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Pelvic Floor Therapy

Getting 85 minutes alone with a practitioner is pretty rare. At our clinic we believe in the importance of having time to hear your story, perform a thorough orthopedic exam, and of coures the pelvic floor exam.

In this article we will outline exactly what to expect on your first visit.

Part One: Listening to Your Story and Education About Pelvic Floor Therapy

The therapists at Femina Physical Therapy are specialists in pelvic health and all of the different things that can contribute to pain: medical history, past surgeries, conditions such as endometriosis, menopause, pregnancies, bowel/bladder habits, diet, sexual history, and so on. The bottom line is that we want to hear your stories, and will listen closely to what you have to say.

So What's The Lowdown On Pelvic Floor Therapy?

Your therapist will begin by answering questions such as:

  • "What is the pelvic floor?"
  • "What does pelvic floor therapy look like?"
  • "How will this therapy help?"

And we will of course address any other questions or concerns you may have. We want you to feel that you are in collaboration with your therapist, and a primary goal is to help you learn how and why pelvic floor therapy may help you.

Part Two: The Orthopedic and Whole Body Assessment

Most pelvic floor conditions involve other parts of the body. At Femina Physical Therapy, we believe in treating the whole person, not just individual areas or muscle groups.

Following the discussion of your history, your therapist will screen the entire body, looking for muscle imbalances, dysfunctional movement patterns, and neuropathic or orthopedic issues that might be playing a part in your pelvic floor issue.

We will evaluate your posture, pelvis position, hip and spine flexibility and range of motion, position of the sacrum, and muscle tone throughout your abdomen, back, hips, glutes, and thighs. We may do tests to see if the peripheral nervous system is involved in your pain. We will also test your core strength and how stable your pelvis/back area is, and test for issues like Diastasis Recti (separation of the abdominal muscles that is common after pregnancy).

Part Three: The Pelvic Floor Assessment

After your orthopedic exam an evaluation of your pelvic floor muscles will be performed with your informed consent.

Our pelvic exams are much different than what you may have experienced at the gynecologist or urologist - there are no stirrups and you will not be asked to scoot to the end of the table. There are NO speculums. YOU are in control of what happens and how far your therapist examines.

Instead, you’ll be asked to relax on a big comfy pillow and to throw your legs over a big soft bolster, the idea is to help you and your pelvis relax so we can best assess what your pelvic floor muscles are doing that day.

The examination is generally performed with a single gloved finger, and the therapists will always work with you and your body so as to not cause you any unnecessary pain. The therapist will leave the room so you can undress from the waist down and put on an examination gown. When the therapist returns they will begin the pelvic floor examination with a skin check, looking for any irritation or dryness of the tissues.

After that, there will be an external palpation of the pelvic floor muscles from the outside. The therapist will palpate around your pubic bone and sitting bones, assessing pelvic floor activity and looking for dysfunction. After a palpation, the therapist may ask you to do a kegel (contract the pelvic floor muscles as if you are stopping the flow of urine), and they may also ask you to bear down as if you are passing gas or a bowel movement. This is in order to see if muscle control is normal and to screen out possible conditions such as dyssynergic defecation (read my blog about that by clicking the link).

After this external assessment of the pelvic region, is the internal portion of the pelvic floor exam. For adults, this is generally done either intra-vaginally or intra-rectally. Again, this is performed generally with a single gloved finger, no speculums, tools, or anything else. All of our therapists have a very gentle touch and are constantly checking in with you to make sure you are comfortable, safe, and feel in control. I do have to be honest, the lube is cold, so be ready for that! But you can be sure that our therapists will work with you to keep the exam as tolerable as possible, and YOU are in charge of how far we examine you.

Part Four: Treatment on the First Visit

Since our evaluations are a full 90 minutes, there is often time to start treatment on your first visit. Your therapist will communicate to you what they are finding and will start treatment that day, often prescribing you some “homework” to work on right away, to start improving your condition.

What does the treatment look like?

The treatment modalities you will receive in pelvic floor therapy depend on your body and the issues present. In general, if your muscles are tight, the techniques used will focus on releasing the tension. If your muscles are in need of strengthening, the therapist will work with you on gaining strength and coordination in your muscles.

Some of the modalities used at Femina Physical Therapy can include (but are not limited to):

  • Manual therapy including soft tissue massage, connective tissue manipulation, muscle energy techniques, and myofascial release to treat connective tissue dysfunction and myofascial trigger points
  • Internal pelvic manual therapy to treat sensitive tissues, muscle spasms, trigger points, and muscle guarding that can cause issues like pain with sex, frequency and urgency of urination, and pain with bowel movements
  • Therapeutic exercises to strengthen the pelvic floor
  • Biofeedback technology to help you focus on relaxing the pelvic floor
  • Electrical stimulation using the InTone device
  • Photobiomodulation Therapy for pain relief and encouraging cellular healing and desensitization of scar tissue adhesions, tender trigger points, and muscle spasm pain.
  • Visceral mobilization (gentle massage techniques that loosen internal adhesions and restore movement to the organs including the intestine, bladder, uterus, and ovaries) to improve motility and GI organ function
  • Training in self treatment techniques so you can start to manage your systems at home. These techniques can include self pelvic floor massage using medical dilators
  • Neuromuscular re-education and autogenic relaxation to reduce chronic muscle over-activity and improve parasympathetic nervous system function, including pain management and digestion
  • Patient Education and Empowerment
  • Lifestyle modifications like sexual positioning, stress reduction, bladder and bowel habits, hygiene, and optimal fluid intake and dietary fiber intake.

Pelvic floor issues can greatly affect quality of life. Let the therapists at Femina Physical Therapy help you along the journey back to wellness and happiness! Make an appointment today and let’s get started.

What Our Patients Have to Say

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Testimonial by R.H.

No one could tell me why I was having pain during sex--sharp pain, not just uncomfortable, pain. I was referred to Heather Jeffcoat after researching several different options. I had seen a specialist who told me physical therapy would not help and my only option was surgery. I really didn't want to go that route, so when we got a referral, I decided to try it--it can't hurt, I thought. I am so glad I did. She diagnosed the problem right away, which was a relief in itself.

To know why I was having pain eased my mind immensely. And to hear that she could fix it without surgery was another relief. She said she could fix the problem in 6 weeks. I think it was actually 4 for me. She was very methodical, and treated me as an intelligent human being capable of participating in my own recovery. I would absolutely recommend her to anyone. She did not try to prolong my session numbers, she worked hard to accommodate my schedule (and the fact that I had to bring a baby to sessions), and she was completely honest the entire time. It is so hard to find someone with these characteristics, much less a professional who is so good at what she does. She has my highest respect.

-- R.H.

Testimonial by R.D., age 38

"I had a severe tear during childbirth that was not stitched together correctly and therefore healed poorly. Even after having a surgery a year later to remove the scar tissue, I was still having pain, and no one could explain why -- there was no overt 'reason' to explain the pain. I had tried other 'specialists' and even saw another physical therapist who had me do hip / leg stretches -- what a joke! I was about to give up and just 'live with it' until thankfully I kept searching online and found Heather.

Read more: Testimonial by R.D., age 38

Testimonial by A.B.

Before I was referred to Heather Jeffcoat I was living in a nightmare. I had been married to my husband for three years and I was suffering from Vaginismus. That all changed when I visited my OBGYN and she said she knew of someone with a great success rate. To be honest I was hesitant at first because my first doctor had already told me that all I needed to do was order dilators from the internet and I should overcome my problem. She was wrong because I had followed the book on how to use the dilators with absolutely no advancements in my condition. However, that all changed when I went in for my first visit and Heather took the time to explain my condition and how we were going to work together to overcome it.

I remember leaving her office with a glimmer of hope that I could live a normal life. As my sessions continued I began to see immediate results. With only four sessions and a strict dedication to my home programs I was cured of Vaginismus. In the beginning of this process I was made aware that my health insurance company might not cover the costs, which was disappointing but today I can say one hundred percent that it was the best money I ever spent. Now thanks to Heather I am finally enjoying my life to the fullest with my husband. Thank you Heather, I can’t begin to tell you how much I appreciate all that you have done for me. I will never forget it. Those who are suffering from these types of conditions don’t be afraid because she makes you feel so comfortable and the end result is worth it. Good luck to you all and I hope you experience the success I have.
-- A.B.

Testimonial by S.P., Age 26

I would like to start off by thanking Heather Jeffcoat for educating me and curing me of Vaginismus. I had been married for almost three years before I was referred to Heather. I never knew about Vaginismus until almost three years into my marriage. I knew something was wrong when I went on my honeymoon and came back a Virgin. I had always imagined how magical my first night would be but boy was I wrong.

Read more: Testimonial by S.P., Age 26

Testimonial by R.M., Age 40

I can’t speak highly enough of the theapists at Femina Physical Therapy and how much they have helped me grow, discover, and love my body. I had had painful sex for my entire life, and didn’t know that there was anything that could be done about it. It was at the point where my husband and I were not having sex for MONTHs, because it was just too frustrating, and I hated feeling like I was the ONLY woman out there who had this problem, especially at my age. I finally brought it up to my doctor because I was turning 40 and my husband and I were barely having enough sex to conceive. And she brought up pelvic floor, PT. I didn’t even know this was a “thing”.

Read more: Testimonial by R.M., Age 40

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

Read more: Testimonial by Lauren B.

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