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What to expect in a Pelvic Floor therapy session


If you are experiencing symptoms such as pelvic pain or discomfort, bladder or bowel issues (including incontinence), painful sex, musculoskeletal aches and pains (including back, hip, sacroiliac joint, tailbone), pelvic organ prolapse, changes related to hormone shifts occurring in peri and menopause, or changes due to pregnancy and postpartum recovery, pelvic floor therapy can help you decrease or resolve your symptoms.  A lot of pelvic floor issues can be successfully managed without surgery as well.  

Each person is different, therefore an individualized program will be key to helping you resolve your symptoms.  Pelvic floor therapy consists of helping you to better understand your symptoms and guide you through a process of retraining, releasing, and when appropriate, strengthening, not only your pelvic floor muscles but other areas of the body that may be impacting dysfunction in the pelvis.


Some issues are quicker to resolve than others.


Factors that can contribute to this are:

*how long the condition has been there (usually the less amount of time the condition has persisted the quicker it is to resolve)

*How well a person can follow through with a self-treatment or home exercise program 

*Other factors that affect daily life, including daily stress levels, routine and mindset  (all of which can shift to help with the healing process)


Some people may have their issues resolved in a 1-3 sessions with a focus on assessing their coordination, strength and flexibility, identify and correct patterns that have been causing dysfunction in their day to day routine, being guided through specialized home exercise/self-treatment program for their condition, and answering any further questions about how to maintain their pelvic floor health  


Other people will start off with more frequent sessions for their condition and then transition to a maintenance program. 


Generally people start noticing changes within the first few visits.  


What to expect before and during the first visit:


First and foremost, you are welcome to schedule a discovery call with me in which you can learn about my approach and ask me any questions you may have, including your goals and concerns.  This will help to determine if I am the right person to help you with what you need.


Before your first appointment I will be sending you some paperwork to fill out.  The questions will focus on your current symptoms, your therapy goals, your past medical history and any other information you would like to share.  There will also be specific questions regarding your pelvic floor health, including pain/discomfort in daily activities (including sex), urinary and bowel issues you may be experiencing.  *You can answer only what you are comfortable with  as I understand these can be personal questions* If along the course of treatment you would like to add in more detail, this will help with your therapy process. 


The first visit will be focused on an interview in which we will discuss your goals and your current experience of what you are seeking help for.  We will also review your medical history.  The muscles of the pelvic floor impact some of our most personal habits (including peeing, pooping and sex).  We will focus on education about your condition, along with education on a basic understanding of the pelvic floor anatomy using a pelvic floor model and other visuals.  We will review what to expect from the therapy, as well as your role in the process.  My approach is whole body in nature, therefore I will be looking at ways the rest of your body impacts your pelvic floor symptoms.  I will perform a postural assessment in standing (which includes back and hips), as well see how your body responds to moving in different positions.  I will also look at you laying down to see where your body is at.  


Internal work

Many people ask if an internal exam is part of the first visit.  An internal exam provides information about your strength, coordination, flexibility as well as myofascial restrictions which affect your pelvic floor, organs and overall posture.  However, there is a lot we can work on to help you meet your goals that can in addition to internal work.  While internal work can help many, it is not for everyone and can be not necessary or appropriate at times.  We can further discuss your specific case on your first visit.   



Common goals include being able to exercise and cough without peeing, being able run a few errands without having to rush to the bathroom, enjoying sex without pain, moving and exercising without fear of making a condition like prolapse worse, being able to enjoy the day’s activities without persistent pain, or urinating less frequently during the night for a better nights sleep.


What can you expect after your first visit and going forward from there?


The first visit is an opportunity to set a good foundation to build on with future sessions.  You will come away with a better understanding of your condition, your body and how pelvic floor therapy works.  We may identify and discuss patterns in your body that may be causing dysfunction.  You will typically have at least 1 or 2 strategies to start applying to your daily routine to shift dysfunctional patterns and help with achieving your goals. Depending on the timing, we will begin some manual therapy, simple exercises or behavioral modifications to help you progress.   


In future sessions your treatment may consist of (but is not limited to):

Somatic movement

Myofascial release therapy

Coordination exercises for the pelvic floor and associated areas

Functional stretching, movement and strengthening program, specifically tailored to meet the demands of the activities you want to get back to.

Assistive device training as needed (with devices specific to pelvic floor and associated areas)

Education on behavioral patterns, movement patterns and posture that affect your day to day function


Some of the self treatment strategies you might perform outside session can include:

Self myofascial release for the pelvic floor and associated areas using a wand or dilators

Self myofascial release for other parts of the body

Follow through with specific strengthening, stretching and flexibility exercises to incorporate into your daily routine, and specifically tailored to meet the demands of the activities you want to get back to.

Breathing and posture awareness strategies to incorporate into your daily routine, and specifically tailored to meet the demands of the activities you want to get back to.

Nutrition and behavioral changes to incorporate into your daily routine


All sessions are 1:1 with the time devoted entirely to you.  The treatment space is private and not shared with anyone else.  I will do my best to accommodate any specific needs or concerns you may have.  I will be available in between sessions by phone, email or texting to answer any questions or concerns. 


Some FAQ are:


Is internal work done on the first visit?

The answer is: it depends.  Laying a good foundation in the first session is key.  This can include establishing a working knowledge of your body, your condition, belief systems and attitudes impacting your symptoms and lifestyle, establishing goals, outlying a map on how we can achieve them as well as a clear idea of what your role will be in the process I have found to be essential for positive outcomes.  From there assessing your body, posture, movement patterns will provide us with valuable information about how your body responds in day to day life.  Internal assessment can give us valuable information and that might happen in the first session but it may not depending on where we are at with the other aspects of the session.  We will discuss this and determine if an internal exam is going to be the best option to include in your first session.   *Please note that if we determine that internal work will be a part of your evaluation or treatment plan, a physician (or physician’s assistant, nurse practitioner) script will be needed for this portion.  For other modalities I use, no script is needed.  Please contact me with any questions about this.  


How many sessions will I need?

Again it will depend on your condition and goals.  For some issues can be resolved within few visits, for others it takes longer.  Average length of time for people to notice significant changes or meet at least one of their goals is 3-6 visits.  Most people notice changes within the first few visits as long as they are scheduled on a consistent basis (typically a week apart).  I have found that the shorter amount of time the condition has been there, the shorter amount of sessions are needed to reach their goals.

How should I prepare for a session?

Appropriate Session Attire: For the effectiveness of the modalities offered, I ask that you wear clothing that you are comfortable in for standing evaluation, movement and hands on techniques without the presence of draping (top sheet).  For any internal portion of the assessment a sheet will be provided for privacy.  

Myofascial Release may be used during your session.  This modality in particular requires skin on skin contact, so ideally I suggest loose exercise shorts and/or a two piece bathing suit or loose exercise shorts (not yoga pants or spandex) and a sports bra or camisole/tank top. Of course your comfort is of primary importance and if you have any questions about appropriate clothing to ensure your comfort and the effectiveness of the modalities performed please don't hesitate to speak with me.

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