Pelvic Floor Physical Therapy (or Pelvic PT) is a specialized type of physical therapy that treats bowel, bladder and sexual dysfunction by addressing restrictions, weakness and/or injury to the musculoskeletal and neuromuscular system.
Whoa. It might be helpful to translate that tangle of terms! There is a bowl of muscles between your hips, holding up your organs: your bladder, rectum and your uterus or prostate, if you have one. These muscles have important jobs, like providing hip stability, keeping you leak-free, and making sex enjoyable. But many things can go wrong with pelvic muscles and the nerves that activate them, and when the muscles and nerves aren’t happy, everything else can go a bit haywire, too. Muscles can be too tight, too weak, in spasm, injured, full of scar tissue — all things that make it hard for them to do their job properly. This can create a domino effect on our our urinary system, our reproductive system, our digestive system, our mood, our relationship… you name it!
And these issues and concerns are not limited in scope: so many of us are dealing with pelvic health issues or have unanswered questions we try to shrug off. These problems don’t just go away on their own, and many people often suffer in silence, assuming this is “the new normal.” Others take medication for years or decades or get surgery to “fix” their pelvic problem, with limited success. And 1 in 3 new moms report bowel and bladder issues after giving birth; half of all new moms have pelvic pain in the months after they’ve delivered. It doesn’t need to be like this.
So we pelvic floor physical therapists use our hands and our smarts to work on the muscles, tissues and nerves that need it, empowering you to heal yourself as we use our clinical expertise and work together with your body to resolve those “down there” problems.
No, you no longer need a referral from your medical doctor to see a physical therapist – you now have what we call “direct access” to our services!
The only exception to this rule is if you have never had a gynecological exam: in that case, we may ask that you visit a gynecologist before starting pelvic physical therapy. If you have male genitalia and are seeking treatment, we may ask that you consult with a colorectal doctor or urologist prior to an internal exam of your pelvic floor muscles. These requests are to rule out conditions that are not within our scope of practice to diagnose.
If you did get a referral script from your physician, please bring it with you to your first appointment or you can upload it as part of your intake paperwork.
NOTE: although you can see your PT without a referral, some insurance companies will still only reimburse you for out-of-network services if you received a referral from your medical doctor. Please contact your insurance company prior to your first visit if this is a concern.
Many people think that pelvic floor PT is all about kegels (a contraction and relaxation of the pelvic muscles). But it’s an incorrect comparison, just like lifting up the laundry basket a few times a week to get an upper body workout is not the same as working with a trainer who gives you a personalized exercise program with sets, reps and endurance training specific to your body. You can see how one would help you speed along to your fitness goals while the other might just make you sad about how you have to do laundry again. So, we might check to make sure you are actually doing those kegels properly – 30% of women do them incorrectly and in some cases, this can put them at risk of worsening their condition. Learning the correct form and providing you with a tailored and functional training program will help you resolve your concerns much faster. But not everyone needs kegels! Sometimes the issue is tightness, not weakness, or nerve impingement and not muscle irritation. A good pelvic PT can help you figure all that out and point you in the right direction. So if you've started kegeling on your own and nothing is changing or improving – and especially if it's worsening! – please consider checking in with a pelvic PT.
Think of the issue you are struggling with right now. Maybe it has to do with incontinence, so you have cut down on your water intake and your social life for fear of an accident in public, and are now dehydrated and miss your friends. Maybe you stopped running or taking an exercise class because you’re worried about pelvic heaviness (prolapse), or you go to the bathroom 26 times a day and it is affecting your ability to focus on your work. Maybe sex with your partner is no longer enjoyable because of pain or scar tissue buildup or a lack of function. Maybe you don't jump with your kids at the trampoline park because you don't want to leak. Maybe you’ve never been able to consummate your union after waiting years to connect intimately with your partner. Maybe you are tired of being in pain or embarrassed about your body. And on and on and on.... These problems don’t just go away on their own or (wild guess here!) you wouldn’t be reading this right now. Pelvic floor physical therapy can help resolve these concerns, whether you've been dealing with the issue for two weeks or twenty years.
Dress in comfortable clothing that you can move in and that has some stretch to it, like yoga pants and a t-shirt. This is because there is an orthopedic assessment prior to the pelvic assessment where we will assess your range of motion and may ask you to do a variety of motions (e.g. squat, lunge).
Ideally you should complete the intake questionnaire online before your appointment to maximize the time we have in your session for evaluation and treatment, not filling out forms. You will have an opportunity to upload any medical imaging, medication lists and a form of payment when you do the forms online. If you are printing them out to complete by hand, please also bring a form of payment to your visit, as well as a list of your medications, vitamins, supplements, and any other types of treatments you may be undergoing at this time. Also please bring the name and contact information of your medical provider (e.g. ob-gyn, urologist, proctologist, gastroenterologist, primary care physician), and a referral (script) if you have one.
Please note that you do NOT need a referral to be seen for pelvic floor physical therapy, though your insurance provider may require a referral from a medical doctor in order to reimburse you for your visits.
Getting a complete history is very important in order to best understand your condition and how it has affected your life. So for the first part of the appointment, we will be asking a lot of questions — about treatments you may have already tried, surgeries you’ve undergone, your perinatal history if you carried or delivered any children, your toileting habits and whether it is painful to urinate, have a bowel movement, or have intercourse with a partner. Intake forms that are thoroughly filled out before your visit means we’ll need less time to clarify the details of what brings you in. We’ll listen to what you have to say and jot down some notes.
Yes, these are personal topics and it may be difficult for you to discuss them openly. Please know that our conversations are entirely confidential and the more complete of a history that you can provide, the better we can understand your problem, provide an accurate diagnosis and develop your personalized treatment program for our sessions together. It may also be helpful to remember that pelvic PTs do this work all day long, so while it may be the first time that you are speaking to someone about your condition, it's not the first time that we've worked with someone whose concerns are identical to or very similar to your own.
After getting your history, we do a postural and musculoskeletal assessment: basically, looking at the way your joints and muscles move, their range of motion, strength and endurance, and assess any imbalances you have that may be contributing to your condition. Then, with your permission, we can conduct an external and internal pelvic floor muscle exam to check your pelvic floor muscles and tissues and identify what other factors may be contributing to the issues you’re dealing with. For those familiar with gynecological appointments: there are no stirrups or speculum involved here, and we can absolutely stop at any time. If at any point you feel uncomfortable or in pain, please let your therapist know immediately. Though we treat patients every day, we completely understand that what is a totally normal day of work for us may be a highly stressful or anxiety-provoking experience for others. Our priority is to ensure that you feel as comfortable and as safe as possible throughout your visit and to always treat within your boundaries, whatever they may be on any given day. Pelvic floor physical therapy is only successful if we work together and communicate openly.
Afterwards, we will go over the clinical findings, address any questions or concerns you may have, review some initial exercises or stretches appropriate for your condition, and discuss our treatment plan going forward so we can meet your goals.
Internal pelvic floor muscle examinations are the gold standard for understanding what’s happening “down there.” You wouldn’t go to a dermatologist and ask her to check your skin through your clothes, and you wouldn’t get a cast put on without an X-ray to prove the bone is broken. Pelvic floor physical therapists have specific, high-level training to assess the muscles, nerves and connective tissues that make up the pelvic floor, and we can do this by performing an internal exam, accessing the area via the vaginal canal and/or the rectum, depending on what area we need to assess. That said, not everyone needs to or wants to start with an internal assessment and it is NOT a requirement.
Discomfort, pain, fear, religious views or simply not wanting it are all 100% perfectly acceptable reasons. Just let us know! There are also several conditions that can often be treated successfully using external techniques only if you do not wish to have an internal exam.
Before any external or internal pelvic muscle exam, your therapist will show you on a model of the pelvis the muscles and structures we will be assessing. You will be asked to provide consent before any assessment or treatment, and most importantly, you can change your mind at any time. Your PT will leave the room for you to undress from the waist down and lie on the treatment table, covering yourself with the sheet provided. There are no stirrups or speculums involved in pelvic floor physical therapy for those who are familiar with gynecology appointments. We use clean, non-latex gloves and first observe your pelvic floor muscles externally, assessing tissue quality and health, as well as muscle activation and coordination. The internal exam involves inserting one or two gloved fingers into the vaginal canal, or one finger in the rectum, in order to access and assess the front and back portions of your pelvic floor muscles. We are examining the strength, endurance, muscle tone, coordination, connective tissue and tissue quality of these areas. While we talk you through the entire physical exam, you will provide feedback about any areas of discomfort, altered sensation, or limited mobility.
We can stop at any time, and depending on your comfort level or our time constraints, we may not even get to the internal exam on your first visit. Again, you will never be asked to undergo an internal pelvic muscle examination if this is something you have expressed that you do not want.
If you would like us speak to your therapist(s) regarding any trauma(s) you have experienced that may impact your ability to receive care, please provide their information in your intake forms with a note stating that you give us permission to contact them prior to your appointment. Knowing what might be triggering or upsetting to you given your personal history will allow us to create the most holistic and healing environment possible during your visits.
Finally, if you are presenting with concerns that include worsening night pain, bruising of unknown origin, and bleeding or pain with urination or defecation but have yet to be assessed by a gynecologist, urologist or colorectal MD, we ask that you see one of these specialists before we do any internal work. It’s important to us that we provide you with the best, most complete care possible and there may be necessary tests beyond our scope of practice that should be completed by an physician before a physical therapist provides treatment. Please ask for a referral to a medical doctor should you need one.
Initial evaluations are 65-75 minutes. Followup sessions are 45-55 minutes. Telehealth appointments are slightly shorter to account for the additional time needed to send you a thorough post-visit write up of the exercises and techniques discussed at during your virtual appointment.
Clinic Appointments: Initial evaluations and consultations range from $275-$325 for 65-75 minutes. Followup sessions are $225 for 45-55 minutes. Telehealth/virtual appointments (same prices) can be interspersed with in-person visits if this is appropriate for your condition and treatment plan. The cost range is because pricing differs between our New Jersey and Vermont offices; contact your local office for more information: 201.942.4429 (Hoboken, NJ) and 802.357.5747 (Burlington, VT). VIP in-person care is priced with additional travel expenses in mind.
Appointments are always one-on-one time with a licensed doctor of physical therapy. Appointments are typically only once a week or every other week, and as your symptoms start to improve, we often space out these visits to once every few weeks or months. The typical treatment time frame is 6-12 weeks: for some people it takes less time, for others it takes a bit more, depending on the nature and severity of your condition and provided you are diligent in doing your assigned therapy exercises and in attending your sessions. Those with common bladder conditions, for example, often take only 4-8 weeks to see improvement. If you anticipate needing to space out visits due to financial considerations, work/childcare obligations, travel plans or any other reason, please let us know so we can efficiently and effectively formulate your treatment plan of care.
The invoice you will receive (also known as a ‘superbill’) after your appointment is submittable to insurance, and you may be able to receive reimbursement for a significant portion of the cost of your visits. Contact your insurance company to find out more.
All major credit cards are accepted. Cash or checks (made out to The Pelvic PT) are also accepted. An invoice with treatment codes, also known as a ‘superbill,’ will be sent to you after every session through the patient portal. You can submit the superbill to insurance to apply for reimbursement for the services provided. It is your responsibility to determine your out-of-network benefits prior to attending physical therapy in order to determine your eligibility for reimbursement.
We have chosen not to enter into any contracts with insurance. Why? It allows us to offer you longer treatment times and higher quality service so you heal faster, and in less visits, while getting the personalized care and attention you deserve. When was the last time a doctor spent more than 20 minutes with you?
In terms of getting reimbursed for your visits, we will be provided with a detailed invoice (also known as a ‘superbill’) which you can submit to your insurance company. This means that even though you will pay the full fee upfront, you may be reimbursed a significant amount by your insurance after submitting the claim. It is up to you to establish your out-of-network benefits to determine your eligibility for reimbursement before your visit.
If you do not have out-of-network benefits, you may be able to obtain a referral and a letter of medical necessity from your medical provider and petition your insurance, letting them know that the only pelvic PT you have been able to find in your area who is trained at the level you need to address your condition is out-of-network, and asking if they may be able to accommodate you for what your medical doctor has deemed a necessary treatment. Not all pelvic physical therapists have the same level of training or expertise, so if you’re not getting better or feel like you’re going in circles, we recommend you find another clinician!
We also strongly encourage those with limited or no health insurance benefits to still contact the office. Alternative options will be shared on how to obtain the care you need to restore health and long-term quality of life, including prevention/maintenance/wellness programs, or referrals to community resources that best address your current medical and financial circumstances. This is part of our commitment to promote accessibility to health care for all members of our community.
You will be provided with an invoice (also known as a ‘superbill’) after each visit if you are planning to submit to insurance. It contains codes that the insurance companies need to be able to provide reimbursement. Be sure to call your insurance company directly or check their website if you have questions about filing a claim, your claim status, or your EOB (Explanation of Benefits). They will let you know what your out-of-network benefits are, which form you should complete to submit your claim, and how long until you can expect the claim to be paid. Follow-up with your insurance company after your claim has been submitted to make sure they have all the necessary and properly completed documents. We cannot guarantee that your claim will be reimbursed as every insurance company and plan comes with its own rules and regulations, but we can assist by providing a letter of medical necessity if your claim is rejected.
For some, telehealth appointments are the only care they need to effectively address their concerns! For others, a hybrid of in-person and virtual visits work best. Still others are simply looking for feedback on their current plan of care and exercise program with another clinician and use the time together as more of a ‘therapy audit.’
Virtual appointments are much more than a conversation with a pelvic health physical therapist. Please dress in clothes and be in a space that will allow you to move and bend easily. This is because we will visually assess how you are activating your hip, back and leg muscles as we guide you through a series of movements – and later, as we instruct you on appropriate exercises. We’ll discuss your pelvic health concerns and what strategies you’ve tried so far, and get a sense of your awareness of these muscles and how well they are working with a variety of techniques. After each visit you will get a writeup of the topics we discussed including pictures or video of the exercises that will make up your home program. If you can, seek out a private space where you can ask and answer questions about your concerns honestly and openly during these sessions. And as with in-person visits, you are always welcome to have someone in the room with you during your appointments if you would like.
While you will never be disrobed on screen, you may be asked at follow-up appointments to use a mirror off-screen to check pelvic muscle activation or to have access to your genitals to try the techniques we have planned for that appointment. An example of this would be guidance on the proper usage and positioning of dilators internally for post-operative care or hypertonicity. That said, we will only work within your comfort zone at each appointment and can always modify as needed.
I primarily work with people during their fertility, pregnancy and postpartum journeys, but also treat a range of pelvic floor issues throughout the lifespan and across the gender spectrum. My patients are health-conscious, ready to learn, diligent and motivated to start their healing process.
From diastasis recti to pudendal neuralgia, from organ prolapse to dyspareunia (pain with sex) to urinary incontinence — the types of conditions that a pelvic PT can treat are vast and wide-ranging. If you leak when you sneeze, have problems when you poop, or getting ‘frisky’ doesn’t feel so fun anymore, it’s time to talk to a pelvic floor PT. If you are planning to get a hysterectomy, prostatectomy, gender-affirming surgery (or any other abdominal or pelvic surgery that will impact your daily life), you will greatly benefit from working with a pelvic floor PT both pre- and post-operatively to help you recover more quickly and with less complications.
Yes. If there is abdominal restriction or if pelvic floor muscles are tight, in spasm, or uncoordinated, it can make it difficult for the body to welcome a pregnancy and allow for implantation. Pelvic floor PTs spend much more time with their patients than the typical gynecologist (usually 45-60 minutes compared to 10-15 minutes), and we can often pick up on muscular imbalances and circulatory or nervous system issues that may be a contributing factor to your current inability to conceive. Our treatment also often costs much less than current fertility options on the market while empowering you with a much deeper understanding of your personal anatomy and function.
We also work closely with other wellness professionals who understand the importance of a holistic approach to addressing the physical, hormonal and nutritional imbalances that may be impacting conception.
Yes! Low back pain, round ligament pain, pubic symphysis dysfunction, sacral misalignment, pelvic pain or sacroiliac joint dysfunction are all common conditions affecting pregnant women. There is so much we can accomplish externally and if warranted clinically, we can gently assess the muscles, nerves and tissues internally as well so we establish your pre-delivery baseline of pelvic muscle strength, coordination and endurance. We will also work on posture, core stabilization, strengthening and lengthening of your muscles. Depending your knowledge and experience, we can discuss appropriate birthing positions given your medical history as well as exercises and techniques that will make labor and delivery easier for your body. This includes effective post-operative care for scheduled C-sections as well.
So whether you have specific aches and pains to address or simply questions and concerns about how to protect your pelvic floor during labor and delivery, a few visits during pregnancy can be a great introduction to the amazing support that pelvic health therapists offer pregnant people at this wondrous and powerful stage in life!
Please also be sure to tell us if you are pregnant or suspect you may be pregnant even if it is early on in your first trimester.
Yes, absolutely. Men also have pelvic floor muscles and can greatly benefit from working with a pelvic floor physical therapist to address a variety of issues, such as erectile dysfunction, bowel or bladder incontinence, scarring or weakness, painful intercourse or ejaculation, and testicular or scrotal pain. These problems can sometimes arise after surgery (e.g. prostatectomy, abdominoperineal resection), injury (e.g. car accident, during intercourse), and activities that create compression or involve impact to the genitals (e.g. biking, martial arts).
If you have bruising of unknown origin, painful or bloody urination or defecation or worsening pain at night, we ask that you first visit with a urologist or colorectal physician prior to your initial evaluation with our office to rule out any serious conditions beyond the scope of our expertise to assess. This will ensure that we can provide you with the best and most appropriate care. If you have erectile dysfunction issues and a family history of cardiac events or hypertension, we urge you to first check in with a cardiologist: erectile dysfunction is sometimes the first sign of an issue with your cardiovascular health!
Yes! We work broadly across the gender spectrum in all its diversity and with people at every stage of their gender-affirming journey, whether that is pre-operative, post-operative, or with no desire for surgery but who simply have pelvic health concerns and are seeking a knowledgeable and welcoming provider. We are happy to work closely with the rest of your care team to provide you with the best possible treatment and you are always welcome to bring a partner, friend or family member to your appointments if you would like. Both our Vermont and New Jersey clinics have gender neutral single-user bathrooms available.
We strive to use the language that you prefer for your genitals to minimize any dysphoria and we’re always open to any suggestions you have that will make our clinics the right place for you to get the expert care you deserve. Feel free to reach out with any questions or concerns before making an appointment.
Yes! Menstruation does not affect pelvic floor muscle treatment in any way and the work we do either internally or externally can often decrease the discomfort you may normally experience during your cycle. That said, we understand that you may not wish to have any internal work done during this time. If that is the case, please let us know so we can plan to work externally or so we can reschedule your visit accordingly.
If you currently have an active infection or a flare-up, it is best to hold off on coming to your appointment until it has cleared – we absolutely don’t want to risk transmitting a localized infection to another part of your body or making your symptoms worse by working on the tissues in that area. If you need a referral to an MD in order to seek treatment, please don’t hesitate to get in touch.
If we identify what may be an active infection when working together, external or internal pelvic treatment for that day stops and we shift to other parts of the body as per your care plan (e.g. posture, deep core strengthening, abdominal scar work). We will resume when the infection or flare-up has cleared. Please know that you will need clearance from your MD in order to resume treatment unless you have already been prescribed and are taking the appropriate medication.
At the moment we accept patients under the age of 18 on a case-by-case basis only and require a parent or guardian to be in attendance at all appointments.
If you are considering seeking out pelvic physical therapy and have a history of trauma, you may want to first work with your mental health provider or therapist to address any anxieties you have regarding this intimate type of care. (If you need a referral to a therapist, please check our Resources page).
Ask your therapist to contact us directly and they absolutely do NOT need to mention you by name: we'll simply set up a call to educate them about our approach and how we conduct exams and treatment here at The Pelvic PT. This will allow them to provide you with accurate information and prepare you effectively. And this way, even if you decide to seek out another pelvic health provider, your therapist has a thorough grounding in what an experienced and compassionate pelvic PT can offer. They'll be able to knowledgeably check in with you about your experience and we'll know that you're being well taken care of, wherever you go.
If you have already made an appointment and would like us speak to your therapist(s) regarding any personal or medical trauma(s) you have experienced that may impact or influence your care plan, please provide their information in your intake forms and note that you give us permission to contact them prior to your appointment. Please complete your forms at least several days ahead of your visit so we have ample time to connect with them.
Knowing what might be triggering or upsetting to you given your personal history will allow us to create the most holistic and healing environment possible during your visits. We always take our cues from you: working in an intimate area of the body can bring up lots of emotions and we strive to hold a safe space for you, taking breaks or shifting the type of work we're doing together as needed on any given day.
You may feel moved to discuss what you're feeling or experiencing as we do this important physical work in session and we absolutely welcome you to do so. (And also, you might not and that's fine too!) Either way, we deeply respect the vital work done by mental health professionals and recognize that these skills fall beyond our scope of practice, so we may also encourage you to discuss any observations or insights you gain from our visits with your therapy provider.