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Your Pelvic Floor Therapy Questions Answered – Our Most Commonly Fielded Questions (part 1)

We love to educate people about pelvic floor therapy, but we most often share what we think you should/want to know.

Thanks to our team, we have learned what inquiring minds want to know when they are seeking pelvic health PT. We are here to provide you with the quick-and-dirty answers to the questions you have asked!

**Stay tuned for part 2, as well as further deep dives into many of the questions below for more information.

Do I need a referral from a doctor to see a pelvic floor therapist?

Thank goodness, no!

After years of advocacy work, residents of all 50 states now have some level of direct access to Physical Therapy! In North Carolina, it is unrestricted and has been since 1986 (we are early adopters ;). If you live outside of NC, check out this APTA article that provides information about restrictions in various states. Some healthcare networks (e.g., UNC, Cone Health, Duke, etc.) may still require referrals to their clinics, but this is a system-wide, not state-wide requirement.

Is pelvic floor therapy covered by insurance?

It depends.

At Garner Pelvic Health, we have chosen to be out-of-network with all insurance companies in order to provide you with the most cutting edge care.

This means that we do not file insurance for you, and you are responsible for the full service fee at the time of service. Some insurance companies provide “out-of-network” coverage, however. If your policy allows for out-of-network coverage, then we can provide you a “superbill” with all the information needed to submit your own claim. You’d be surprised at how much you can get covered through submitting superbills, because our pricing is very competitive with insurance-based PT.

What is the difference between private pay (cash-based) and insurance-based physical therapy? Quite a bit.

For starters, we spend a full hour with you, up to an hour and a half for evaluations, and every second of that time is spent 1 on 1 with you.

✅ We provide cutting edge, advanced services techniques that most clinics in the US don’t yet have access to or offer.

🚫No short 45 minute or even 30 minute appointments and evaluations.

✅ We spent 75-90 minutes on evaluations and an hour on follow ups.

🚫No being juggled with a bunch of other patients at the same time.

🚫No being turned loose in a gym among a bunch of other people with a list of exercises

✅ You get 100% of our attention, our PT’s see 1 patient every hour.

🚫No seeing a different therapist every time you come in, and no getting non-evidence based care.

✅ You stay with the same therapist the entire time, unless you choose, or your care dictates you see another specialist in our practice (such as with ultrasound imaging, pessary fitting, dry needling, functional medicine, or integrative or lifestyle medicine. We have MANY advanced services and each therapist specializes in something different)

✅ We are able to provide you with concierge care – you can contact your therapist directly with questions.

✅ We provide remote monitoring (yes we can monitor your progress virtually) and telehealth.

Can I do pelvic floor exercises at home?

Absolutely! BUT…

Many times doing pelvic floor exercises (aka “Kegels”) can lead to worsening symptoms when done incorrectly or for the wrong reasons. We find that it is rarely simply “weakness” of the pelvic floor that leads to symptoms. It is more often a combination of poor deep-core coordination, postural issues, scar tissue, and spasms (along with lifestyle and other factors) that create dysfunction. We provide a comprehensive examination to determine what the underlying issue is and help you understand how to fix or manage it.

Also, we provide telehealth if you are just concerned about how to physically “show-up” for treatment! Contrary to what you may think – pelvic physical therapy CAN be done via telehealth.

How many pelvic floor therapy sessions will I need?

The Magic-8-ball says, “answer unclear.”

Without doing a thorough examination, it is impossible for us to give you a precise answer. A rough estimate would be that for a “simple” case, it could be ~ 3-6 visits. For a “moderate complexity” case, it may be 6-12 visits. Finally, for a “complex” case, it may be 8-20+ visits, but it is highly variable. The good news is that you are part of the plan-building and can do a lot to influence how long it will take, as well as the final outcome of your treatment.

guessing how many pelvic floor therapy treatments are needed

We will build a plan that fits around your individual needs, and the more you do at home, the less you will need us. For this reason, we often start with a higher frequency (e.g., 1-2x/week) and then taper off to every-other week, monthly, etc., to make sure that you get exactly what you need and nothing more or less.

How long does a typical pelvic floor therapy session last?

Generally, evaluations are 75 min, and treatment appointments are 55 min.

We can, however, schedule longer (e.g., 90 min. or more) appointments as needed. This can be helpful if you have a long commute or need to start with more intensive treatment.

We have highly specialized therapists at GPH, and regularly have patients that fly in from a different state or country. So far, we have seen patients from over half the states in the US and across 5 continents!

Is pelvic floor therapy painful?

Generally, no…

This being said, pain is a good guide to help us understand and treat dysfunction in the body. By identifying “tender” or “trigger points,” we are able to determine patterns of imbalance within the body. We can then develop a plan to correct them. Some manual therapy techniques such as trigger-point release or dry-needling can be uncomfortable. Most patients, however, are happy to undergo the relative discomfort in the name of healing. If you are nervous about experiencing pain, make this clear to your provider. We will find ways to work with you that are within your individual comfort zone.

What should I expect during a pelvic floor examination?

Pelvic floor therapy exam

The pelvis is just one part of your anatomy, and we will always treat you as a whole person. We will assess posture, pelvic alignment, strength, range of motion, and more, just like any other PT session.

We are one of the few providers in the US that also utilizes rehabilitative ultrasound imaging (RUSI) to further assess what is happening inside the pelvis, back, abdomen, torso, and hip as well!

Garner Pelvic Health

If it is deemed appropriate, an external and internal assessment of the pelvic structures may also be performed. Sessions are led by each individual’s needs, and no procedure is ever mandatory. This being said, it is often very helpful, as a part of a thorough examination, to do an internal examination of the pelvic structures. This includes:

Positioning, full draping (you are never fully exposed), and either a single or at most 2 gloved fingers for assessment or half of a smallest speculum (for prolapse checks only). This allows us to assess the strength, coordination, and status (relaxed, spasmic, weak, etc.) of the pelvic floor muscles. The great news is the process doesn’t take long – just a few minutes! The other good news is there is often immediate relief to long-standing problems because it is impossible to reach some structures without internal work. So I hope that’s encouraging for you!

Finally, we will make sure that you understand what we have found and include you in building the plan to help you achieve your goals. Then we will provide you with some tools to get started!

Who benefits from pelvic floor therapy?

Anybody with a pelvis!

Those who really need pelvic PT are individuals who are experiencing any type of bowel, bladder, or sexual dysfunction, as well as individuals with pain in or around the pelvis (low back, hip, groin, etc.). This is common during and following pregnancy but can occur at any phase of life and in all genders.

But…

The reality is that your pelvis connects the upper and lower halves of your body and affects many different regions of the body when not working optimally. The pelvic floor, diaphragm, and vocal folds all act to regulate pressure within the chest, abdomen, and pelvis. The Vagus nerve also connects all three of these key regions. For this reason, individuals who are experiencing vocal strain, breathing difficulties, anxiety, headaches, diastasis recti, and many other conditions also benefit greatly from pelvic floor PT as well.

Click here to learn more about pelvic floor therapy specifically for Men’s Health and Gender Affirming Care.

More Questions?

Stay tuned for part 2!

In the mean time……..

Book your free consult today to have even more questions answered by one of our therapists!