Just like any professional (or human), not all physical therapists are created equal. Have you ever been to an incompetent dentist or hired a bad plumber? I have done both – one who told me I had 5 cavities when I had none and one who told me I had to dig up my garage to find a pipe when it was located on the complete other side of the house and required no digging at all. Before I drilled into my healthy teeth or hired an excavator to destroy my garage floor, I thankfully got a second opinion. If you aren’t comfortable with your PT, aren’t getting better, or your PT’s methods just aren’t making sense…seek out a second opinion.
It may surprise you to know that pelvic floor physical therapists are simply licensed physical therapists that say they can treat your bowel, bladder, and sexual symptoms. Seriously, there is no definition of a pelvic floor physical therapist that requires them to have a certain number of continuing education or supervision hours. Some PTs dabble in the pelvic floor here and there and may not even realize the complexity of the population or have taken one course, opened their own practice and you are one of their first patients. Now of course we all have to start somewhere, so ask your therapist what kind of mentorship or supervision they have if this is their first rodeo.
Look for a happy physical therapist. If your PT works in a practice where they are seeing 10+ patients a day, chances are your therapist isn’t necessarily bad; they are just burnt out. I strongly believe pelvic floor PT appointments should be an hour long or more. You should not feel rushed and you should be with the same therapist for your entire appointment. If you are being handed off to an aide to do some exercises or sitting by yourself with a hot pack and electrical stim on your back (or in your vagina) chances are you are not getting the best treatment. If your appointments are less than an hour long, consider seeking out a different provider.
Is your physical therapist practicing some form of voodoo? Let me tell you, some physical therapists and pelvic floor physical therapists in particular can get pretty “out there” when it comes to their beliefs and treatments. If that is your style, namaste…but it isn’t mine and when I saw a pelvic floor PT that supposedly moved my energy with the palms of her hands, I went for that second opinion. Pelvic floor physical therapy does not belong under the umbrella of “alternative methods” – it is actually “the” treatment for pelvic floor related dysfunction – it beats out medications and surgeries in many cases and it works when it is evidence-based.
If your pelvic floor PT hasn’t gone inside, are they even a pelvic floor PT? If you are comfortable with internal vaginal or rectal work, your PT should be too. If your PT sessions look like a general PT session for a stiff hip or a sore back, then you may not be getting to the crux of the problem. Going internal is not necessary for all pelvic floor diagnoses and may take you some time to get comfortable with, but it should at least be on the table (literally). This includes the evaluation – if your pelvic floor PT hasn’t assessed your pelvic floor internally then you haven’t had a complete evaluation. Obviously, if you aren’t comfortable with the internal component, a pelvic floor PT should never force, coerce or manipulate you to participate in it.
Are you only hanging out internally? Ok, I said internal work can be a necessary component of pelvic floor PT but it can’t be the be-all and end-all. You should be doing exercises – stretching, mobility, and strengthening exercises at some point (and hopefully early) in your treatment plan. If you aren’t doing exercises and are just getting “internal releases” done, you are treating the symptoms and not the cause. Additionally, learning how to perform the internal manual therapy on your own will allow you to get quicker results and have more control of your symptoms.