Finding a Pelvic Physical Therapist: Where Do I Even Start?

sos_pelvic_PT.png

It took me seven months after giving birth to get myself to see a pelvic physical therapist (PT). But I should have gone much sooner. Perhaps around the six-week postpartum mark.

Instead, I suffered more than half a year with a wobbly back, back and shoulder pain, and unstable hips. I also had vaginal heaviness, perineal scarring and incontinence (urinary, gas, and occasionally fecal). I hoped it would all go away on its own since, well you know, childbirth is natural.

Pelvic PT isn’t only for women who’ve had vaginal births. A C-section requires rehabilitation too. That’s major surgery and incisions through layers of your abdomen. Regardless of how you delivered, pregnancy shifts the insides and outsides of our bodies, and sometimes we need help safely getting back to “normal.”

I knew about pelvic PT and the kind of help it offered these common postpartum issues, but I was hesitant to see one.

This kind of PT can be intimate. There's often both external work and internal work (as in vaginal and sometimes rectal) depending on the issue.

It's not the same as going to rehab for tennis elbow because we carry emotions in that region. When that area wasn’t working properly I felt more vulnerable and embarrassed about it. Having a stranger look, touch, stretch, move, exercise that area required my emotional commitment first.

5 Things I Wish I Knew Before Waiting so Long To See a Pelvic PT

  1. You can ask for a consult with a PT over the phone or email. Discuss concerns or ask questions about what treatment looks like.

  2. A well-trained and professional PT will always ask and wait for your consent. Some treatment involves internal vaginal or rectal work. If you feel “off” in those areas, having someone touch or examine them may provoke uneasy feelings. A PT should never pressure you to disrobe or receive treatment you don’t want that day. Your comfort and feeling of safety are extremely important.

  3. On a related note, internal or intimate treatment is something you can work up to. A lot of treatment plans include non-internal work. This can include correcting posture, working on breathing mechanics, releasing tissue tension throughout the core, and strengthening exercises.

  4. Ask if the clinic offers sliding scale or a new mom package. More often than not, insurance doesn’t cover pelvic PT. This to me is an outrage considering how important it is for postpartum women. The out-of-pocket expense is a barrier for most moms, but I think of the saying, “and ounce of prevention is worth a pound of cure.”

  5. A good pelvic PT (or any health provider) will understand the limits of her practice. A good clinic will have a network of allied professionals to refer patients for issues beyond their scope of knowledge. For instance, I had an underlying hormonal issue that caused vulvar pain, making internal treatment uncomfortable. My PT sent me out to a specialist in this area.

 Me (left) with pelvic PTs Marisa Alonso (co-founder of  Body Connect Health and Wellness ). Marisa just finished giving a free community workshop on pelvic health for pregnant and postpartum mamas (circa 2016).

Me (left) with pelvic PTs Marisa Alonso (co-founder of Body Connect Health and Wellness). Marisa just finished giving a free community workshop on pelvic health for pregnant and postpartum mamas (circa 2016).

If I knew about those five things before or soon after giving birth, I wouldn’t have hesitated for months to find a pelvic PT. Instead, I waited until I was desperate to seek help. Here’s what it took:

  • I got sick of tolerating a lot of things I knew weren't normal like having trouble controlling my farts. I had constant spotting coming from vaginal granulations. I felt like my vagina weighed a ton and I wasn’t able to run without feeling like my lower back was going to crap out. Also, I could feeling my perineal scar tissue bunching in weird ways.

  • I was terrified of never again feeling normal “down there.” I knew the longer I waited the longer it would take to rehabilitate my pelvic dysfunction. I wanted to not be afraid of sex and to not have any pain with it. I also wanted to not fear the OBGYN.

  • I felt like a fraud. Quickly "bouncing back" to my pregnancy weight gave people around me the false sense that my pregnancy and delivery were no biggie. I'm just fit like that! How I looked physically didn't match how I felt. I wanted to feel as good as I supposedly looked.

  • I started to feel resentful about giving birth, toward my husband for not "getting it," toward girlfriends for not giving any warning, and at my body for deeply disappointing me. I was in a dark and desperate place. My resentments were delusional. I knew this and decided to help myself to a better place.

Photo by DAJ/amana images / Getty Images

When I started my search I didn't have any local recommendation for the D.C. area since I just moved. A good girlfriend of mine is in the industry and she pointed me in the right direction.

Qualifications

Pelvic PT is fairly new, but it's an emerging specialty in the physical therapy world. As it should be! Dr. Hollis Herman and Dr. Kathe Wallace are leaders in the field for the US. Those certified from the Herman and Wallace Pelvic Rehabilitation Institute are trained by the industry's gold standard. For those in Canada, you may want to check out Diane Lee (British Columbia) and Pelvic Health Solutions (Ontario).

Here are some tips to help in your search

  • Ask your health professional, a girlfriend, or Google.

  • Check out the clinic's website. This is the face of the practice and often the clinic's first interaction with you. The clinic website should put in the effort to answer common questions a prospective patient may have, explain what to expect at your first visit, educate you on what they do and how they can help, highlight the therapists' experience and credentials, and convey that their practice is an inviting and safe space.

  • Reach out to the clinic. I called my clinic. The office manager listened to my questions and concerns. She also suggested I email one of the therapists for more detailed information. I emailed, and the therapist wrote back within days and answered all my questions.

  • Find out if your insurance provider will cover pelvic PT sessions. At best, most insurers consider pelvic PTs "out of network providers." Why this isn't standard postpartum care and isn't covered fully by insurance companies is criminal.

  • Talk to and try more than one therapist. Personal comfort and fit are important, also you gain different perspectives from each therapist. There are many paths to healing. Find one that feels right for you.

  • Find out if you'll get one-on-one attention. This is very intimate care. You shouldn't be left alone with exercises or a device, while the therapist is off working on another patient or doing paperwork.

  • Make a list of questions you want answered to help inform your decision. No question is too small. A good pelvic PT should patiently answer your questions.

A Note About Why Your OBGYN Never Recommended a Pelvic PT for You

It’s not your OBGYN’s fault. They weren’t trained to deal with pelvic floor dysfunctions. At my 6-week follow up, my doctor simply put his finger in my vagina, told me to squeeze and said, “Your pelvic floor is weak, that’s to be expected.”

I pushed for 7-hours and had a vacuum delivery with 3rd degree tearing. He was there. I old him about my incontinence and vaginal heaviness. His recommendation? Surgery, if it doesn’t get better. He’s a wonderful OBGYN and meant well, but he just wasn’t aware of all the options before surgery. This is common among women’s health professionals, but slowly changing.

Either way, have a conversation with your provider about pelvic PT. We need more women asking about it. Even if they’re not familiar with pelvic PT, you’ll still want to get cleared to engage in this therapy. If you’re getting the clear for sex and exercise at the 6-week mark, you’re probably fine for pelvic PT, which is milder on your pelvis than sex!

What obstacles stand in your way of seeing a pelvic PT? Are you curious about seeing one but still not sure how to start? Posts your questions and comments below.

*updated from April 26, 2016


**Medical disclaimer: This post is provided as information and resource only. This information should not be used as a substitute for professional diagnosis, treatment, or advice. Always seek the guidance of your physician or other qualified health care provider with any questions you may have regarding your postpartum care and conditions.