Author: Riva P

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What Should I Expect at My First Pelvic Floor Physical Therapy Appointment?

If you’ve been diagnosed with pelvic floor dysfunction, you may be wondering what you can expect from your first pelvic floor physical therapy appointment. You may already know about physical therapy for other parts of the body, but pelvic floor physical therapy is different. You are entrusting us with a very private part of your body. It’s understandable, therefore, to feel confused and concerned. Knowing some of what to expect at your first pelvic floor physical therapy appointment, though, can go a long way toward easing your mind:

 

  • You will be there for a while. Pelvic floor physical therapy is not a quick visit, and that’s especially true for your first pelvic floor physical therapy appointment. How long can you expect your first pelvic floor physical therapy appointment to take? First sessions are typically an hour, and subsequent appointments are usually 45 to 60 minutes. 

 

  • Even though the session is long, you will have to change clothes fast! Physical therapy day is not the day to wear a complicated jumpsuit. Although your therapist should be patient while you change, you don’t want to spend too much time struggling with buttons or zippers. You need that time for your session. 

 

  • You will be expected to talk about your symptoms, medicines and medical history at your first pelvic floor therapy appointment. The night before, it’s a good idea to write down a summary of what brings you to pelvic floor physical therapy. Have you noticed urinary frequency? An increase of pain? Are you leaking? How long has this been going on? Don’t feel embarrassed. We need to know, just like any healthcare provider needs to know about your symptoms. Don’t be surprised if your pelvic floor physical therapist asks you about your sexual activity either! We’re not doing it to be nosy or judgmental. If your therapist is asking, she needs to know. It’s in order for them to understand your symptoms so that they can best help you. There is no wrong answer. Just answer truthfully. 

 

  • You will be asked for paperwork and IDs. This is why it’s a good idea to prepare the night before! You should have your driver’s license, health insurance card and a prescription from the doctor who is referring you to pelvic floor physical therapy (should that be required).

 

  • You may feel strange at first, and that’s ok. No matter how lovely your therapist is, having that part of your body explored by someone you don’t know could feel odd. Don’t be afraid to speak up in the session for anything you need that will make you feel more comfortable, whether that is an extra pillow or a fan. (We don’t want to treat your pelvic floor only to hurt your neck with improper support!) Over time, you may find you feel less strange during pelvic floor therapy appointments as they become more routine. 

 

  • There will be an external exam as well as an internal one. The external exam may involve your back and hips, among other areas. In addition to an internal vaginal exam, your physical therapist may ask to do a rectal exam. Remember, though, you always have the right to refuse any part of an exam, whether at a physical therapist’s office or anywhere else. This is as true for your first pelvic floor physical exam as it is for your 31st: Just because you approve an internal exam, for example, during the first appointment doesn’t mean you can’t refuse it later on. You are always in control, and you should always let your therapist know if you are in pain during a session!

 

  • You may have homework. You may need to do exercises and work with a dilator. Remember: You are a partner with your therapist in getting better – it’s not just him or her doing the work alone! Added bonus: patients who do their homework get better faster.    

 

  • You won’t be cured after the first session. You may have wanted this problem over with yesterday, but you must understand that physical therapy is a process. It’s not the same as taking a painkiller. That being said, the average time spent in physical therapy is 6 to 12 sessions. 

I hope this guide has helped. Going to your first pelvic floor physical therapy appointment is a brave, powerful step that can help put you on the path of a more comfortable life without drugs or surgery. You may question sometimes whether to keep going, especially during weeks when you have a setback, but know that it and you are always worth the effort. If you are in the New York area, feel free to contact me for a free phone consultation, so I can further encourage you about starting pelvic floor physical therapy.

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What “Only Murders in the Building” Can Teach Us About Our Pelvic Floors

In a recent episode of the wildly popular Hulu series “Only Murders in the Building,” the pelvic floor was an unexpected plot point. Charles-Haden Savage (Steve Martin) was visiting chiropractor Dr. Maggie (Veanne Cox). He wanted to find out more about Sazz Pataki (Jane Lynch), the (spoiler alert) murdered stunt double who was also a dear friend. After talking to Dr. Maggie, Charles realized that his relationship with Sazz might not have been as good as he thought it was, and he became depressed. Glenn (Paul Rudd), feeling sorry for him, asked, “What have you got for heartache, Mags?”

“Well,” she replied, “relationship worries are stored in the pelvic floor so….”

“Whoa ho ho! No. No,” Charles said nervously, while protectively putting his hands over his crotch.

It’s a typically funny Steve Martin moment but also a teachable one.

I think most of us understand that the mind affects the body. Anyone who has ever felt her heart race or stomach hurt during a stressful moment knows this all too well! Stress may also play a part in the health of your pelvic floor: It makes our muscles tighten, which can slow down circulation, both of which can potentially result in pelvic floor dysfunction.

Relationship worries are a factor that can give rise to dyspareunia, which frequently shows up in women who have hit menopause, though it can occur even if you are pre-menopausal. Up to one-half of postmenopausal women may be affected by dyspareunia. Put simply, it’s pain during sex, and that can be just a little bit up to extremely uncomfortable. Maybe you thought this was normal? Your cross to bear? You’ll be happy to learn that it’s not, and is definitely treatable. It can be helped by changing the soap you use to a milder one, using lube when you have sex, vaginal estrogen if atrophy is a concern, and counseling. Relationship problems aren’t the only possible emotional cause of dyspareunia. Being taught that sex is something to feel guilty about, past sexual abuse, or even a previous traumatic pelvic exam could be to blame.

Vaginismus is one cause of dyspareunia. We don’t know how many women suffer from it because we’re not encouraged to talk about it, even in this day and age, but we know physical and emotional trauma can be a factor. The muscle spasms and pain of it can make penetration impossible, which of course can be incredibly frustrating for both you and your partner. Talk and sex therapies can help. Getting treatment can greatly increase your quality of life, since a healthy sex life is so important for our happiness!

The pandemic may have given some of us a condition known as “pandemic pelvis.”  COVID was, in some ways, the perfect storm for pelvic floor dysfunction. Those strong emotions the pandemic unleashed – stress and fear – could have been the reason our pelvic floor muscles were tightening. (We were also likely in front of the computer more than usual, perhaps in a seat that wasn’t super ergonomic and were coughing a lot, which is not great for incontinence!)

The University of Miami recommends getting more active as a way to deal with stress. “Physical activity is a great way to clear your mind, spend time in nature, reduce stress on the body from prolonged sitting, and encourage blood circulation—all of which can help reduce symptoms of anxiety and depression,” the university notes.

One cause of pelvic floor dysfunction is straining to have a bowel movement, which is something many of us might do when we are rushed and stressed! Increasing fluids, having a healthy diet and exercise can help.

Think of the pelvic floor as a messenger, alerting you when you might be experiencing too much stress. It might be just the thing that forces you to take a hard look at the way stress shows up in your life and inspires you to take better care of yourself. Once you are less stressed, it can help not only your pelvic floor, but so many other aspects of your life. 

And unlike Steve Martin’s character in “Only Murders,” you don’t need to be stressed at the prospect of pelvic floor physical therapy to treat a pelvic floor condition that may be related to stress! If you are in the New York area, please contact us at Revitalize so we can help you live a less painful and stressful life!