Frequently Asked Questions
I work with my patients in a pretty intimate area of the body, so it is understandable to have questions — lots of questions. If you have a concern that’s not addressed below or need additional information, please email me at firstname.lastname@example.org. There is no question too small or too strange! Trust me on that.
Pelvic Floor Physical Therapy (or Pelvic PT) is a specialized type of physical therapy that treats bowel, bladder and sexual dysfunction through the musculoskeletal and neuromuscular system.
Whoa. Basically, what that means is that there is a bowl of muscles between your hips, holding up your organs: your bladder, rectum and uterus, if you have one.
Lots of things can go wrong with those muscles and the nerves that feed 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, full of scar tissue — all things that make it hard for them to do their job properly. For example, 1 in 3 new moms report bowel and bladder issues after giving birth, and about half of all new moms have pelvic pain in the months after they’ve delivered. These problems don’t just go away on their own, and many just suffer in silence, assuming this is “the new normal.” Others take medication and get surgery to “fix” the problem. Instead of all that, we pelvic floor physical therapists use our hands 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.
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 buddies. Maybe you stopped running or taking an exercise class because you’re worried about leakage, or organ prolapse, or you go to the bathroom 26 times a day and it’s 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 are tired of being in pain, or embarrassed about your body. These problems don’t just go away on their own. Pelvic floor physical therapy is about more than just returning your bowel, bladder or sexual function, and strengthening or lengthening pelvic muscles. It’s about giving you the tools you need to reclaim your life.
From diastasis recti to pudendal neuralgia, from organ prolapse to 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 had a hysterectomy or a prostatectomy (or any other pelvic surgery), you may also greatly benefit from working with a pelvic floor PT both pre- and post-operatively to help you recover more quickly and with less complications.
I primarily specialize in pregnant and postpartum patients but also treat men and women throughout the lifespan for a range of pelvic floor issues. My patients are health conscious, ready to learn, and motivated to start their healing process.
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 after surgery (e.g. prostatectomy), painful intercourse or ejaculation, testicular or scrotal pain.
At the moment I do not accept patients under the age of 18 except on a case-by-case basis. I can provide you with referrals to pediatric pelvic floor physical therapists in NY and NJ who do so.
Initial evaluations and consultations are $225 for 60 minutes. Followup sessions are $180 for 45 minutes. This is always one-on-one time with me as a licensed doctor of physical therapy. Appointments are often only one time a week, and as your symptoms start to improve, we can drop these visits down to once every few weeks. The typical treatment time frame is 6-12 weeks: for some folks it takes less time, for others it takes a bit more, depending on the nature and severity of your condition. Those with bladder conditions often take only 4-8 weeks to see improvement, provided you are diligent in doing your assigned therapy exercises and in attending your sessions.
NOTE: The invoice you will receive (also known as a ‘superbill’) is submittable to insurance, so you can often get reimbursed for a significant portion of the cost of these visits. Contact your insurance company to find out more.
All major credit cards are accepted. Checks are also accepted and should made out to Dr. Judith Meer or to Fizio PT LLC. An invoice (also known as a ‘superbill’) will be emailed to you after every session. 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.
Unfortunately, I’ve chosen not to enter in any contracts with insurance. Why? It’s the only way I can offer you longer treatment times and 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 15 minutes with you?
In terms of getting reimbursed for your visits, I will provide you 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.
Though I have no affiliation with them, using a service like Better (see below) may also be an easy way to get reimbursed with minimal headache.
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 is out-of-network, and asking if they may be able to accommodate you for what your medical doctor has deemed a necessary treatment.
I 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/
You will be provided with an invoice (also known as a ‘superbill’) after each visit. 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, and 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.
Though I have no affiliation with them, using a service like Better (see below) may also be an easy way to get reimbursed with minimal headache.
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 and you can just call to make your appointment.
The only exception to this rule is if you have never had a gynecological exam: in that case, I do ask that you visit your gynecologist before starting physical therapy. If you are male and seeking treatment, I may ask that you consult with a proctologist or urologist prior to any internal exam of your pelvic floor muscles.
If you did get a referral, please bring it with you to your first appointment.
NOTE: though you can see your PT without a referral, some insurance companies will *only* reimburse you if you received a referral from your medical doctor. Please contact your insurance company prior to your first visit if this is a concern.
Initial evaluations are 60 minutes. Followup sessions are 45 minutes.
Please bring a list of your medications, vitamins, supplements, as well any other types of treatments you may be taking undergoing at this time. Also bring the name and contact information of your medical provider (e.g. ob-gyn, urologist, proctologist, gastroenterologist, primary care physician), and a referral if you have one. You do not need a referral to be seen for pelvic floor physical therapy unless you have never had an internal exam before. Dress in comfortable clothing that you can move in, like yoga pants and a t-shirt. Please also have a form of payment.
Getting a complete history is really important in order to understand your condition and how it has been affecting your life. So for the first part of the appointment, I will be asking a lot of questions — about treatments you may have already tried, surgeries you’ve undergone, your birth history, your toileting habits and whether it is painful to urinate, have a bowel movement, or have intercourse with a partner. I’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 more thoroughly I can understand your problem, provide an accurate diagnosis and develop your personalized treatment program for our sessions together.
After getting your history, I do a postural and musculoskeletal assessment: basically, I look 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, I conduct an external and internal pelvic floor muscle exam to check your pelvic floor muscles and identify what other factors may be contributing to the issues you’re dealing with. There are no stirrups or speculum involved, and we can stop at any time. If at any point you feel uncomfortable or in pain, let me know immediately. Though I do this work with my patients every day, I completely understand that what is a totally normal day of work for me may be a highly stressful or anxiety-provoking experience for others. My priority is to ensure that you feel as comfortable and as safe as possible throughout your visit. Pelvic floor physical therapy is only successful if we work together and communicate openly.
Afterwards, we will go over my findings, address any questions or concerns you may have, and discuss our treatment plan going forward to meet your goals.
Internal pelvic floor muscle examinations are the gold standard for understanding those pesky problems “down there.” Think about it: you wouldn’t go to a dermatologist and ask her to assess 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 do this by performing an internal exam of the vagina and/or the rectum, depending on what area we need to assess.
However, not everyone is comfortable with an internal exam, and your job is to let me know what those boundaries are so we can determine if it’s appropriate to proceed. Discomfort, pain, fear, or simply not wanting it is a perfectly acceptable reason. Just let me know. There are several conditions that can be treated successfully using external techniques if you don’t wish to have an internal exam, though in some cases we may plateau in your progress if we only do external work.
Before we do any external or internal exam, I will show you on a model of the pelvis the muscles and structures I 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. I 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 speculum involved in pelvic floor physical therapy. I’ll use clean, non-latex gloves and first observe your pelvic floor muscles externally, assessing tissue quality and health, as well as muscle 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. I am examining the strength, endurance, muscle tone, coordination, connective tissue and tissue quality of these areas. While I talk you through the entire physical exam, you will provide me feedback about any areas of discomfort, altered sensation, or limited mobility. We can stop at any time, and may not even get to the internal exam on your first visit, depending on your comfort level or our time constraints.
NOTE: if you have never had a gynecological appointment (for women), you will be asked to get one before we do any internal work. Similarly, men who have never visited a urologist or proctologist may be asked to see one before we do any internal work. I ask this because it’s important to provide you with the best, most complete care possible and there may be necessary tests or treatment to be completed by an MD before a physical therapist provides treatment. Please ask for a referral to a medical doctor should you need one.
Many people think that pelvic floor PT is all about kegels. 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 speed you along to your fitness goals while the other one just makes you sad about how you have to do laundry again, right? So, we 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 training program will help you recover much faster. But not everyone needs kegels! Sometimes the issue is tightness, not weakness. Pelvic PTs can help you figure all that out.
Yes! Low back pain, round ligament pain, sacral misalignment or sacroiliac joint dysfunction are all common conditions affecting pregnant women. While I don’t do internal exams on pregnant patients, there is so much we can still accomplish externally. We will also work on posture, core stabilization, strengthening and lengthening of your muscles, and depending your knowledge and experience, we may also discuss appropriate birthing positions and exercises that will make labor easier and more tolerable for your body. Please also be sure to tell me if you are pregnant if you’re early on in your first trimester.
Yes. 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.
Yes. Menstruation does not affect pelvic floor muscle treatment in any way and can often decrease the discomfort you may normally experience during your period. If you do not wish to have any internal work done during this time, please let me know.
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 I identify what may be an active infection when we are working together, I will stop any external or internal treatment for that day and work on other parts of the body as per your treatment plan (e.g. posture, deep core strengthening). 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 an appropriate medication.