Women’s Pelvic Floor Physical Therapy Frequently Asked Questions (FAQ), Upper West Side, New York City, NY

Women’s health physical therapists assess and provide care for musculoskeletal disorders that may arise to women throughout their lives, with specialized distinction of the physiological differences and the impact of hormones on their condition and recovery. Women’s health concerns are as diverse and varied as the women themselves and expand from young athletes to postmenopausal women.

Pregnancy and delivery imposes incredible stresses on a woman’s body. There is solid research concluding skilled physical therapy can profoundly reduce pregnancy-related back and pelvic pain while enhancing quality of life. Prolonged labor or difficult deliveries may produce pelvic pain, pelvic organ prolapse, or incontinence. Physical therapy can strengthen the stability of the pelvis to minimize if not eliminate pain and incontinence, frequently preventing the need for surgery or medication.

Pelvic floor pain and incontinence can be experienced by women of all ages. Pelvic pain is often under-diagnosed or misdiagnosed. I am trained to identify the contributing musculoskeletal factors in order to address the underlying causes of pelvic pain and take a holistic approach to solving the issue. Here are some common questions women have regarding pelvic floor physical therapy.

What is the pelvic floor?

The pelvic floor is composed of muscles that span from the pubic bone in the front of your body to your tailbone. These muscles have many responsibilities including providing support to organs in your pelvis and abdominal region, bladder and bowel control, overall postural stability and sexual functions. Organs contained in the region include your bladder and rectum, and the uterus in females. In order to provide proper bladder and bowel control, the muscles must function properly and coordinate together to prevent leakage or retention of urine or stool. In addition, these muscles aid in overall postural control and can help prevent low back pain when they work properly.

What is a pelvic floor physical therapist?

A pelvic floor physical therapist is a state licensed physical therapist (PT) who has an advanced degree in physical therapy, but also has specialized training specific to working with the pelvis and pelvic floor muscles.   Thus I am able to examine the pelvic floor externally and internally as well as the abdominal, lumbo-pelvic and hip regions.  These advanced skills enable me to work with clients with pelvic pain, bladder and bowel issues as well as sexual dysfunction. 

What is pelvic floor physical therapy?

Pelvic floor physical therapy is a specialized type of physical therapy that treats bowel, bladder and sexual dysfunction through the musculoskeletal and neuromuscular system. There are situations where the muscles and the nerves can get injured. For example, 1 in 3 new moms report bowel and bladder issues after giving birth, and about half of all new moms have pelvic pain in the months after they’ve delivered. These problems don’t just go away on their own, and many just suffer in silence, assuming this is “the new normal.” Others take medication and get surgery to “fix” the problem. Many women benefit tremendously from pelvic floor physical therapy without the need for surgery. I provide guidance on how to treat and activate the pelvic floor muscles, empowering you to heal yourself.

What is pelvic floor dysfunction?

Pelvic floor dysfunction is a disorder in the muscles and/or nerves of the pelvic floor, or in the surrounding skeletal structure. It is extremely common to have a dysfunction in the pelvic floor: The pelvic floor muscles surround the urethra, rectum, vagina and prostate; therefore, if there is a dysfunction in these muscles it can result in urinary, bowel or sexual dysfunction. Pelvic floor dysfunction can involve the muscles becoming weak or too tight leading to poor musculature function. When they are weak, they are unable to support your organs, or they are unable to prevent urinary or stool leakage (incontinence). When they are too tight, pain may be a result preventing people from walking, sitting or having comfortable sexual relations.

How does one get pelvic floor dysfunction?

The occurrence of pelvic floor dysfunction is typically multi-factorial and difficult to identify. It can be the result of trauma, childbirth or from abdominal or pelvic surgery, such as a hysterectomy. It can occur due to having chronically poor posture or holding pattern of the pelvic floor, muscle incoordination, atrophy due to medication or hormonal imbalances, from urinary tract or yeast infections, or from a malalignment of the pelvis.

Can Men have pelvic floor dysfunction?

Yes, I treat men and women.  A few examples of commonly seen cases among men include prostatitis, testicular/perineal pain, athletic injury or conditioning, nerve dysfunction, abdominal pain, post surgical pain, and various bladder dysfunctions.  I primarily specialize in pregnant and postpartum patients, but also treat both men and women throughout the lifespan for a range of pelvic floor issues. My patients are health conscious, ready to learn, and motivated to start their healing process.

How does the pelvic floor cause bladder & bowel problems?

The pelvic floor is a hammock of muscles that holds all the pelvic organs and is critically involved in their function. For example, when your pelvic floor is too tight, weak, or uncoordinated this may result in the inability to store urine or in some cases cause bladder area pain. Problems with the pelvic floor can also cause overactive bladder symptoms including urinary urgency and frequency. Pelvic muscles that are weak or not functioning well with the rest of the core may cause urinary and/or fecal incontinence. In some cases, constipation may be a result of muscles being tight and not being able to relax.

I have other conditions I think are causing my pelvic pain (interstitial cystitis, endometriosis, IBS); what will therapy do for me? 

Often there are associated musculoskeletal findings (overactive or short muscles, poor posture, and/or trigger points) in the abdomen or pelvic girdle associated with these conditions. It can be very helpful to learn to manage the musculoskeletal findings often associated with abdominal-pelvic pain. There are also other triggers that will aggravate symptoms, such as dietary factors and stress, and it is important to have a multidisciplinary approach to treating these conditions. Pelvic floor physical therapy is just one component of the treatment process.

Is it normal to have pain with sex?

It is not typical to have pain with sexual intercourse nor is it something you should live with or suffer through. When muscles in the pelvic floor are tight or short, develop tender trigger points, or don’t move properly sexual intercourse may be painful or impossible to engage in. With menopause or treatment for breast cancer, these muscles may also atrophy and lack lubrication, which also contributes to pain during sex.

I’m trying to get pregnant. Can pelvic floor physical therapy help with that?

Yes. If pelvic floor muscles are tight, in spasm, or uncoordinated, it can make it difficult for the body to welcome a pregnancy and allow for implantation. Pelvic floor physical therapy will address and help these muscles relax. Keep in mind though, that pelvic floor therapy is not recommended after IVF.

I’m having pain during pregnancy (either new, or old pain that is getting worse), and everyone tells me it will go away, your thoughts?

During pregnancy, it is completely normal to feel pressure on your pelvic floor muscles due to the growing uterus. Doing proper pelvic floor exercises can help decrease your pain.

I don’t have any current pelvic floor issues, how can Pelvic floor physical therapy help prevent common pregnancy-related issues?

Being proactive and having your pelvis assessed can actually aid in smoother labor and delivery and decrease your risk of developing pelvic health issues postpartum. This may include self perineal massage close to your delivery date, pelvic floor optimization (strengthening/downtraining), and core strengthening and stabilization.

Is it normal at my age to pee a little when I  cough or sneeze?  I’ve been doing this for a very long time. 

The answer is NO. It is not normal for anyone to leak urine at any point in the lifespan. There are likely reasons that you are experiencing leakage which we can treat. And it is never too late to begin addressing them!  I can help you move beyond pads and back to the things you love.

Are you just going to teach me kegels?

Kegels are not indicated for everyone. You will need to be assessed first to determine which exercise is right for you. Kegels are the common term for contracting pelvic floor muscles and the first thing people think of when it comes to the pelvic floor, but pelvic floor muscles need to be able to do three things:

Contract: Strengthening the pelvic floor muscles requires precision of muscle control, enabling the right intensity of contraction for the right task. The goal is a pain free contraction, in any posture with natural breathing patterns, without unnecessary hip or spinal movement. These are not indicated for a shortened, painful pelvic floor.

Relax: Your pelvic floor muscles need the ability to rapidly and fully relax after any intensity of contraction, with all surrounding joints in positions of comfort. If the hip, pelvis or spine joints are irritable, the pelvic floor muscles will react by splinting the region in a contraction.

Lengthen: Pelvic floor muscles must lengthen and relax the right amount for the task. Muscles that are unable to lengthen and relax can result in straining during bowel movements, which can cause prolapse, hemorrhoids and pain.

I am trained on the ways the body is influenced by the colorectal, urologic, gynecologic, sexual, orthopedic, neurologic and biomechanical systems and can determine if you need to lengthen or strengthen your pelvic floor muscles. Your customized treatment will include extensive education about the drivers of your condition and address all systems influencing your pelvic floor.

I’ve had these problems for a very long time, do you think you can still help me?

Many patients have come to me after trying various medical interventions with limited or partial success. I work to identify the root cause of your problem by addressing all musculoskeletal and neuromuscular dysfunction instead of just one piece of the puzzle. I have had success with patients who reported issues that began years ago, yet they never knew the right help was out there. It’s never too late to get the care and treatment you deserve to improve and move forward.

My doctor told me to do kegels but I do not know if I am performing them correctly, how can I tell?

Kegels, or more specifically, pelvic floor muscle contractions, can be an effective method to reduce some pelvic floor symptoms, however, they are not appropriate for everyone and many individuals (~50%) perform them incorrectly.

Can I file for reimbursement with my insurance?

Please check with your insurance regarding “Out of Network” benefits for physical therapy in an office setting. We can either provide you with an itemized “superbill” to submit to insurance or electronically file claims directly.

Is an internal examination necessary?

An internal examination does not have to be performed at your first or any other visit. I will be able to evaluate and treat you externally. We will only do an internal exam if you are comfortable. Either way, we will be able to gather a wide range of information. Directly palpating the muscles and other structures that may be affected gives us the most thorough understanding of what’s causing your symptoms.

How often will I see you as my physical therapist?

I respect our clients’ time and financial resources and will provide the education, treatment and resources to get you better as quickly as possible. Your course of care is customized depending on the complexity of factors involved. Client readiness to make life changes and priority of self-care is critical for making progress. Just like with medication, the right dosage of care needs to fit the complexity of the condition. Short or infrequent visits are not successful in resolving complex, multifactorial needs. The most typical course of care is one or two visits per week for 6-12 weeks, or for more complex scenarios, one to two visits per week for 6-16 weeks. Foundational care plans of four visits can be designed for clients with limited insurance or financial resources to get their education and treatment plan underway.

How is payment and insurance handled?

I am an out-of-network provider for private insurance companies. I use this model to spend the maximum of time with patients providing direct, individualized care. Clients are offered a detailed receipt that allows them to apply their payment to flexible spending accounts or toward their out-of-network deductibles. I also have treatment session packages to reduce cost and a no Interest Payment plan. I strive to prevent cost from inhibiting the care many individuals need.

What payments methods do you accept?

I accept cash, personal checks, credit cards, FSA and HSA accounts.

Do you have payment plans? 

Yes. I have 6, 8, and 12 week payment plans available. Please contact us for more information

Do you offer telehealth services?

Yes, click here to learn about our online Telehealth physical therapy services.

Reach me if I can answer any questions on physical therapy, serving you locally in New York City or anywhere online virtually through “telehealth“.

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Tel. 646-643-4688 Office: 155 W 72nd Street #606 NEW YORK, NY 10023

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