Each 60-minute treatment session will be one-on-one and will include some or all of the following elements:
During your first visit I will perform an hour-long initial evaluation, which will include a detailed medical history and a full musculoskeletal evaluation, including an evaluation of your posture and mobility. In most cases, I will perform an internal vaginal and/or rectal exam to assess the structures of the pelvic floor. I will be evaluating the strength, flexibility, range of motion, and coordination of your pelvic floor muscles just as I would for any other muscle in the body. We will then sit down and discuss the results and create a treatment plan.
Some insurances require a prescription right from the start, but in most cases a patient can be evaluated by a physical therapist and then treated for 30 days or 10 visits, whichever comes first, without a prescription. Any visits beyond this will require a prescription from a licensed physician, osteopath, podiatrist, or nurse practitioner. This rule applies for all types of physical therapy.
I do not take insurance, which means I am an out-of-network provider across all insurance carriers. I can submit claims on your behalf if you provide your insurance information in advance so that I can verify your out-of-network coverage for physical therapy. If I submit out-of-network claims on your behalf, then you will be responsible for the co-pay/co-insurance at the time of your appointment. If you do not have out-of-network benefits, then payment is expected at the time of your appointment.
I am not a Medicare provider, which means that I cannot treat any patient who has Medicare coverage – even if that patient wanted to pay me in cash. Unfortunately, this is a Medicare rule (which I think is misguided).
Please wear (or bring to change into) clothing that you would exercise in.
Yes – men have pelvic floors too! About 40% of my patients are male. I treat men for conditions that cause pain or dysfunction (urinary, bowel, or sexual). See conditions I treat for further information.
Interstitial cystitis (IC) (also known as painful bladder syndrome (PBS) – Suprapubic/abdominal pain that may occur with urge to urinate or after urination. Often associated with urinary urgency, frequency, nocturia, and incomplete emptying of the bladder.
Prostatitis – nonbacterial inflammation of the prostate associated with pelvic pain and voiding symptoms.
Urinary frequency/urgency – urinating more than 8x during wakeful hours.
Nocturia – nighttime urination greater than 1x/night.
Incontinence – Leakage of urine due to muscle weakness or tightness. Can be related to a strong urge to urinate (urge incontinence) or with an increase in abdominal pressure such as coughing or running (stress incontinence), or may be a combination of both urge and stress incontinence (mixed incontinence)
Urinary retention – Difficulty emptying the bladder when urinating. May be caused by pelvic floor dysfunction, typically due to tightness or coordination difficulties of pelvic floor muscles
Constipation – Difficulty having a bowel movement, which may be worsened or caused by tight pelvic floor muscles and impaired coordination of pelvic floor and abdominal muscles.
Incomplete emptying – Feeling of incomplete emptying after having a bowel movement, may result in straining and/or multiple attempts to have a bowel movement throughout the day. May be due to tightness, weakness, and/or poor coordination of pelvic floor muscles.
Bowel frequency/urgency – May be related to constipation, diarrhea, irritable bowel syndrome or incomplete emptying.
Incontinence – Leakage of stool from the rectum, may be related to stool consistency and/or pelvic floor weakness.
Painful intercourse – Pain during or after sexual activity due to nonrelaxing, uncoordinated, and/or tight pelvic floor muscles. Pain may be at initial or deep penetration and may be associated with muscle spasms or involuntary contraction of pelvic floor muscles.
Pain with ejaculation – may be a result of weak and/or nonrelaxing pelvic floor muscles.
Vaginismus – involuntary spasm of pelvic floor muscles that does not allow penetration.
Pudendal neuralgia – The pudendal nerve provides both sensory and motor innervation to structures in and around the pelvic floor. It provides motor control of the external anal sphincter, sphincters of the bladder, and pelvic floor muscles. When the pudendal nerve is injured, a variety of sensory and motor changes may occur in any of the structures that the pudendal nerve innervates. This may result in pelvic pain with sitting, bladder or bowel symptoms, and/or painful sex.
Levator ani syndrome – Tightness, spasms and tension in the levator ani muscles (deep muscles of the pelvic floor) may cause pain in the sacrum, coccyx, rectum, and/or vagina. Pain may worsen with certain activities and may radiate into the abdomen, groin, hip, buttocks or legs. Often associated with bowel, bladder, or sexual dysfunction.
Endometriosis – A condition where tissue similar to tissue found lining the uterus (endometrium), is found outside the uterus. This results in cyclical pelvic pain related to the menstrual cycle. Symptoms depend on where the endometrium tissue is located and may result in pain during sex, urination, and bowel movements. The pain from endometriosis can also lead to tight and nonrelaxing pelvic floor muscles, resulting in further pain not caused by the endometrial tissue itself, which can therefore remain even after the endometrial tissue has been removed or treated with hormone therapies.
Coccydynia – coccyx (tailbone) pain can occur in a variety of ways, including after a fall directly on the tailbone, during the process of childbirth, or due to athletic injury. Pain is usually present with sitting or when coming to a standing position after sitting for a period of time.
Pelvic girdle pain – Pain anywhere in the pelvic girdle, typically, but not exclusively, associated with instability of the joints of the pelvis during pregnancy and the postpartum period. Includes pain in sacroiliac (SI) and pubic symphysis joints.
Vulvodynia – Burning, irritation, and discomfort of the vulva that may interfere with wearing of tight clothing, sitting, and/or sexual intercourse.
Hernia – Rehabilitation post inguinal hernia, sports hernia, femoral hernia, epigastric hernia or umbilical hernia is focused on the goal of reducing recurrence rate and returning to prior level of function.
Hysterectomy – Rehabilitation after a hysterectomy is focused on returning to prior level of function with reducing the risk of pelvic floor strain and pelvic organ prolapse. Also addressed is scar mobility and general conditioning and recovering abdominal and pelvic floor strength.
C-section – C-section recovery can be hampered by a painful and/or immobile scar and rehabilitation focuses on abdominal muscle function as well as postpartum recovery that may also include pelvic floor rehabilitation.
Prostatectomy – The removal of the prostate usually due to a diagnosis of prostate cancer can result in urinary and sexual dysfunction that can be greatly improved with pelvic floor physical therapy.
Episiotomy – A surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician during the second stage of labor. Rehabilitation focuses on scar mobility and pelvic floor healing as well as general postpartum rehabilitation.
Occurs when the organs of the pelvis (bladder, uterus, and/or rectum) descend into the walls of the vagina as a result of weakened muscle and connective tissue structures in the pelvic floor. This may result in feelings of heaviness or fullness in the vagina, and can also be associated with bowel and/or bladder dysfunction. Causes include pregnancy and childbirth, straining, genetic predisposition, and/or hormonal changes in menopause.
Pregnancy-related pelvic girdle pain (see pelvic girdle pain)
Diastasis recti – a separation of the muscles in the abdomen that results in a feeling of weakness and limited functional mobility.