I’ve been a pelvic floor physical therapist for over eleven years now, and the number one question I hear in my clinic, day in and day out, is “why?”. Sometimes this “why” is in the context of curiosity – “why do I have a prolapse?” or “why is there pelvic pain?”. But most of the time the “why’s” are coming from a place of confusion (and…ummmmmm…flat out frustration), like “why did no one tell me this before?”, “why didn’t anyone look at that?”, or “why don’t [insert medical professional of your choice] know about this?”.
When it comes to bladder, bowel, and sexual function, I believe pelvic floor PT’s are theeeee best specialists for the job *dusts dirt off her shoulder*. Urologists, gynecologists, and gastroenterologists – they have their place – but they’re first and foremost surgeons, and unless your concern requires an operation (PS…it rarely does), the next best thing they know how to do is prescribe medication (that often only masks the problem and comes with its own slew of side effects). But pelvic floor PTs? We’re musculoskeletal experts that take every system into account, spend more than five minutes with you, and are trained to treat in a way that gets to the root cause of the problem.
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Now let me be clear, there are great, good, and…uhhhh…not-so-good pelvic floor PT’s out there. Some of us have completed hundreds of hours of hands-on continued education, logged years and years of clinical experience, and taken a test to become certified, whiiiiiiile others attended one online course and have been calling themselves pelvic rehab therapists since. Unfortunately, there’s no governing authority ruling who’s truly qualified or regulating the quality of pelvic health care, so your provider could be anywhere along this spectrum.
And if you’re anything like me, you don’t have time, energy, or money to waste on appointments with a medical professional who doesn’t check all the boxes necessary to see success.
While your options may be limited by things like scheduling, location, or insurance, I’ve found from personal experience that it’s worth the extra effort to work with someone who knows what they’re doing and avoid the frustration, disappointment, extra expenses, and time suck that comes with trying others who don’t.
I’m not over here saying I know everything or that I’m the best pelvic floor PT in the world, but I have become someone that patients see (& see results with) after getting little to no improvement with other providers in the past. Not only do I have a proven track record of success, but I hear about what these other therapist do (or *ahem* don’t do) that leads to less than optimal outcomes, and [that] is what I’m here to share with you today.
Is your pelvic floor physical therapist doing [this]?
I don’t need every woman in the world coming to yours truly for pelvic floor PT, but I do want all women to get the exceptional pelvic health care she deserves. While the profession figures out how to implement quality control, it’s up to Y-O-U to advocate for yourself, expect excellence, and refuse to settle on seeing anyone who doesn’t provide the type of care necessary to see results. If you’re wondering what ^^that^^ looks like and could use a few check boxes as you start your pelvic health journey (orrrrrrr have a sense your current therapist isn’t quite cutting’ it), look no further, friend.
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This one’s gonna ruffle a few feathers, but that’s never stopped me in the past. I’ve been standin’ on soap boxes, droppin’ mics, sharin’ hot takes, and dyin’ on hills since the start of this blog in 2019, and I’m not stopping now. In fact, the longer I’m in this profession (we’re going on twelve years now), the more confident I am (and the less you-know-what’s I have to give) about standing up for what I believe in.
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God bless anyone who gets into this profession to help people, but there are good and bad pelvic floor PT’s just like there are good and bad chiropractors, plumbers, accountants, and police officers. Let’s make sure you know who to look for and what you’re getting into as you take care of “down there”. Because your pelvic health provider? They can make all the difference.
INTERNAL ASSESSMENT & TREATMENTS
Let’s be honest…if you went to a knee specialist, eye doctor, or back surgeon and they didn’t actually look at or touch said body part, you would (hopefully) walk away feeling like something was missing aaaaand pursue a second opinion. The same could & should be said for the pelvic floor. If you don’t get an intra-vaginal and/or rectal exam (depending on what you’re being seen for), no one has properly assessed your muscle tension, strength, coordination, or control.
Occasionally there are times internal work is contraindicated – when there’s lack of patient consent, during the first trimester of pregnancy, within six weeks of birth or surgery, for pediatrics or pre-sexual adolescents, or in the presence of an active infection – but in my humble opinion, this should be the exception, not the rule. Unless my patients fall in one of ^^those^^ categories or there’s another extenuating circumstance, every. single. appointment. includes an internal component so 1) I know their body’s current status, 2) I can objectively assess progression or regression, and 3) I’m sure they’re properly performing what I’m teaching them.
Call me crazy, but if your pelvic rehab therapist doesn’t look at or touch your pelvic floor on a regular basis, they’re not doing actual or effective pelvic floor physical therapy. Stretching & bridges & breathing & planks are all lovely components of treating the pelvic floor, but there’s also *cough cough* so much more.
WELCOMES TMI
Google calls libras “the savviest of snooping signs”, and this trait has definitely served me well as a pelvic floor PT. While I generally (& genuinely) love me some gossip, secrets, and alllll the personal information you’re willing to give, this “no such thing as TMI” motto is a must when getting to the bottom of your pelvic floor problems.
A *good* pelvic rehab therapist will ask about it all – a detailed medical history with no stone unturned, your current bladder, bowel, sexual, and musculoskeletal function, and future goals for your body – and listen in a way no one else has before. I think I say “tell me more about that” at least ten times when getting to know my patients, because I believe they know their body better than I ever will, and the help they deep-down need is often hidden in their stories, concerns, and complaints.
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It’s your provider’s job to ask the right questions, bring up the uncomfortable, and urge you to tell them more. They should be listening for clues, pieces of information you might not even realize are important, and make sense of it all through their therapist’s brain. Believe me when I say there is no such thing as “awkward” or “uncomfortable” or “oversharing” in a pelvic rehab office, and this rule should apply on both sides.
CONTINUALLY ASKS FOR CONSENT
Between endometriosis, a severe vaginal tear with birth, and multiple miscarriages, I’ve had my fair share of pelvic and women’s health appointments. In other words, I’ve been in my patients’ shoes *multiple* times, and I know what it feels like to have providers who recognize their role & respect my body, aaaaaaand those who don’t. After both good and bad experiences, my hot take is this – just because someone is your doctor does not give them autonomy over your body (maybe read that sentence again before moving on).
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I don’t believe in cookie-cutter physical therapy, but there are a few sentiments and statements every single one of my patients hear:
- “This might be my clinic, but it’s your appointment and your body. You always call the shots in this room, not the other way around.”
- “I will never do anything you’re uncomfortable with. I will always tell you what I’m doing (before I do it) and why. You have full say and can change your mind at any time.”
- “Is it ok with you if I [insert any & every assessment and treatment here]? Let me know when you’re ready.”
After over eleven years as a pelvic floor PT, I’ve come to realize that if you’re not comfortable in a pelvic rehab appointment, it’s not your fault…it’s your therapist’s. I constantly ask for consent because it keeps my patients calm, comfortable, confident, clear, and in control about what’s going on – exactly how it should be. If you don’t feel like ^^that^^ in your pelvic health visits, you have full permission to demand a bit more dialogue along the way.
ASSESSES EV-ERY-THING
The pelvic floor is a sling of muscles at the bottom of a ring of bone. The bladder, bowel, and reproductive systems sit in it and pass through it along with the circulatory, nervous, and lymphatic systems. Hormones are involved, there’s almost always a psychosocial component, and everything from the jaw to the feet are connected. Long story short, this is a complex area and everything needs to be taken into account when assessing and treating the pelvic floor.
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Even if your only complaint is leakage when you sneeze, a good pelvic floor physical therapist will ask about it all (both in their intake paperwork and in person) and analyze it all too. I can’t tell you how many times I’ve detected an underlying issue we were able to prevent from becoming a problem in the first place by being thorough.
I’m not crazy enough to think everything is connected to the pelvic floor, but *ahem* everything is connected to the pelvic floor, and a strong knowledge base in every associated system is what makes pelvic rehab therapists thee best specialist for the job of treating pelvic floor dysfunction. And whether or not your PT asks about, looks at, and addresses every system is often the difference between a quick (but temporary) fix and real, lasting results.
DON’T START WITH KEGELS
There are some pelvic floor physical therapists who think kegels were created by the devil himself and refuse to even say the word out loud. For the record, I’m not one of them. I believe repeatedly contracting the pelvic floor muscles in an attempt to strengthen this area has its place, but kegels are not the main focus and definitely not where I have (or ever will) start with any of my patients.
If a patient is complaining of leakage, urgency, or prolapse in conjunction with the presence of pelvic floor weakness, the pelvic rehab therapist should be getting to the bottom of WHY the pelvic floor is weak first. Are the pelvic floor muscles actually too tight? Is it their poor posture or lack of core strength? Maybe there are bad bladder habits or lifestyle limitations? Doing kegels before getting to the bottom of all that *waves hands wildly* is a recipe for improvements that plateau or even adverse outcomes.
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This is why the Emsella chair doesn’t work. This is why you’re not seeing results from doing daily kegels with the witch woman on Instagram who (weirdly) gets me to contract my pelvic floor by simply moving her hand up and down while saying “squeeze”. Kegels are a piece of the pelvic health puzzle, but they’re not the be-all-end-all or even the bulk of it. If your pelvic floor PT doesn’t offer you anything other than contracting your pelvic floor 261 times per day, this is a red flag and reason to seek a second opinion.
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MAKES TREATMENT PERSONALIZED, PRACTICAL, & APPROACHABLE
I don’t know about you, friend, but I’m busy. And I don’t have a square to spare when it comes to my bandwidth, brainpower, or bank account. If I’m at an appointment, it likely took jumping through a few hoops to get there, let alone leave and implement what I learned. Because this is my reality as a firefighter wife, mom, homesteader, business owner, and generally multi-passionate person, I know it’s my patients’ reality too, and that must be taken into account when making a plan of care and passing out prescriptions.
This is why I ask my patients about their lives – what they do for work, who they’re caring for, what their average day looks like – and what their goals are for pelvic rehab. All the pelvic floor appointments in the world mean nothing if the exercises are too extensive to complete or the homework doesn’t align with her heart for being there. Complicated and time-consuming don’t necessarily equal accomplishment…in fact, I find the more simple and sustainable something is, the more likely it will lead to success.
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Does this personalized and practical approach take more time and energy on the therapist’s end? The answer is a resounding YES! But it’s not about our comfort, it’s about your confidence and clarity, and when the tips & tricks fit seamlessly into your day, you can be sure the provider had you in mind when creating that treatment plan for you.
Questions to ask when looking for a *good* pelvic floor physical therapist
If you’re in the market for a pelvic floor PT that checks all the boxes above, there is (unfortunately) some proactivity on your end that needs to happen to ensure exceptional results. This website is my favorite place to find a pelvic health practitioner in your area – just put in your zip code, city, or state to see the options nearest you. Once you have a few names or locations, I highly recommend calling around and asking the following questions:
- What do your assessments involve? Do your assessment and treatments include internal work?
- What is your experience with [insert pelvic floor problem here]? What does treating this typically look like?
- Are there any systems you have in place to ensure your patients are comfortable? Do you regularly ask for consent?
- How much time, on average, do your patients spend doing their home exercise program?
This isn’t about being difficult or demanding, it’s about finding a provider who knows what they’re doing, takes time to understand your body & goals, and treats you like the complex (& capable) person that you are. Because that’s when the magic happens – when the bladder leakage stops, pelvic pain improves, and you finally get your life back.
It’s time to get that quality care you deserve, friend.
I understand that finding a good pelvic floor PT can feel like searching for a needle in a haystack, especially when you’re already struggling with uncomfortable symptoms, limited by location or insurance coverage, and simply exhausted from the whole process. But you deserve a provider who sees you, listens to you, treats you as a whole person, and empowers you to take control of your health. Settling for less isn’t just frustrating, it’s a waste of your precious resources.
So whether you’re just starting your pelvic health journey or you’ve been struggling for years without seeing the results you deserve, I’m giving you permission to advocate for yourself – to ask the hard questions and expect excellence. And if your current provider isn’t checking these boxes? Find someone who will. Your pelvic floor health is worth it. You’re worth it. Now go get the care you deserve.
Amanda
Disclaimer: The content provided here does not constitute medical advice, nor is it a substitute for personalized healthcare. I’m a doctor, but I’m not your doctor. If you have concerns about a medical condition, diagnosis, or treatment, you should consult with a licensed healthcare professional.
Disclosure: Some of the links above are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase. No pressure, but I have a feeling you’re gonna like what I’ve taken the time to put my recommendation behind.
