Home FAQs
Who We Are News and Events
Your Session Where We Are
Treatment Options Online Resources
Pelvicology Contact
FAQs Myths and Misconceptions Glossary Further Resources
 
 

Frequently Asked Questions

How will my intervention at Essential Physical Therapy differ from “regular physical therapy?”   > Answer

Where does chronic pelvic pain come from?   > Answer

What life activities are affected by chronic pelvic pain?   > Answer

What are other impacts of chronic pelvic pain?   > Answer

Why haven’t I heard of this before? Why hasn’t my doctor mentioned this as a treatment option for me?   > Answer

Does this kind of therapy work? Will it help me?   > Answer

How many sessions would I need?   > Answer

What are my treatment options?   > Answer

What will therapy involve? Do I need any advance preparation?   > Answer

How long will it take before I feel better?   > Answer

Can I do anything to feel better until I see you?   > Answer

Do I need a doctor’s prescription to see you?   > Answer

Is it safe to start physical therapy during my pregnancy or do I need to wait until my baby is born?   > Answer

What should I bring/wear to my first appointment?   > Answer

My mother had prolapse. I heard this runs in families. Is there anything I can do to prevent this from happening to me?   >Answer

It seems like all of my symptoms began around the same time, about a year or so before my last period. Can they be related to menopause?   >Answer

Common questions during/after treatment

Dilator: If I do not hold it in place the dilator is pushed out - is that ok?   > Answer

Paresthesia: When doing the scalene stretch it feels like I hit my funny bone – is this ok?   > Answer

When I got home I started right away on my physio but I think I may have overdone it and caused some irritation. The physical irritation is nothing compared to a really weird emotional feeling that comes before it. It is manageable but uncomfortable. Hard to explain but my emotions inside my pelvis are upset.   > Answer


How will my intervention at Essential Physical Therapy differ from “regular physical therapy?”
Many physical therapists provide components of the interventions we provide as part of their program. They may or may not be specialists in treating chronic pelvic pain, and often do this as part of a general physical therapy practice. We are experts in treating pelvic pain conditions, and treat pelvic conditions exclusively. We provide a comprehensive evaluation and design a treatment program addressing the root cause of each individual’s condition. Many of our clients come to us having attended extensive physical therapy with one or more practitioners, and having suffered for many years without relief. Our program empowers clients to continue to improve in relatively few visits, through self-administered treatment in the comfort of their own home. We provide a comprehensive consultation which takes into consideration the entire individual, rather than just pelvic symptoms. We work closely with a variety of practitioners to develop a holistic intervention program that helps the individual resume participation in their life roles.

Where does chronic pelvic pain come from?
Pain becomes chronic when the cause of the pain is not addressed adequately in a timely fashion. Often patients with pelvic pain are treated for their symptoms, rather than addressing the root of their problem. In many cases pelvic pain is the result of muscle spasm or imbalance of the pelvic floor muscles, regardless of the triggering event. Triggers for pelvic pain may include childbirth and associated conditions, inflammation (of the prostate or seminal vesicles or bladder), hormonal imbalance (menopause), infections (such as urinary tract infection, prostatitis, yeast infection, bacterial infection), trauma, scar tissue restriction, post-radiation or chemotherapy, sports related injuries (cycling, running, intense bodybuilding), stressful life situations, emotional or sexual abuse.

What life activities are affected by chronic pelvic pain?
Sitting, driving, sexual activity and participation in exercise are commonly affected. People who suffer from chronic pelvic pain often complain of difficulty concentrating and engaging in social activities.

What are other impacts of chronic pelvic pain?
Emotional impact may include depression, anxiety and feelings of helplessness or hopelessness. Social isolation is common, and personal relationships are often impacted. Participation in work is often limited by this and by physical discomfort. Some people have to stop working while suffering from chronic pelvic pain. Most people report that their sleep is impacted by the condition.

Why haven’t I heard of this before? Why hasn’t my doctor mentioned this as a treatment option for me?
Chronic pelvic pain often goes misdiagnosed as prostatitis, vulvar vestibulitis or infection even when no signs of inflammation are present. While it is important to be evaluated by your physician to make sure that no infection or pathology of the organs are present, many physicians are not familiar with the techniques used to treat the muscles of the pelvic floor. Physicians who are used to treating pathologies of the internal organs may not be consulted regarding musculoskeletal injuries on a daily basis, and may therefore not be familiar with assessments and interventions geared toward these structures.

Does this kind of therapy work? Will it help me?
As long as a patient has had a thorough medical check-up and pathology has been ruled out, our experience has shown that myofascial trigger point release, relaxation, and neuromuscular re-education are effective treatments for pelvic pain and dysfunction.

How many sessions would I need?
This depends on how long you have had your condition and on its degree of severity. It is generally easier to effect change in a condition which has not become chronic. The average number of visits at our clinic is 6-8, and this is over a 12 month period. Occasional patients require only an initial evaluation/education session or 2 to 3 additional visits. Occasionally patients require 10 to 24 visits in a 12 month period. Our goal is to help our patients understand their condition and learn how to best administer therapy at home. We use our therapy time to administer hands-on work. We pride ourselves on educating our patients and their spouses (or significant others) to administer self-treatment.

What are my treatment options?
We generally advise patients to make an appointment for an initial evaluation (a 2 hour appointment) to determine, with the patient, the best treatment options. For those who do not live in the immediate geographical area and may have to commute a significant distance, we suggest one of three options. a) Patients can enroll in an intensive 5 day pelvic wellness immersion where they will learn everything they need to continue treatment on their own at home. b) They may come in over a 3 to 5 day period to get a good start on a home program. c) When appropriate, telephone conference appointments are available via telephone / webcam. View treatment options.

What will therapy involve? Do I need any advance preparation?
It is helpful to send us a "timeline" of your pertinent medical history and results or reports on any tests you may have had prior to your initial consultation. A bladder &/or bowel diary completed over 2 days is often helpful.
Therapy will include: Myofascial trigger point release to involved muscles, applied externally and internally (where indicated). Sometimes scar tissue release or visceral mobilization is necessary. Relaxation and stress reduction techniques are taught. Behavioral techniques for healthy bowel, bladder and sexual function are reviewed and a comprehensive exercise program which incorporates stretching, strengthening, neuromuscular re-education and core stabilization is designed. An integral part of therapy includes a postural evaluation, taking into account the patient’s activities of daily living.
Some clients benefit from biofeedback training or electrical stimulation to their pelvic floor muscles: if this is the case, we generally recommend doing this at home with a portable device, and we will teach you how to use it properly for optimal outcomes.

How long will it take before I feel better?
That question can better be answered after your initial assessment. The length of therapy is dependent on the severity and chronicity of the dysfunction and on your specific goals for rehabilitation. Sometimes a client has a short-lived (hours to days) exacerbation of symptoms following treatment, however this often leads to improvement in symptom intensity and duration.

Can I do anything to feel better until I see you?
Most of our patients find that soaking for 20 minutes in a warm bath is helpful to relax their muscles and ease discomfort. We advise you to consult with your doctor about the use of medication to help muscle relaxation. Some doctors use such a protocol diagnostically: if the patient feels better on muscle-relaxant medication, the symptoms may be suggestive of a neuromuscular or musculoskeletal problem. A lack of improvement with muscle relaxants does not definitively rule out muscular contribution to any individual’s symptoms. Different individuals respond differently to specific medications, and some individuals respond more positively to mechanical stretching and relaxation techniques than they do to pharmacological intervention.

Do I need a doctor’s prescription to see you?
While a prescription is not necessary to evaluate or to begin treatment, it is a good idea to see your doctor to rule out any pathology of the organs. If you do not have a doctor that you can consult regarding your condition, we would be happy to refer you to an appropriate practitioner. If treatment extends beyond 10 visits or 30 days, which is unusual in our practice, a prescription will be necessary to continue treatment.

Is it safe to start physical therapy during my pregnancy or do I need to wait until my baby is born?
It is always preferable for you to check with your doctor as to whether there are any specific precautions to be taken in your therapy. For example: if you have a low-lying placenta or a cervix prone to early dilatation. While many techniques that we use may be contraindicated with certain conditions, there are many interventions that can be safely applied even during pregnancy or early postpartum.

What should I bring/wear to my first appointment?
We suggest you wear comfortable, loose-fitting clothing. Please bring your completed intake forms, timetable detailing condition from onset to present, any reports or test results, and a prescription from your physician (Click to download form). Bring along some form of exercise clothing.

My mother had prolapse. I heard this runs in families. Is there anything I can do to prevent this from happening to me?
Many conditions, including prolapse can be prevented by avoiding the behaviors that cause prolapse in the first place. See the wellness & prevention section of our web site for more information on preventing this condition.

It seems like all of my symptoms began around the same time, about a year or so before my last period. Can they be related to menopause?
Many pelvic conditions, including urinary urgency, incontinence, and sexual pain are linked to the hormonal changes associated with menopause. These changes can begin well before a woman’s last menstrual period. For more information on preventing these symptoms, see the wellness & prevention section of our web site.

Common questions during/after treatment

Dilator Use: If I do not hold it in place the dilator is pushed out - is that ok?
Muscle spasm or bearing down is what would push the dilator out: Take your time inserting it- not against resistance (relax and wait until it is easy to insert, and insert in small increments, with progressive relaxation to allow it in further). If it pushes out, it is time for you to do conscious relaxation techniques: hold it in place with a "monitoring finger" feeling for when it stops pushing against your finger.  Then remove your finger and see if it will sit in place without pushing out.  It should never shoot out, it should come out slowly and easily- you should easily remove it with no abrasion or need to tug.

Paresthesia: When doing the stretch it feels like I hit my funny bone – is this ok?
The funny bone feeling is an indication that the muscle is compressing the nerve- it needs to loosen up to stop doing this.  As long as the sensation goes away within a minute or so of stopping the stretch/tissue work, it is okay to continue. 

When I got home I started right away on my physio but I think I may have overdone it and caused some irritation. The physical irritation is nothing compared to a really weird emotional feeling that comes before it. It is manageable but uncomfortable. Hard to explain but my emotions inside my pelvis are upset.
This description is not unusual at all, and in fact is a positive outcome.  This type of work often stirs up emotional responses that have been blocked.  As one lets go of tension in pelvic muscles that are habitually held tightly, the emotional release can be intense... and the pelvic muscle irritation can as well, since they don't want to "give up" old habits that they know so well.  Some exacerbation is ok.  I would recommend that you continue to do the work, but that you work closely with your mental health practitioner during this process for the following reasons: to both help you deal with the emotional release that comes with the work; as well as to determine how much emotional response you can handle while doing the physio work. (i.e. determine your tolerance threshold, and when to move forward/when to back off (in small increments) so that you can progress without large setbacks).