What is Pelvic Health Physical Therapy?
Orthopedic and physiologic function of abdominal and pelvic organs, hips, low back, pelvic floor, core and breathing muscles are interrelated. High tone or laxity of tone in your pelvic floor muscles, faulty posture alignment and body mechanics are common reasons for compromised pelvic function. Natural processes like pregnancy and birth no matter how long ago (once post-partum always post-partum), menopause, or enlarged prostate can also compromise pelvic function. Disruption of function can happen for a variety of reasons including: injury, accidents, surgery, trauma, prolonged sitting, sedentary lifestyle, heavy and repetitive physical labor, even medical treatment such as chemotherapy and radiation.
Changes in function may happen suddenly or gradually progress until your symptoms become pronounced enough that you can’t ignore them anymore. For instance, many people think leaking urine as they age is normal, and does not qualify as incontinence because only a little leaks out occasionally. Common doesn’t mean normal. While urine leakage is common any amount leaked, even one drop, is not considered normal past the point of childhood potty training. Furthermore, bladder leakage is not inevitable as people get older. Many people think nothing can be done and they have to live with their symptoms. Many people and health care providers aren’t aware that treatment by a specially trained practitioner can improve your symptoms and lessen the impact they have on your quality of life and your family’s too.
Treating pelvic health involves assessing the overall movement and function of the body including movement and breathing patterns, postural alignment, body awareness, strength, range of motion and coordination. Physiologic function of the pelvic and digestive organs is also evaluated. Areas of the body that pelvic health physical therapists commonly assess and treat are: bladder, bowel, pelvic floor, tailbone, abdomen, spine and lower back, hips, groin, and legs.
Conditions that pelvic health therapist can help you address include:
- Leaking urine or stool with daily activities and/or exercise
- Urinary or fecal urgency
- Separation of the abdominal muscles AKA Diastasis Recti
- C-section or other abdominal surgery scars that can restrict movement or organ function and cause pain
- Bladder, rectal, vaginal, testicular, penile pain
- Pelvic organ prolapse
- Painful sex
- Pain while sitting
- Restoring post-partum pelvic health and function after giving birth
- Recovery from treatment for gynecologic or other cancer affecting the pelvis
- Recovery from abdominal, pelvic or back surgery including c-section, hysterectomy, prostate surgery, bladder suspension, hernia repair
- Hip joint replacement surgery
What is the difference between Health Coaching and Physical Therapy?
Health Coaching: Physical function is intact. The person seeking coaching wants to update and improve their lifestyle and behavioral management strategies to achieve desired goals and/or develop a self-care and exercise maintenance program to continue on your own.
Physical Therapy: Physical function has been compromised and needs to be improved or restored. Treatment begins with an initial consultation to obtain a history of your current situation, assess your current level of function and establish a plan of care based on your goals for treatment. Follow up visits help you progress toward your goals for treatment. During the process of treatment you will learn new skills so you can manage your symptoms between visits and on a long term basis. Periodic re-evaluations assess your progress toward your goals and determine any necessary changes to your POC until you are ready for discharge from care. PT includes health coaching. Discharge from therapy is the point where rehabilitation shifts to wellness whereby, you, the client, becomes responsible for maintaining your results.
Do you treat women and men?
Yes. I also treat young adults, dancers and athletes.
Will I need to have an internal pelvic exam?
Not necessarily. No assessment or treatment method is done without your informed consent. While directly assessing the current level of your pelvic floor function, coordination, strength/power, flexibility and tone via an internal exam is very helpful you do not need to have an internal exam to receive treatment or benefit from it.
What can I expect during treatment sessions?
The focus of your first visit will consist of understanding the problem you would like to address which includes a functional assessment along with understanding your reason for seeking treatment and what you would like to achieve through treatment. It is not uncommon for the second visit to be a continuation of your first visit depending on the complexity of the issues to be addressed. During the initial consultation process a plan of care for follow-up sessions will begin to emerge. Follow up visits work on improving your function and learning safe, effective skills to manage your symptoms at home and moving you further along toward achieving your goals. Modalities such as manual therapy, neuromuscular motor control training to improve body mechanics and movement patterns, exercise training to improve strength, coordination and flexibility, visual and tactile biofeedback to improve postural and body awareness, lifestyle and behavioral management techniques to manage your symptoms long term.
What do I wear to appointments?
Clothing that you can comfortably stretch and move in without too much bulk or thick seams.
Should I still come to my appointment if I am menstruating?
Yes. There are other things we can do besides internal work.
How many sessions will I need?
There are many variables to consider depending on the complexity of your symptoms and what you would like to accomplish with therapy. On average, people come for 6 – 8 weekly visits. As progress is made and self management skills improve, the time span between visits typically spreads out to every other week or once a month.
What is your cancellation/refund policy?
At minimum of 24-hours notice is required to cancel a scheduled appointment without any financial ramifications. If you cancel a previously scheduled appointment inside of 24-hours of your appointment time you will be assessed $75 missed appointment fee unless you can reschedule your appointment within the same week.
Missed Class Policy: If you purchase classes at a discounted rate you may make up an equivalent level class within the same week or class series provided there is room in the class you’d like to attend. Contact Lesley to confirm there is space in the class you’d like to attend. There are no refunds for missed classes once the class series ends.
Inclement Weather: If you are concerned about driving during inclement weather you may cancel and reschedule a previously schedule 1:1 appointment. If you miss a class you may make your class up per the Missed Class Policy. If a class is canceled by Inner Rhythms due to weather and you have paid for a class series you may make up the class per the Missed Class Policy. If absolutely necessary, you may be able to make up your class in the next occurring class series.
Multiple Session Discount Packages/Refunds/Transfers/Multiple Visit Expiration:
- Multiple session discount packages must be paid in full prior to or at the first visit. Multiple session payment plans for 4-visit and 6-visit packages are available. Contact Lesley to make arrangements.
- No refunds are available for missed classes in a class series or unused visits from a multiple session discount package.
- You may not transfer any unused classes or unused visits from multiple session package to another person.
- 4-visit package expires 2-months from the date of purchase or initial consultation, whichever happens last.
- 6-visit package expire 3-months from the date of purchase or initial consultation, whichever happens last.
Do you accept health insurance?
No. I am a cash- based fee-for-service practitioner. Therefore, I am considered an out-of-network provider by insurance companies. Not accepting health insurance removes the potential of the company to limit the number of they will pay for along with what treatment codes or combination of codes they will cover and reimburse. You can submit a superbill that I can provide to your insurance company for reimbursement purposes.
Another advantage of not accepting insurance is greater transparency about the cost of services. There is no change in the hourly cash rate regardless of what treatment interventions and combinations are used. If you have a high deductible insurance policy this is advantageous because it helps you more easily budget the cost of treatment. With a high deductible plan you will not know the cost of treatment until it is processed by your insurance company. Typically, you find out the amount you are responsible for paying after treatment has occurred or even ended. If you plan to submit a superbill to your insurance company it is strongly recommend you do some due diligence in advance to find out if your treatment will go toward your deductible. (See below)
As a client you are responsible for contacting your insurance provider and understanding the physical therapy benefits of your particular plan.
Some questions to ask are:
- Do I need prior authorization for my visit?
- Do I need a referral? (While Maine is a direct access state some plans require a referral.)
- What is my deductible and how much has been paid toward it to date?
- What percentage of reimbursement does my plan provide?
- Does the percentage change with an out-of-network provider?
- Will the cost of services from an out-of-network provider go toward my deductible or total out-of-pocket expenses?
- Is there an annual cap or limit to the number of visits or amount of money for therapy? How do I submit a claim?