Questions to Ask a Pelvic Floor Physical Therapist

Pelvic Floor Physical Therapy changed my life. After my first son was born I felt overwhelmed by how to return to fitness, keep up with my son, and heal my Diastasis Recti. Prior to getting pregnant I had never heard of Pelvic Floor Physical Therapy, nor was it recommended to me. Luckily, I self referred after things felt just a bit "off." Over time I've seen an increase in awareness, referrals, professionals entering the field, and interest from pregnant and postpartum people in finding a provider.

Why see a Pelvic Floor Physical Therapist?

Seeing a Physical Therapist trained in Pelvic Health can help you better understand your pregnant or postpartum body and symptoms. Together you and your provider can design a program and treatment plan to alleviate symptoms, or prevent them.Pelvic Floor issues are rarely isolated, so working with someone who treats the whole body and person is incredibly valuable. Some conditions treated by a therapist include:

• Diastasis Recti

• Pelvic Organ Prolapse

• Bladder or bowel issues, including incontinence

• Painful sex or pain with penetration

• Pregnancy & Postpartum Recovery

• Musculoskeletal Pain - back, hip, SI join, SPD pain, low back pain, tailbone pain, etc.

Two of the biggest questions I receive from mamas looking for care are:

• How do I find a Pelvic Floor PT? I don't know where to look. Here is a great resource. 

• What can I expect at my first appointment? Check out this interview with Dr. Allison Feldt too!

• What should I ask before and during my first appointment?

In today's post I've rounded up 25 questions to ask before, during, and after your first Pelvic Floor Physical Therapy appointment. This list includes community contributions from four Pelvic Floor Physical Therapists too. I've included links to their websites below :)

• Dr. Ivy Colbert - Empower Physical Therapy

• Dr. Jennifer Santamaria - Femme Strong Physical Therapy

• Dr. Sam Chernak - Find her on Instagram here

• Dr. Jaime Goldman - Origin Mother and Child 

Questions for your first Appointment

Before Your Appointment

1. Can I have a phone or virtual consultation first? I’d love to see if you’re a great fit for me. Many Physical Therapists will do a short consult for free. While the conversation won’t be a full evaluation, it’s a great time to ask a few questions and get a sense of the types of patients the PT sees, their treatment philosophy, and personality. – Dr. Ivy

2. What are your personal goals (the patient)? Do you want to run, play with your kids, jump without leaking, etc.? Communicating these goals with your therapist will ensure you’re both on the same page. – Dr. Jenny

3. What is expected from me (the patient) during a session and the days in between? It’s important to understand the amount of work and the commitment you need to put in as well. It’s not a passive process. – Dr Jenny

4. Can I bring my child with me? If PT isn’t accessible due to childcare, I encourage you to ask. I brought both of my children to PT with me when they were younger. You may find you want a solo trip once your children get older.

5. Do you accept insurance? If not, can you explain why? Many fantastic providers are cash pay. This allows them more time with you, amongst many other things. Most cash pay Physical Therapists are passionate about serving you, the patient, in a holistic and complete way. I encourage you to ask about payment plans, FSA funds, and other ways to make PT accessible for you.

6. What should I wear to Physical Therapy? Wear something comfortable you can move around in. Your PT may complete a movement screen or assessment. If I was out and about I would pack a pair of comfortable shorts to bring with me.

7. What kind of equipment do you use? Would I need to be purchasing any extra equipment or devices? Depending on your treatment plan a Physical Therapist may recommend buying items like a pilates ball, foam roller, resistance bands, amongst other items. These are typically low cost and easily purchased.

8. I’m on my period. Should I wait before scheduling my appointment? If you are on your period or not comfortable doing an internal exam, the internal exam can wait until your next appointment. You can, however, still see your Pelvic Floor PT for external work and/or evaluation.

9. I’m not having symptoms – do you think it’s still worth a visit? I strongly recommend all pregnant and postpartum people see a physical therapist. Pelvic Floor issues are rarely isolated and you may discover a seemingly unrelated issue can be treated through Physical Therapy support. Our bodies are changed dramatically during pregnancy and need the TLC and support during the postpartum period, no matter how long ago you had your kid(s).

During Your Appointment

1. What is your plan for treatment? After you’ve had your initial consultation, I encourage you to ask your PT about their treatment philosophy and how they can support you. Some Physical Therapists find that patients stop coming back, and sometimes this is because the patient doesn’t understand the treatment plan and/or didn’t think it was helping. Keep the communication open and be involved in your overall treatment plan, making it work for you, your interests / needs, and schedule. –Dr. Sam

2. What percentage of your patients have the same condition I do? How often have you treated _____ (insert concern) in clinic? This may help gauge the therapists comfort and experience with treating patients with similar symptoms and/or background. – Dr Ivy

3. What is your success rate with treating clients with ____ (insert concern)? Ideally the PT is optimistic about treating you.

4. How long before I see / feel a noticeable difference from Pelvic Floor Physical Therapy? This opens the conversation for frequency in completing exercises, scheduling appointments, and setting goals. This will vary of course based on diagnosis, mama, and adherence to the program.

5. Can you help me understand this diagnosis? Ask the therapist to explain the diagnosis so you better understand why it occurred and how it will be treated. Special note to avoid placing blame on yourself or others. This is a question to better help you focus on the treatment plan and things you can be doing outside of sessions to help drive a better outcome / you closer to your end goal.

6. Is there anything else I can be doing at home to help with my recovery? Most Physical Therapists will give you a home exercise program, but it couldn’t hurt to ask if there’s anything additional you can be doing at home to make sure all your bases are covered. – Dr. Ivy

7. If symptomatic in certain positions – can you also assess me in standing (for example)? If there are movements your PT may have missed in your evaluation that bring on symptoms, ask them to complete an additional screening.

8. If internal work is desired or completed:

• Can you explain what you will be doing, step by step, before we start? This may help you feel more comfortable before the internal exam. Many Physical Therapists will also use a pelvic model or diagram to show hand placement and anatomy. – Dr. Jaime Goldman

Pelvic Floor

1. If you do not want an internal exam: What are options for treatment without internal work? A skilled Pelvic Floor PT can gather a lot of information by visual observation and hands on external palpation. Your pelvic PT session can be incredibly effective without internal work if that’s not something you want or feel ready for. – Dr. Jaime Goldman

2. If you want to learn more about your body / see what is going on: Can you hold a mirror so I can see what you are doing? This may be particularly helpful for those with symptoms to better understand what to look for (i.e. POP). Also – our bodies and anatomy change after having children. This is an opportunity to familiarize yourself with changes and anything to look out for in the future. You can also ask the therapist to guide your finger to the spot or area being discussed. – Dr. Jaime Goldman

3. Should I see additional providers to help with our treatment plan? Physical Therapists have a great referral network. Perhaps a Webster Trained Chiropractor, Acupuncturist, Lactation Consultant, Registered Dietician, Mental Health Counselor, Urologist, Postpartum Doula, Massage Therapist, Postpartum Fitness Coach, etc. could be a great resource for you. These providers will only add value to your treatment/recovery.

4. How will this treatment affect my day-to-day/fitness routine? Understanding how this impacts your day-to-day routine will help you be more successful and budget your time.

Postpartum Specific

1. Can you assess for Diastasis Recti? 

2. Can you assess for Pelvic Organ Prolapse? Particularly if you are experiencing any heaviness, pelvic discomfort, or see any noticeable bulging. Note: If you already have POP and become pregnant again a therapist can support you in managing symptoms as well through your pregnancy.

3. Should I be completing more Kegels? Many mamas are instructed to complete Kegel exercises postpartum. But, this may or may not be what your body needs. If Kegels are right for you a Pelvic Floor PT can provide direction in a home exercise program.

Pregnancy Specific

1. Push / Labor Prep: Can we review positions and breath strategy for pushing? This is SO helpful during pregnancy. A Physical Therapist can help you understand (and feel) for bearing down, releasing pelvic floor tension, and how to push correctly. I often found I was given opposite direction in Labor & Delivery and the prep I did with my Physical Therapist was very helpful. This post also dives into helpful cues for pushing, all of which can be practiced / reviewed in sessions.

The Take-Away

Your first appointment will likely be longer and include some initial advice and education, an examination / screening, and an open conversation. After your second appointment you should have a more complete plan, which may evolve based on how your body responds to exercises completed at home and in clinic, plus soft tissue work. The biggest piece of advice is to voice up, express your concerns, and what you are / are not comfortable with. This should be a collaborative and stress-free process for you.

Questions on Pelvic Floor Physical Therapy, or returning to exercise after baby? I'd love to chat . 

Feel good mama.

xoxo,

Erica