Pelvic floor physical therapy (PFPT) is a specialty area of healthcare performed by physical therapists who have undergone additional training in pelvic floor evaluation and treatment.

Pelvic floor physical therapists undergo training that is above and beyond the regular physical therapy curriculum and, in some cases, achieve additional certifications for the treatment of common pelvic floor issues.

These include urinary and fecal incontinence, constipation, pelvic pain, vulvar and vestibular issues, pregnancy and postpartum issues, post prostatectomy issues, post breast and gynecological rehabilitation, and post-surgical rehabilitation.

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What Does Pelvic Physical Therapy Entail?

The first appointment with a pelvic physical therapist will consist of a thorough evaluation of your past medical history, discussion of your current symptoms, concerns, and goals, and evaluation of your body.

The pelvic physical therapist will ask questions about your bladder patterns including how often you urinate, if you leak urine accidentally, how much fluid and what types of fluid is consumed, and how frequently you feel the sensation to urinate.

See our guide to Physical Therapy for Incontinence

They will also ask question about bowel movements, and whether you experience pain in the pelvic region, abdomen, back, or hips. Additionally, they will discuss with you whether you experience pain or other physical issues with intercourse.

They will ask about prior surgeries, medications, and medical treatments that you have undergone, and what methods you currently utilize to manage your symptoms.

All these questions are pertinent as the bladder, bowels, and reproductive organs are all located in the pelvic bowl, share common nerves, connective tissues, and can affect one another when they are not performing optimally.

A physical examination generally begins with evaluation of posture and functional capabilities, especially pertaining to the hips, spine, and pelvis. The therapist will measure your range of motion of these joints and test strength of some of the outer muscle groups.

They will assess scar tissue, and monitor your breathing patterns, as the diaphragm shares a mechanical relationship with the pelvic floor and many people with pelvic floor issues have difficulties regulating optimal breathing.

An internal vaginal or rectal examination may be performed on the first visit, and it also may be deferred. The purpose of the internal vaginal examination is to provide the pelvic physical therapist with the opportunity to assess any scar tissue present, to test the pelvic floor muscle strength, coordination, and endurance, and to assess the fascia and muscle extensibility.

Additionally, the pelvic PT will assess for tender points throughout the pelvic floor muscles. The treatment plan is created based on these evaluation findings and will be used to create an individualized plan to help eliminate your symptoms and reach your goals.

Does Insurance Cover Pelvic Floor Physical Therapy?

Most insurance carriers cover pelvic floor physical therapy. Every plan is different, and some pelvic floor physical therapists are in network with some insurance carriers and not others.

You can verify that your treatment will be covered by calling your insurance carrier or calling the pelvic physical therapist you intend to see to verify what the out-of-pocket costs are.

Some physical therapists are located in cash pay clinics that are out of network and do not accept insurance. Many of these physical therapists can provide an invoice and you can proceed to seek reimbursement from your insurance carrier independently. Prices for cash pay practices vary.

How does a vaginal dilator work?

When a vagina feels tight, a dilator gently loosens and expands the vaginal opening and canal, allowing you to progress at your own pace and increase the size and length incrementally as comfortability increases over time. There are many resources on our website on how to stretch your vagina. Dilators train the vaginal muscles and tissues to relax and expand, encouraging blood flow and elasticity to the area and calming the associated nerves during sex, for example. Dilators also help women become psychologically more comfortable with the idea and feelings of penetration, increasing their level of comfort at their own pace and on their own time in the privacy of their homes. Overall this helps to increase self-confidence and calmness.

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How Do I Get in To See a Pelvic Physical Therapist?

A primary care provider, nurse practitioner, or specialist can provide a prescription or referral for pelvic physical therapy treatment. Many of these providers have existing relationships with pelvic PT’s that they trust and work well with for continuity in care for their patients.

The referral is commonly sent from the provider to the pelvic PT on your behalf, though some providers may give you a paper form of a referral or prescription for you to take to the physical therapy clinic to schedule your first appointment.

If your provider does not know of any pelvic PT’s, you can advocate for yourself by locating one on the Intimate Rose pelvic provider website:

Or on the American Physical Therapy Association’s Academy of Pelvic Health PT locater.

Many states also allow direct access to physical therapists. This means that you can call a pelvic physical therapy clinic and request an evaluation without a doctor’s prescription or referral.

Pelvic physical therapy is a highly specialized form of physical therapy performed by skilled physical therapists. It is beneficial to address issues such as incontinence, bowel issues, and pain in the pelvic region.


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