Debunking Four Myths About Pelvic Floor Physical Therapy

So you think you might have pelvic floor dysfunction, and you’ve read that physical therapy can help. You’re nervous/excited to get started, and have already researched some doctors and therapists, but you find yourself putting off actually contacting anyone. Then, after a few weeks of debating, you abandon the idea completely. Maybe your pelvic floor will just magically fix itself? (Unfortunately, that is highly unlikely.) 

Or maybe, just maybe, you need to see what’s keeping you from getting the care you need. It’s possible that you’re hindered by a false belief, or several. I want you to feel better, so let’s separate fact from fiction. Prepare to be surprised and relieved! Pelvic floor physical therapy can be affordable, effective, comfortable, and 100% right for you!

Myth #1: It will be too expensive. If you live in the US, you know: Healthcare can be very costly. Unfortunately, many pelvic floor physical therapists are out of network providers. This means that they are not in network, or contracted with your insurance company. This is because pelvic floor PT is a speciality within orthopedics, and we work with our patients one on one. (Can you imagine how awkward it would be if pelvic floor PTs were juggling 2-3 patients at a time, which they often do at typical outpatient orthopedic PT? Yeah, that model would be terrible.) And…insurance companies set their reimbursement rates assuming that physical therapists are seeing several patients simultaneously…and we obviously are not. BUT, just because we’re typically out of network providers does not mean you’ll be going into debt over treatment. If/when you can prove to your insurance company that there are no in network providers, they may grant you an “in network exception” or “gap exception.” Basically, they would then treat the out of network provider AS IF they are in network and reimburse you based on the mutually agreed upon amount. So be sure to ask your insurance company about your eligibility for these secrets that they hide all too well.

You also may be able to limit costs by working out a plan that lets you see your therapist less often. Your physical therapist could also have a payment plan that works for you or offer sliding scale options, similar to what we offer at Revitalize Physical Therapy. Never be ashamed to be honest about your financial situation with your physical therapist. They understand! Finally, it is important to bear in mind that unlike outpatient orthopedic PT for, say, your shoulder or knee, which is often 2-3x/week, pelvic floor PT is often 1x week (with some homework in between sessions). This means that even if your therapist is out of network, you would only be paying for one session each week.  

Myth #2: It will be weird. If you’ve never had pelvic floor physical therapy before, it can sound strange. But remember: Your physical therapist is a medical professional, the same as any doctor, and you need this to treat a medical condition, and enjoy a better quality of life. Your therapist does this work day in and day out to help people eliminate pain and improve their quality of life, and there is nothing weird about it for him or her! It’s their job, their calling and their passion. They have changed people’s lives with this therapy, and they want to do the same for you. Your physical therapist can work with you to make sure you are as comfortable as possible. Iatrophobia, a fear of medical care, can be treated with cognitive behavior therapy as well.

Myth #3: It won’t work. Physical therapy is a legitimate and effective treatment for pelvic floor dysfunction. Don’t assume it doesn’t work just because you are not cured after one or a few sessions. It will take time. I repeat: IT WILL TAKE TIME. It is a process, not a pill. However, the majority of people do see improvement if they stick with it. On average, most of my patients start to notice significant improvements within 6-8 visits, if not sooner. My average PT appointments are about 60 minutes, and your “homework” doesn’t need to take a lot of time either, and can be accomplished while listening to relaxing music or a podcast. It can be easily incorporated into part of a routine you do while winding down at the end of the day

Myth #4: I don’t need pelvic floor physical therapy, and I can manage fine without it. Pelvic floor dysfunction is a sneaky beast, and it can be hard for the average person to identify it just based on symptoms that don’t seem all that serious. It is possible to think running to the bathroom more often, constipation, or back pain are just a part of getting older. The best guidance? If you have any symptoms of pelvic floor dysfunction, see a trusted healthcare provider to see if therapy may be right for you. You may not consider getting a physical for your pelvic floor in the same way you would for your heart or blood pressure, but paying attention to that part of your body can be very beneficial for your quality of life.

Are you feeling better about making that call or sending that email now? I hope so. Look, it’s ok to feel scared! You are embarking on something you’ve never done before. But you should focus on conquering your anxiety, because on the other side of it, great healing awaits! You may be faced with numerous challenges in your recovery journey but don’t let your greatest barrier to receiving the care that you deserve be you!

Opening the Door to a Recovered Pelvic Floor: Your Guide to Getting Care for PFD

When you’re in pain, all you can think about is getting out of it, but if you have pelvic floor dysfunction, that’s going to take a lot of work. You have to get a diagnosis, research the right clinician and/or therapist, commit to months (or sometimes years) of therapy, and do all the “homework” your therapist assigns. Oh, and let’s not forget the emotional work as you learn to be patient while your body becomes a more functional and less painful place to exist. The good news? The process can be a lot easier when you have the right plan in place.

First, let’s talk about getting a proper diagnosis because without that, you can’t receive proper treatment. Even if an internist or gynecologist is familiar with pelvic floor dysfunction, that doesn’t mean you’ll be immediately (or ever) receiving that diagnosis. As I say in my book The Inside Story, misdiagnosis happens because pelvic floor dysfunction may not be at the top of your doctor’s mind. He or she might want to run diagnostics or perform further testing. If you do, in fact, have PFD, these tests will be negative, because they do not detect pelvic floor muscle overactivity. Your doctor may be wonderful and well-intentioned, however many of them simply do not know about PFD from their medical school training. (Shout out to Tight Lipped, a wonderful organization that is working on fixing that problem! Learn more about it here.) You will likely have better luck with a urogynecologist, whose specialty is the pelvic floor, or an internist or gynecologist who has a history of recognizing pelvic floor disorders. But even if you get the right diagnosis, you may find a clinician who doesn’t have a good understanding of how pelvic floor dysfunction needs to be treated.

If your doctor can’t relatively quickly determine your pain driver, or primary source of pain, then you might have to advocate for yourself. In America, we have direct access. This means you can go ahead and schedule an appointment with a pelvic floor physical therapist without a referral. (Keep in mind that not all states allow for the same level of direct access, so make sure you know the rules in your state before seeing a therapist.) 

In the same way you should ask for a recommendation for a good doctor, you should do the same for a pelvic floor physical therapist. You may feel like you are the only one experiencing your symptoms, but I promise you that is not the case. Don’t be surprised if you find out your aunt or friend had the same problem and knows of a skilled provider. The internet can also be a good starting point for research. In the USA, you should search the American Physical Therapy Association’s website for a trusted therapist in your area.

Make sure your therapist has at least six months of experience. Sometimes this information will be found on their website or LinkedIn, but don’t be afraid to ask. 

Also ask how many continuing education classes your therapist has taken and which ones. Personally speaking, I like the Herman & Wallace Pelvic Rehabilitation Institute. Their courses and teachers are amazing!

Finding a therapist who solely treats pelvic floor dysfunction may be tough, but at least half of his or her patients should be experiencing PFD. 

Inquire about your therapist’s credentialing. The letters you see may be confusing, so let me help you break the code! WCS is very good. This stands for the ​​Board Certified Women’s Health Clinical Specialist from the American Physical Therapy Association, the gold standard within the physical therapy community for being considered an expert in pelvic health. (To put it in perspective, I am pretty sure I studied longer and harder for my WCS than for my licensing examination!) There are other letters you may want to look for. BCB-PMD means that one is board certified in biofeedback for pelvic muscle dysfunction. PRPC means that the clinician has Pelvic Rehabilitation Practitioner Certification through Herman & Wallace. CLT is a Certified Lymphedema Therapist. 

Now, evaluate your choice. Interviewing your pelvic floor physical therapist might seem like a tough thing to do, but it is vital. Do a trial visit. Consider how you feel. Is your therapist caring or dismissive? Is the staff friendly, and helpful with insurance or payment plans? Are you given homework? Has your therapist outlined your goals? A therapist may be great at what he or she does, but it’s important that you feel comfortable. As you will notice on my website, I allow potential patients the opportunity to receive a free phone consultation before making an appointment with me. 

Having pelvic floor dysfunction can be a scary and frustrating experience, but it’s less so when you are well-informed about your options and when you are empowered to best take care of your body. Whether you choose to seek care with Revitalize Physical Therapy or another respected healthcare provider, I hope this guide allows you to be your own best advocate. To your health!