What your pelvic floor PT will never tell you.

In the world of pelvic health, we as practitioners unfortunately encounter women on an almost daily basis who are carrying shame surrounding their condition. Shame that they’re dealing with something so private, self-blaming for their condition, or that they’ve let it go on for so long without seeking help. I tell patients all the time that for every one woman who is coming to see me to get help, there are likely dozens who are suffering in silence, and not getting the help they need for a host of reasons. 

There are plenty of statistics that show how common pelvic floor issues are, yet the research also agrees that pelvic floor issues are widely underreported and, as a result, under treated. As an example, 1 in 7 women in the U.S. deal with chronic pelvic pain (pain symptoms lasting more than 3-6 months), with an estimated 50% of cases being undiagnosed. (1)

With all this being said, it is very normal to feel nervous about pelvic PT. Will my therapist judge me? Will I have to divulge personal details? Most people don’t wake up excited to discuss their bowel, bladder, or sexual dysfunction with a stranger. As pelvic PTs, however, we have dedicated not only 7 years of academic training to receive our doctor of PT degrees, but have also completed hundreds of hours of additional education to be able to discuss just those topics with you! We truly love hearing your stories, the good and the bad, to help create a plan for healing. 

To ease your apprehension about pelvic floor PT, here are

10 things your pelvic floor PT will never tell you during your appointment.

1)    This is your fault.

No matter how your symptoms started, it’s not your fault. It’s not because you don’t exercise enough, stretch enough, or have sex often enough. It’s not because you waited too long to seek care, or because you had your kids close together. Every body is different, and there are many reasons why yours may not be serving you in an optimal way right now. 

2)    Next time, you need to shave before you come. 

Guess what? We don’t care! Be it your legs, arm pits, or vulva, we truly don’t notice. Our assessment and treatment can be completed in the absence or presence of body hair. What you choose to do, or not do, with it is completely up to you!

3)    You can’t bring your kids.

We love babies and kids of all ages! At the end of the day, we want you to get the care you need. If that means you need to bring one or even several kids to your appointments, we can always make it work. Be it holding your baby, letting your older kids hang out on the floor and get some extra screen time (they’ll be thrilled to oblige), or involving them in your exercises, please don’t let this be a reason that you don’t come.

4)    You have to spend at least 30 minutes per day exercising, or you won’t get better.

As a mom, I am the first person to commiserate that it truly feels like there are never enough mintues in the day. While there are guidelines out there for optimal numbers of minutes, reps, or volume of exercise, I will always give you a realistic plan catered to your goals. Want to run a marathon? Great! Want to just get through your day without peeing your pants, feeling your hips ache, or be able to pick up your kids without passing gas? Awesome! I’ll give you tools in your tool box to address that in a realistic way.

5)    This ONE exercise is going to solve all your issues.

Unfortunately, there is no magic button in the world of rehab. Your body is a complex system of interacting parts, and reducing this to one problem/solution is never the answer. This means that healing can take time, and will be multi-faceted. If you’ve ever been told “just do this to fix your problem,” kindly seek a second opinion 

6)    You have to stop doing this exercise, drinking this beverage, or engaging in this activity.

I will never tell you to stop running, doing Cross Fit, drinking Diet Coke, or scrolling social media before bed. The fact is that we need things in our life to help us unwind and bring joy! Instead, we may try to figure out how, if at all, your activities are affecting your pelvic floor, and find ways to modify accordingly. 

7)    If you had done things differently, this wouldn’t be a problem.

Assigning blame to yourself is not only incorrect, it also over simplifies your problem. Our job is to put together the many puzzle pieces that are causing your issues, and help you understand them. See #1 for further detail, and re-read if needed. 

8)    Why don’t you just relax.

Has anyone in the history of the world ever responded positively to this feedback? No. In fact, I think most of us have the stark opposite reaction, and for good reason. Is stress a major contributor to pain, over active nervous systems, and musculoskeletal issues? Yes. Instead of being dismissive and placing the burden on you to “relax,” we help to not only find ways to manage stressors, but increase your body’s adaptability and response to them. 

9)    There’s nothing else we can do.

We may reach a point in which PT is no longer serving you, we will always help to create a next steps plan. This may be seeking a second opinion from another PT, referring you to a OB/GYN or specialist to further diagnose or treat your medical symptoms, or considering additional therapies, such as mental health therapy. Even if the plan involves focusing on your home program instead of coming in for visits, we are here to help with that transition. 

10) Your pain is in your head.

Whether you have directly, or indirectly been told this, this is dismissive and reduces the complexities of the body to a single source. Even when no clear cause has been identified for your symptoms – your ultrasound, urine cultures, CT scans, or PAP smears are all negative - we will do a comprehensive exam to figure out what’s going on from a musculoskeletal and neuromuscular stand point. What we do know about neuroscience tells us that pain does originate in the brain, and that sometimes the pain response our brain creates is not always equal to the cause (this could be an entire other blog post, stay tuned!), but rest assured our goal is to address both your physical symptoms, as well as your pain response, and determine how we can utilize PT interventions to reduce this response, as needed.

Source:

(1) Dydyk AM, Gupta N. Chronic Pelvic Pain. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554585/