any PT’s in the Wilmington, NC area or really anywhere close to Wilmington. I would be willing to travel some distance if I could find a PT. I am miserable and it is starting to have an effect on my marriage and I am grasping for answers. Help!!!!!

    Jamie

    • Dear Jamie,

      There are a few options that I know of in North Carolina:

      1. Jennifer Briggs in Raleigh at C.A.W.H. Rehab, 9195719912 jbriggs@cawhrehab.com
      2. Krystina Todd in Charlotte, you can contact her at krystina.todd@carolinashealthcare.org

      3. Natalie Sebba: Lenox Baker location: 3000 Erwin Rd., Durham, NC.

      4. There is also a Women’s Health Physical Therapy Residency at Duke University Hospital, so there are women’s health PT’s practicing there.

      I hope this info helps!

      All my best,
      Marcy

        • Hi Amy, Saw your post from 201 where you mention having a wonderful PT in Wilmington, NC. Would you please share the name and practice?

          Thanks,
          Billue

          • I can’t believe I’ve been fighting this issues for 8 years. Today I found this blog. I’m not alone! I can so relate.

            Biofeedback gave me my bladder back but not my bowels.

            Liz, I know it’s 3 years after you posted, but maybe you can still use the info. I, too, have pelvic floor issues that I had no idea could relate from childbirth 35 years ago. I’m from the Grand Strand in SC and found a gyn/urologist at Duke in Raleigh NC who in turn said it was another issue and referred me to a gastroenterologist. He sent me to a PT for internal/external pelvic floor treatment who was very helpful. She’s wonderful, Amy Pennullo, 919-206-4860. Since it is 4 hours from me at Duke Medical I’m going to a PT at Rebecca’s PT in Mt. Pleasant SC beginning next Monday, 843-553-7676. She recommended another in Wilmington, NC, but it’s about as far but unfamiliar territory for me. Maybe you could benefit from them. PT for Women Services, 910-798-2318.
            Amy thinks there’s hope for me. I sure hope so as my life revolves around the bathroom. I’m just so tired of it. After a colonoscopy last summer I’m afraid I’ve messed up my intestinal tract with laxatives. It took the doctor double the time because she had to irrigate. I thought I was empty. 🙁 For 8 years I thought I lost motility in my intestines when it was muscle weakness/scar tissue/whatever with evacuating my bowels. I get the urge but can’t release. It’s miserable as many of you know. I blamed it all on neuropathy from chemo treatments for leukemia. Who knows!
            Good luck to all. I look forward to reading more stories and reporting back about my pelvic floor treatment with hopes of helping others.
            Sincerely.

          • Chris, how has your experience been with Rebecca’s Pt? My experience was not good. They did very little manual therapy and my hour long appt was filled mostly with e-stim and meditation. They had multiple patients at a time and when I asked why they don’t spend the solid hour with a patient like I had before they said they couldn’t do that or they wouldn’t make any money. My issue is primarily PFD/PN due to hypermobility and weakness but I have been so disappointed in the lack of Pelvic floor PTs in Charleston SC. I haven’t found anyone.

    • Hi Jamie,

      I hope you’ve found some help already, but I just wanted to introduce myself and let you know that you have closer options for Women’s Health PT!

      I personally work with women’s and men’s health diagnoses in Jacksonville, NC at Synergy Physical Therapy & Sports Medicine! Likewise, there is a physical therapy clinic in Wilmington which might be of help!

      Feel free to call the clinic (910-238-2259) or check out the website at http://www.synergyptnc.com

      Amanda Biehl, DPT, CLT

    • if you are a woman, there is a place in wilmington called physical therapy for women, 5919-123 oleander drive, phone – 910-798-2318. they specialize in pelvic health.

  10. Thank you for getting the word out about Pelvic floor PT. I had heard of your names 5 yrs ago when I had pudendal neuralgia. I researched and found an excellent PT here in Charlotte, NC, who understood hypermobility and my tight pelvic floor. Most of my muscular issues are from my Obturator, Piriformis, and at times the back of the pelvic wall. It took a year to get me pain free, but it was a horrible time. We did work as you do, internally working on trps, myofacial work and lengthening, and external work on the muscles as well.
    1 year ago I was diagnosed with Ehlers-Danlos Type III Hypermobility, so this explained much about why I had tight muscles, some from guarding, some from compensation of the pelvic muscles due to my dislocating pelvis. Presently, on and off again, my PT will have some sessions to work on some of my tight PF muscles, but I am relieved much faster, as I dont have as many trps there,I now know what to recognize, and I also do home mantainence with dilators and some manual manipulation using strumming across some taut bands.
    With EDS, I struggle with dysmennorea, and am at times working on trying to eliminate the period with my NC pills, as there is not much positive. I have a higher likelihood of dislocation of the pelvis, more pain, and possible flare up of PF muscles. Any thoughts on dysmennorea and working toward less pain? Could it be abdominal trigger points below the belly button I should check?
    Anyhow, thank you for all of the knowledge you are getting “out there” to the medical community and patients as well. Thank you Jessica

    • Hi Jessica,

      Thank-you for your well-written email and bringing attention to the connection between hypermobility and PF disorders. You are correct in that musculoskeletal impairments can contribute to or cause dysmenorrhea. However, we need to keep in mind the reproductive tract and hormonal factors can also be a primary or contributing cause as well. There is research showing the weekly CTM to the low back and sacrum can help reduce dysmenorrhea symptoms reflexively. In our clinical experience, eliminating MTrPs in the abdominal wall and PF muscles, normalizing CT in the trunk and lower extremities can also help reduce the musculoskeletal input to these painful symptoms. In addition, if the current BC pill is not reducing your symptoms I would suggest working with your physician to try other hormonal control methods and possibly a naturopathic doctor to reduce systemic inflammation.

      All my best to you,
      Steph

      • What is CTM? I have pain with sitting and with prolonged standing. Pain tends to be in the glutes, pirifirms, buttocks. I have had two trigger point injections in the obturator internus. My PT has said the muscles are getting looser and I do not have as many trigger points. I still have pain and tingling in the buttocks & hip area.

    • Jessica, Would you please share the name/practice of the PT you have been working with in Charlotte? I have had some bad experiences and am looking for someone who knows how to treat extremely tight pelvic floor. Thank you!!!
      Beth

    • Jess,
      I know you posted your comment a couple of years ago, but hopefully you will be notified of my reply.

      Could you tell me the name of the PT in the Charlotte area you saw? I’ve been driving to Greensboro to see a fantastic PT up there but my schedule is really getting in the way of me being able to continue seeing here regularly since it takes up the majority of my day getting up there and back. I would LOVE to find a great one locally in Charlotte!

      Thank you so much,
      Jill

      • JIll,

        I am also looking for a great Pt in Charlotte. Did you ever get the name from Jessica or find one on your own. Thanks so much .

        Trish

  11. Good morning! So happy to find this link. My next step is finding a PT in my area. Do you have any names for the Charlotte/Gastonia area of North Carolina. Would greatly appreciate it!! Until i find a PT, I have IC and PFD. is there anything I can do at home to help with the pain? Sex is becoming non existent! Thanks! Great article.

    • Hi Sheri,

      I’m so glad you found the article helpful! And it’s great that you’re starting down the path to healing!

      We do have to PTs that we refer to in NC, however they are in Greensboro and Raleigh respectively. Is that doable for you?

      They are: Wilda Young: 336 275 6380, she’s in Greensboro and Jennifer Briggs, 919 571 9912, she is in Raleigh.

      Another wonderful resource for finding a good PT in your area is a Yahoo Group called Happy Pelvis. The members of the group are very knowledgeable about pelvic floor PT!

      Also, you mention that you have been given diagnosis of IC and PN. Do not get too caught up in these diagnosis. The thing about pelvic floor dysfunction is that diagnosis do not necessarily dictate treatment. The more important focus is figuring out what is going on with your pelvic floor and/or the surrounding areas that is causing your pain/dysfunction.

      Please let us know if you have any further questions/concerns. We offer free 15-minute phone consultations, and would be happy to chat with you any time.

      All my best,
      Stephanie

      Please do not hesitate to

    • Sheri,

      My name is Jessica Powley, and I am a Pelvic PT in Greenville, SC. I would be happy to work with you to help you with your IC/PFD.

      I am very familiar with the treatment styles of Stephanie and Liz, and we have similar mindsets for treating pelvic pain. Please feel free to call my office if you would like to discuss treatment.

      I can be reached at (864) 454 – 0952 or via e-mail at jessica.powley@proaxistherapy.com.

      Best,

      Jessica

  12. I am 7 wks post op (hysterectomy w/removal of uterus and cervix only). I have had a catscan, blood tests, and everything is clear/normal. However, i am still experiencing pelvic pain and feelings of heaviness and pressure. Can you give me any recommendations for PTs in my area? Dayton Ohio

    Thanks!

    • Hi Josie,

      I’m sorry, but we don’t have a referral for your area; however, a great place to find a referral for good pelvic floor PT is an online support group for pelvic pain rehab called Happy Pelvis: http://health.groups.yahoo.com/group/happypelvis.

      The members of the group are really great about sharing the names of PTs they have experience with or have heard about! Not to mention that it’s a great resource in general for those navigating pelvic pain rehab, especially in the area of pelvic pain PT.

      All my best,
      Stephanie

  13. I just found this blog and I’m really glad to find out exactly what happens during a therapy session.
    10 years ago this month I had a LAVH/BSO because of extensive endometriosis. Six months later I needed abdominal surgery to remove adhesions, more endo, and my appendix was removed at the same time. Since the surgery I’ve had pelvic and vaginal pain. Penetration is next to impossible because my muscles are so tight. It’s horribly painful. I know that anxiety causes me to guard but I don’t think that’s entirely the cause of the pain. Constipation is also a problem because of medications that I take for chronic pain. I also have Fibromyalgia which may or may not be contributing. My questions are, do you think PT would possibly benefit me? Do you know if there are PTs who are trained to treat Fibro patients, and would it be insulting if I brought articles about Fibro to educate them if they are not? Are referrals from physicians always necessary or is it possible to just find a PT on my own?
    Thanks much for all your information and thanks too for listening.
    ~Wis

    • Dear Wis,

      Yes, I absolutely think you would benefit from PT! I treat patients with very similar histories as yours all the time with success. Not only could PT help with your pelvic pain, but it could also help your constipation and possibly your fibro. Most PTs, especially pelvic floor PTs are very familiar with fibro and treat it fairly commonly. As far as needing a referral from a physician, it depends on the state you live in. Some states allow direct access, meaning you can go directly to a PT without a referral, and some states require a referral. If you find a PT they will tell you if you need a referral or not.

      Please keep us posted on your progress!

      All my best,
      Liz

  14. Hello,

    Thank you for your very informative site!

    I live in Montreal, Canada and am looking for a PT for treating pelvic pain. Would yopu have someone to recommend?

    THank you in advance!

  15. Hi Liz,

    This article talks about possible trigger point injections if there is no change after 4 weeks of PT. I have been doing about 4 months of PT and I still have flare-ups. My physical therapist showed my husband how to do external and internal work on me. He has been doing it for about 2 months now. I have OK days and bad days. (I also think my anxiety has a lot to do with my lack of improvement.) I’ve read the book “A Headache in the Pelvis” and in the book, Dr. Wise says that it can take several months to stop having flares and see improvements. What are your thoughts on this? I do not have pain, just the constant feeling of needing to urinate. I’ve even considered going to Dr. Wise’s clinic in Santa Rose, CA. I’m not sure if it will be worth it if I will be taught things I am already doing. But, should it really take months to see an improvement? There are so many things I have read and heard that contradict each other. Please help. Thank you!

    Paula

    • Hi Paula:

      I attended Dr. Wise’s clinic in 2008. After a year of the practicing the methods I learned there I was still having increased pain and flareups when I had increased stress. Since then I explored mind-body connection methods for feeling emotions and that combined with doing my own physical therapy (massaging my external trigger points) I am feeling quite well. I’m sharing this just to let you know that for many of us our “healing” includes ongoing practices, such as physical therapy, relaxation meditation and mindfulness practices. I’m also sharing to let you know that it is possible to resume a regular diet and exercise and getting back to living joyfully with little discomfort.

      • Thanks for your reply, Gail. Did his audio tapes for paradoxical relaxation help you much? I’m wondering if it is worth the $$ for the “clinic”. I’m doing physical therapy according to what my physical therapist taught me and my husband and what I have also read “A Headache in the Pelvis”. I also have his “Paradoxical Relaxation” book and am practicing that every night. I’m not sure if there is much more he could teach me at the clinic that I don’t already know… Your feedback is appreciated!

        • Paula, it’s hard to know if the Wise clinic has anything new to offer you. My personal opinion is that the concept of paradoxical relaxation is good, but I get a lot more out of open focus meditation (openfocus.com). Healing and moving beyond being stuck in the pain takes a combination of learning to calm the mind, release muscle tension and relax the body and learning to inhabit the body in new ways. Through mind-body connection I have been able to connect with the protective energy in my body and shift how I react to life. I’m a mind-body coach now helping women heal their pelvic pain through the mind-body connection which is a big piece of the formula for healing. It’s really hard to learn how to inhabit your body differently on your own. I’d be happy to chat with about this.

          • I would like to know more about the mind-body connection. Like I said before, I do not have “pain”, but I believe the constant tension in my body is causing my bladder symptoms. Feel free to email me: paulagrant2009@yahoo.com Thanks Gail!

    • Dear Paula,

      Yes, it can indeed take months to see improvement. The key is to make sure you’re tackling all of the factors contributing to your symptoms. It sounds like you are being very pro-active and are on the right path. In addition to it taking time, it often is about finding the provider that is the right fit for you. If you are unhappy with your PT, have you thought of finding another?

      I recommend that you check out his amazing online support group, Happy Pelvis, for folks rehabbing from pelvic pain. It’s a pro-PT group that is moderated by a former pelvic pain patient who is now better after the right, consistent PT. Here is a link to the group: http://health.groups.yahoo.com/group/happypelvis/.

      All my best,
      Liz

  16. had hip replacement at36 her it is two and a half years later and basically crippled with pain majority of the time and shuffled between dr who say it one thing and reffer me and that dr says no its the other ,,, nothing made sense tonight was first time ever heard of pelvis pain have been researching for past 8 hourrs and have seen explenations for every problem i have quite a few that never made sense or that i gave a second thought (figured it was pain pills doin it) but now i know and i need tto know more but mostly was wondering ifthere is anyone in Stockton Ca (therapist and drs) that i cn contact also just wanted to say to everyone going through I feel your pain and nderstand your frustration and thank the lord finally someone can understand mine

  17. Is a “common/normal” part of the pelvic floor pain PT to have the patient’s husband come to an appointment and be shown how to do the internal pelvic wall muscle massage and then do this on his spouse at the appointment ?

    • Dear Reader,

      Yes, our patients often bring in their spouses or partners to learn to do a variety of different treatment strategies on their partners, external and internal. Best, Stephanie

  18. Do you know an OB GYN or urogyncologist or urologist in
    the Los Angeles area that is familiar with pelvic pain,
    that can partner with my PT? I am having trouble getting
    a referral to Julie Sarton because I’ve already been
    through pelvic PT before and “failed” it (per my urologist, who won’t refer me to another PT).
    Looking back at it, there were a lot of things about my PT treatment that was not right, including no treatment plan or goals or adequate explanations from my PT about what she was doing. Most significantly (and sadly)though, I had no medical partner in this. The urologist who referred me washed his hands of me because my problem isn’t a discrete organ problem and he said there was nothing he could do. When I tried to facilitate communication between my PT and my uro my PT said “He did all the talking”….and didn’t tell me what my urologist said.
    When my PT told me “I don’t know that much about nerves”
    (after 15 sessions)I knew I had to find someone else.
    Please help me. I need treatment, and I want a team approach. I’m in pain and I feel lost.

    • Dear Lisa,

      I’m so very sorry to hear about the negative experiences you’ve had so far getting treatment for your pelvic pain! I know how frustrating and maddening it is! But, you are so wise to continue to advocate for yourself and also to educate yourself as to what you want from a PT/provider!

      Here’s the good news: Julie Sarton is one of the best in the business!!! You will be in the best hands with her! Now, let’s get you to her. There are two great physicians that will no doubt prescribe PT for you:

      Dr. Karen Noblett over at UCI Irvine: http://www.ucirvinehealth.org/find-a-doctor/n/karen-noblett/ (In fact, Julie Sarton in the past worked with Dr. Noblett at her offices in Irvine. She has since opened her own private clinic, but I’m betting she continues to work closely with Dr. Noblett.)

      Dr. Andrea Rapkin over at UCLA: http://www.uclahealth.org/body.cfm?xyzpdqabc=0&id=479&action=detail&ref=7267

      Both physicians are stauch advocates of pelvic floor PT and both are pelvic pain specialists who have conducted research in the area. Also, another great thing about seeing either of these providers is that both are knowledgable about administering complimentary treatments such as trigger point injections, nerve blocks and Botox injections, so if these are treatment options that Julie believes will compliment your PT, you will be able to look to them to administer them.

      Here is some further advice: I would give Julie a call and talk to her about your situation also. She is a wonderful PT and will be able to also offer you some guidance as you get yourself set up with a new physician. For instance, just in case there is a long waiting list to get in to see either of the providers I’ve recommended, Julie might have a Plan B for you to see. She has been practicing for many years in her area and will likely have a much longer list of referrals at the ready than we do.

      Hang in there! And remember, you will be in great hands with Julie!

      All my best,
      Stephanie

  19. I was elated to find your blog. The information was extremely helpful. I, too, am looking for a therapist in Las Vegas. Would you know of one?

  20. Stephanie, I was just diagnosed with Pudendal Neuralgia. I had a vaginal hysterectomy 2 years ago & have not been able to sit since. The past 2 years have been horrible.
    I am wondering if you know of a PT qualified in San Antonio Texas?

    • Dear Kathy,

      I am so sorry about all that you are going through. I’m sorry, but we don’t know of a pelvic floor PT in San Antonio. However, below is info for a PT that we refer to in Austin. Also take a look at this blog post about finding a good PT in your area, it might have some tips that will help: http://www.pelvicpainrehab.com/545/how-do-i-find-a-pelvic-floor-pt/

      Dobinsky Angela PT Austin TX (512) 335-9300 angelad@sullivanphysicaltherapy.com Sullivan Physical Therapy

      All my best,
      Stephanie

      • Thank you Stephanie, I appreciate you verifying that information. I made several contacts here & everything pointed me to Kimberlee @ Sullivan PT. I have since seen her twice & she is awesome. Its just the 2 hour car ride that is not the best for this condition. Cannot settle for just anyone at this point. I am so thankful to have finally gotten a diagnosis & find your website & blogs. You bring hope to people like me that are in a disabling situation.

  21. I am feeling so happy to of found this site. I live in norfolk va any recommendations here. When i was pregnant with my daughter 7yrs ago i had horrible hip pain when laying on hip so from then on just didnt lay on hip for 6 years but About a year ago I began a heavy exercise routine I pulled something and had horrible pain trying to sit or have bowel movement. It was hard to get out of bed or walk and strained to just have bowel movement I went o 4 doctors everyone kept saying muscle but nothing was done I moved across country to Virginia and saw more doctors and finally a Gynocologist sent me to physical therapy for my bladder control issues. Finally tha PT said sounds like pelvic floor!! I got better after a month of seeing her my pain went from a 6/10 to a 2/10 but I feel they don’t spend too much time on me while there or maybe I need to find someone who really has more expertise with pelvic floor. Thank you so much for this post you are changing lives. I have 2 children and never even heard of pelvic floor oh! Oh! I read in a past post kegal exercises are not good?? They have me doing those 3/day?

    • Dear Reader,

      I’m sorry, but we don’t know of a PT in Norfolk specifically; however below is a list of pelvic floor PTs in Virginia who have taken our class.

      And in answer to your question, that is correct kegels are not recommended for people with pelvic pain or too tight pelvic floors. Here’s a blog that we wrote on that topic: http://www.pelvicpainrehab.com/507/why-kegels-are-bad-for-your-pelvic-floor/

      Pierce Kristen Warrenton VA (540) 316-2680
      Rich Jennifer Roanoke VA (540) 982-2273
      Gryski Joanne PT Herndon VA (703) 222-5973
      Miller Amanda DPT Richmond VA (804) 270-7754
      Pagliano Carrie PT Arlington VA 2024444180
      Brown Carolyn PT Virginia Beach VA 7573742373
      Simmons Camille PT Alexandria VA (703) 849-8142
      Oxford Kathy DPT Richmond VA 8043309105
      Morris Lydia PT Richmond VA 8042850148
      Pesavento Kathy PT Vienna VA 7039633466
      Silvers Janet PT Burke VA 7035312410
      Kalina Clare PT Fairfax VA 7035919088
      Holmes Judith PT Middlebury VT 8023982700

      All my best,
      Stephanie

    • Dear Reader,

      Below are the PTs that we refer to in Ohio:

      Morris Michelle PT Perrysburg OH (419) 383-5040
      Arbogast Hannah PT Kettering OH (937) 208-7055
      Dubbs Jill PT Rocky River OH 2162272610
      O’Dougherty Betsy PT Lakewood OH 2164458000
      Davis Kay PT Oaklahoma City OK (405) 752-3700

    • I don’t know where you are in relation to Louisville Ky but Susan Dunn PT is a pelvic floor pt in Louisville with a good reputation.

  22. I did not receive a session like what should be at all I was not told what was going on and left not feeling good my biggest complaint is persistant sexual arousal which disappeared with medicine unfourtantley I had to stop the meds die to side effects and the symptom came back after getting up too quick it was as simple as that to set everything off again . My entire pelvic region and back are extremely sensitive and it is very hard to treat me especially being that I have tried and ended up worse twice I am not sure what to do now that this feeling of arousal is back does PT help take this away?

    • Dear Joan,

      Could you be more specific about your location. Our PT referrals are listed by city and I’m not all that familiar with the cities in upstate NY. If you will send names of cities you’re near or willing to travel to then I can send you some referrals.

      Best,
      Liz

  23. Thanks so much for your informative article. My son 24 yrs old has pelvic pain. Can you recommend a really good apt in the Miami FL area. I’d be so thankful.

  24. I am a 71 year old male, living in Oregon. My concern is pain so severe that often the only relief is lying in a luke warm bath, there are times when I spend hours doing that.
    Pain medication helps some, but wears off before I dare take more. I can manage sitting at a computor but a soft pillow is a requirement.
    Try as I might, I cannot find a therapist in this State that does more than give me THAT “look” if I broach the subject.
    Sexuality is no concern and has not been one for well over a decade, but no matter. Same reaction every time.
    An answer as to what I might try would be wonderful.
    Thanks,
    Ted

  25. I have IC and I have had relative relief from my pelvic floor dysfunction for 4 years until recently. I’m in a flare that is unbearable. My TENS and PT used to calm any flares down but now it’s not working. I’m seeing a PT that does myofacial release and trigger points, but after every session I’m flared and feeling much worse than before the session. I’m not sure what to do about this because I know I need the PT, but if it’s putting me in a worse pain flare how do I stop the cycle? I saw this same physical therapist 4 years ago and she gave me my life back but for some reason this time my muscles can’t handle the work. They are spasming more from it. Sometimes she uses an interferential stim after the session. Could that be contributing?

    • Hello Emily,

      The best thing to do is to communicate with your therapist. When you first started PT with her 4 years ago, did you also use the stim then? Usually these units do not aggravate your tissues to such extremes, if at all. I hope this helps.

      All my best,

      Rachel

  26. Hi, i’m from the UK and I have been seeing an NHS physical therapist in Oxford since September for treatment of dyspareunia due to Vestibuldoynia and Vaginismus, but have been feeling increasingly that something has been missing from my treatment. So far, apart from my initial physical assessment I haven’t received any manual treatment, just advice and guidance on how to use the dilators in conjunction with lidocaine, which I’ve been using for some months now with slow and limited progress. There were signs of improvement about 3 months in, but then i had my first cervical smear test, which was extremely unpleasant and it put me off using the dilators for a couple of weeks, which seems to have set me back to square one. I am feeling very demoralised and demotivated to continue with the dilators, which I have always hated using. My Physio has explained about the need to desensitise the introitus as she said that that is my main problem – I can release the subsequent muscle spasm when prompted, but the hypersensitivity at the introitus will continue to trigger the same automatic muscle guarding response until the sensitivity dies down and the key to that is, apparently, to continue with the dilators. I have been left to get on with them with no sense of how long i will need to keep using them for. In addition to the Vestibuldoynia, (which I’ve been suffering from for over 7 years), I also have chronic lower back pain which my physio told me was the result of hypermobile sacroilliac joints. She said the two conditions are entirely separate from each other and recommended a pilates class, but again, I feel there maybe a missing connection somewhere. I don’t have a real treatment plan other than go to a pilates class and keep using the dilators, nor do i have a follow up appointment booked, and, although she said i could make one if i wanted, i am not sure there’s any point. I feel frustrated and abandoned. This is not what i had in mind when i asked to be referred for Physio. The more research I’ve done online, the more convinced I’ve become that there is more to it than what I’ve so far received. It seems like this area of physiotherapy in the UK is quite far behind the States. What would you recommend? Is there any point going back to see my Physio? I highly doubt she offers the kind of treatments you mention in your article. If i do go back to see her, what questions should i ask to get more out of the session? I don’t really want to be telling her how to do her job…Alternatively, do you know of any Physios in the UK with more expertise? What you’ve described in this article and on your website is precisely what I was looking for when I asked to be referred to Physio, and I feel sure it’s the right treatment approach for my condition. I just wish i could find it here in the UK. Thanks.

    • Hello Hannah,

      You may be correct to believe that your low back pain is directly related to your pelvic pain. Often, PFD will produce secondary symptoms in the lumbar region. We recommend that you contact Maria Elliot, PT in London. With regards to the dilators; Along with weekly pelvic pt sessions, patients can make great gains with their consistent use. A qualified therapist will be able to monitor your dilator program, and progress you to the next stage once it is appropriate for you. Maria Elliot’s information is below.

      Maria Elliot, PT
      London UK
      http://www.simplywomenshealth.co.uk/

      All my best,

      Melinda

  27. Can you please recommend a good PTO in the Clearwater Florida area? Looking for someone with experience at handling male urethritis and Prostatitis.

    • Hello Steve,

      I apologize, but we do not have a therapist recommendation in Clearwater, FL. However, I can recommend a couple of PT’s in Orlando, FL. Their contact information is below.

      Ashley Arango, PT
      Florida Hospital Pelvic Health Rehab
      Orlando FL
      (407) 303-8280

      Katherine Marsh, PT
      Florida Hospital Pelvic Health Rehab
      Orlando FL
      (407) 303-8280

      Best,

      Stacey

  28. Hi I’m 3 months post op excision of endo, hyst of uterus and cervix and appendectomy. My hips get really sore and then my lower back goes out and I also continue to have bowel cramps and pain with bowel movements at times and constipation. My surgeon says she could have missed endo but I’d like to give PT a try before going back for surgery. Do you have a Pelvic PT recommendation for Longview WA. I see the info for Portland OR Pelvic PTs but that would be 2+hour round trip for me. Riding in the car causes pain too so I hope there is a closer one. Thanks- Monica

    • Dear Monica,

      Below is the list of PTs that we refer to in WA. All my best, Liz

      Khadduri Lucie PT Lacey WA (360) 456-3300
      Vora Sagira PT Bellevue WA 4256885900
      Allen Tina PT Seattle WA 2065982889

    • Hi Lori,

      We recommend Michelle Shellhaas, PT in Lincoln, NE.

      Michelle Shellhaas, PT
      Nebraska Methodist Hospital
      (402) 815-2061

      Best,

      Casie

    • Hello Margie,

      We do not have therapist recommendations in Spokane, WA but I can recommend therapists in Seattle and Bellevue. Here is their information:

      Tina Allen, PT
      University of Washington-Roosevelt
      Seattle WA
      (206) 598-2889

      Sagira Vora, PT
      Overlake Hospital Medical Center
      Bellevue, WA
      (425)688-5900

      Best,

      Liz

  29. I unfortunately was in an auto mobile accident, where they said my pelvis came out of place and was/ is causing a great deal of pain. After being evaluated they decided to do a tens unit on me (they would leave the room after hooking it up) and then 3 stretches followed by 3 strengthening excerises. I did that for 20 visits. Over a year later and my pain has not changed. Is there anyone you recommend for the Toledo, Ohio area???

    • Hello Jennifer,

      I am sorry to hear that you did not have success with previous treatment. It does not sound like you received internal manual therapy which is an essential component of pelvic PT. Below is a list of pelvic therapists who have taken our course:

      Betsy O’Dougherty, PT
      Cleveland Clinic
      Lakewood OH
      (216) 445-8000

      Michelle Morris, PT
      University of Toledo Medical Center
      Perrysburg OH
      (419) 383-5040

      Hannah Arbogast, PT
      Miami Valley Hospital
      Kettering OH
      (937) 208-7055

      Jill Dubbs, PT
      Lakewood Hospital
      Rocky River OH
      (216)227-2610

      Regards,

      Elizabeth

    • Hello Ryna,

      Unfortunately we do not know of any reputable therapists in St. Louis, but I can recommend a therapist in Kansas City.

      Sandy Gibson, PT
      Saint Luke’s Hospital
      Kansas City MO
      (816) 932-3344
      slgibson@saint-lukes.org

      Regards,

      Stephanie

  30. I noticed no one has talked about pain after treatment? I have my 2nd treatment on Monday and on tus I was in so much pain I blacked out and threw up! It is now Thurs and I am still in pain… Is this normal? Should I continue treatment should I stop? HELP!!!!

    • Hello Barry,

      Below are the therapists and providers we recommend in your area:

      Nishimota & Neujahr Physical Therapy
      Holly Neujahr, PT and Terri Nishimota, PT
      Denver CO
      (303) 260-5092

      Denver Urology Clinic
      Nel Gerig, MD
      Denver CO
      (303)388-9321

      Colorado Physical Therapy
      Laurie Byrne, PT
      Ft. Collins CO
      970-221-1201

      Momentum Physical Therapy
      Mollie Ressler, PT
      Fort Collins CO
      (970) 377-1422

      Best,

      Liz

  31. Dear Liz and Stephanie.

    I live in Charlotte NC and am looking for a PT that you would recommend for my 16 year old son. I saw some much older posts from 2012, but was hoping you would have some new therapists that may have taken your course since that time.

    Thanks so much for your reccommnedations.

    Sincerely,

    Trish Mcleod

    Trish

    • Hello Trish,

      Here are our therapist recommendations near Charlotte, NC:

      Talley Sarah DPT Raleigh NC (919) 571-9912 Carolina Pelvic Health Center
      Wegmann Emily PT Raleigh NC (919) 571-9912 Carolina Pelvic Health Center
      Young Wilda PT Greensboro NC (336) 275-6380
      Briggs Jennifer PT Raleigh NC (919)571-9912 C.A.W.H. Rehab

      Best,

      Liz

    • Hello Jenn,

      We do not have a therapist recommendation located in Tallahasee, Fla but can offer you therapist referrals located in Orlando. Below is their information:

      Arango Ashley Orlando FL (407) 303-8280 Ashleyann83@gmail.com Florida Hospital Pelvic Health Rehab
      Marsh Katherine Orlando FL (407) 303-8280 Katherinemarsh@flhosp.org Florida Hospital Pelvic Health Rehab

      Regards,

      Elizabeth

    • Hello Jo ann,

      We do not have a therapist recommendation for Houston at this time. Are you able to travel elsehwere in TX?

      Best,

      Stephanie

  32. Anyone know any pelvic floor specialists in Maryland or Baltimore? I have been to a few but they do not follow the recommendations in this article.

  33. I read your post. It is very good. I am a male with this issue. It is very hard to get this kind of help. How do I explain it or ask without being taken like I’m looking for something terrible if you know what I mean. I am in Nashville. Do you know of any male therapists near who know about this?
    Thank You!!

    • Hello Anonymous,

      We recommend sharing our blog with the providers you consult with in order to best address your issues. We do not have a male physical therapist recommendation, but we can recommend physical therapists who specialize in this field in th TN area. Here is their information:

      Nieves Alfredo MD Chattanooga TN (423) 4901136 anievesmd@pprsc.net Pelvic Pain and Reconstructive Surgery Center
      Kubic Melissa PT Chattanooga TN (423)778-8660 mbkpt@yahoo.com

      Best,

      Elizabeth

    • Check out Erin Bower with St Thomas Life Therapies or Cate Langley (she may still be with St Thomas or maybe Center for Pelvic Health). I’m a female but I’ve seen both of these therapists and they are great with the pelvic floor. I don’t know if they currently see men but I think Cate used to or they could point you in the right direction.

  34. I was fortunate to find pelvic floor PT to treat my coccydynia (which is a pain in the a**!). Originally referred by Navy physician after failing a course oftreatment at the pain clinic with ganglia impar blocks, chiropractic and counseling. The pelvic floor PT was far superior and got me moving again!
    I also found someone in Bakersfield CA; Paige Talley at Terio Physical Therapy – treatment was excellent and successful.

  35. Hi!
    I’m wondering how PT for persistent genital arousal disorder (pgad) and vulvodynia would differ from pt that only addressed vulvodynia. Have you treated many women for pgad, and what kind of success have you seen?

    Thank you

    • Author Stephanie Prendergast says:

      Treatment can vary based on the individual. As with any patient, the pelvic floor and girdle muscles, nerves, and tissues need to be evaluated. If impaired tissues are identified that may make sense for the symptoms these need to treated. In our experience a combination approach of physical therapy, medications, blocks, and meditation practices are the most helpful.

  36. Hi! I’m so glad I ran across this!

    My story: diagnosed with rectocele in Sept 2015 and just recently diagnosed with mild cystocele. After my 1st diagnosis I was rx’d pelvic floor pt. I went to Sullivan for 12 weeks, once a week for an hour each visit and did kegel exercises every day. My 1st eval she said my muscles were tight, so that the next 2 visits were focused on relaxing with manual therapy and exercises. After that it was an abdominal massage to help with constipation and kegels hooked up to a biofeedback machine (sensors around anus). After 12 weeks I actually felt more pelvic pain and no relief from my rectocele symptoms so I stopped going. She would re-evaluate, but only rectally, and never felt for tightness vaginally again. Earlier this month when I was rx’d with the cystocele my new dr suggested PT with their facility. Being hesitant I decided to call and ask how they treated. The woman seemed very knowledgeable and kind, but said that she wouldn’t even do a manual evaluation or manual treatment. She uses a ‘probe’ vaginally and rectally to determine muscle strength or weakness and will determine a treatment plan based off of that and symptoms. She said they use e-stim and biofeedback every visit, but that the e-stim can be put on a setting that would relax the muscles if need be, while also strengthening. I’m a little suspicious that she won’t go in there and feel around, especially after reading this article. She works for Consortia if that has any meaning. I’m just not certain if I should even go in for an evaluation. I definitely don’t want my prolapses to worsen, so I feel like I need to do something. But I also don’t want to pay for PT that isn’t going to help (especially since I haven’t hit my deductible yet). Any advice?

    • Hello Tina,

      Where are you located? We could possibly find a physical therapist that we recommend.

      Regards,
      Admin

  37. My urologist has prescribed pelvic floor PT for prolapsed pelvic floor and related pain. Like many others, I knew nothing about this therapy and have found your blog very informative. Do you have a recommendation for pelvic floor PT in N.Texas? Primarily near Plano/Mckinney/Denton.
    Thank you for your help.

  38. this is an amazing site…thank you so much…I am thinking about attending the Wise program, but it is so far and it is difficult for me to travel due to the symptoms, needing a bathroom every hour…I live in South Florida…do you have any suggestions in this area. thank you very much.

  39. HI. I have been suffering from pelvic pain for about a year now. I have been seeing a PT in my home town (MIssoula, MT) and the work has been helpful, but not long-lasting. Part of the problem, I believe, is that the PT I have been seeing does not do any internal work. Could you please provide a name of a good PT in Missoula (or elsewhere in MT) that could provide more comprehensive treatment?

    Thanks so much!
    John

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