Patients lie on a medical table with a drape over their lower body. The therapist is gloved with hands working on their abdomen or legs, or any other external body part. Or, with a gloved finger, the therapist is working in the vagina or the anus.

Pelvic floor physical therapy is unlike any other physical therapy. This is a much more invasive and intimate type of physical therapy. On the first visit, there is some talking to get to know the medical history. In understanding symptoms, the source of symptoms and how to intervene, many questions are asked about bladder, bowel and sexual function. These three things go hand in hand. Often when someone is constipated, they also have issues with urinary leakage. When someone has painful sex, they might also feel the need to urinate all the time.

All of this helps to determine the root of the symptoms. The goal is to figure out not just how to quiet the symptoms that are bothersome, but also how to get rid of the problem that is creating the symptoms in the first place. After these questions a pelvic exam is performed with patient consent.

The pelvic exam in pelvic floor physical therapy is unlike a gynecological exam and unlike a prostate exam. This exam is done with primarily comfort in mind. If there is pain in a pelvic floor physical therapy exam, then it causes the pelvic floor muscles to tense, and the exam isn’t providing the information it is intended to provide. Tensing when in pain is a primitive and reflexive reaction. The point of the pelvic floor physical therapy exam is to see how the pelvic floor muscles behave when they are as relaxed as possible.

For a female, this is an exam of either the genitals and/or the tension in the vagina and/or the rectum. If only the genitals are being examined, then a thorough screening with light and magnification is performed from the top down. Checking out the hood of the clitoris, the clitoris itself, the flaps of the labia and the appearance and tenderness of the tissue at the opening of the vagina all tells a story.

For all genders, a gloved and lubricated finger is gently inserted into the orifice most likely corresponding to the problematic symptoms. The pelvic floor muscles of the vagina and rectum are the same muscles. They are just different aspects of the same muscles. If during the exam, pressure is placed in the vagina or rectum and this creates some discomfort, then it indicates that this specific muscle might need to be treated. Pressure on the muscles should feel like exactly that – a pressure, not a pain. A pain means there is too much tension in the pelvic floor muscles. Too much tension means not enough movement. Not enough movement means not enough blood flow. Not enough blood flow means not enough oxygen. Not enough oxygen means too much lactic acid build up. Sometimes, this pain is the pain that one seeks medical treatment for. Sometimes the pain isn’t a “pain”, but it is a symptom, ie. An intense urge to urinate or a tailbone ache. This might be figurative miles away from the bladder, urethra or the tailbone, and yet the muscle being touched provokes a sensation that feels as if it is your actual bladder, urethra or tailbone.

Each appointment is 60 minutes and costs $150 at the time of appointment.  At the end of the appointment a receipt, called a superbill, is issued.  Patients can use this superbill to ask for reimbursement from their insurance companies.  Some insurance companies cover all of the cost of pelvic floor physical therapy, others cover some or none of the cost.  When your doctor refers you to pelvic floor physical therapy, your physical therapist will call you to answer any questions you have regarding treatment or payment.