A pelvic physical therapist is a physical therapist specialized in the pelvic field. To become specialized in that field, an extra three year study is required after a physical therapist has completed their four year education in physiotherapy. The pelvic physical therapist is a real specialist when it comes to pelvic instability, pelvic pain, and other pelvic issues like urinal incontinence, fecal incontinence, a weakened pelvic floor, an overactive pelvic floor, and an organic prolapse. Every muscle surrounding the pelvic girdle isn’t unknown territory to the pelvic physical therapist either. Pelvic pain that’s located in the groin, lower back, stomach, or genitalia can be treated by a pelvic physical therapist as well. It’s not just women that experience pelvic pain or pelvic instability, but men and children can be seen by a pelvic physical therapist as well. 

In this article I am mainly going to talk about the pelvic physical therapist. This is the most common profession when it comes to pelvic therapists, but you can also go to a pelvic exercise therapist, for example. You can also find pelvic floor trainers. There are lots of specialists when it comes to the pelvis. Look at where you’re most comfortable to work on your recovery. Otherwise, have a read through my article that talks about the different specialists. 

Should you still want more tips, advice or information after this, feel free to take a look on the website. I have lots of content! It’s filled with in-depth information, tips a webshop and also exercises too. 

Let us first break down the different types of pelvic therapists. 

What’s the difference between a pelvic physical therapist and a pelvic exercise therapist? 

The biggest difference between a pelvic physical therapist and a pelvic exercise therapist depends on what they focus on. A pelvic physical therapist will focus more on the training of the pelvic floor. The pelvic physical therapists are specialized in training the muscles, and in terms the pelvic floor too. A pelvic exercise therapist will focus more on your daily life and how you can manage specific actions so you experience as little pelvic pain as possible. Both therapists can be valuable to you, but the most important matter is that you have a good feeling about a specific way of treatment. Try out two sessions with a pelvic exercise therapist, and two sessions with a pelvic physical therapist. Like that you will discover what is most suitable for you, but both pelvic specialists are a good bet. 

You can expect somewhat the same thing with every pelvic therapist. They probably won’t be very happy to hear about that fact, but it’s still the truth. Whether it’s about a pelvic physical therapist or a pelvic exercise therapist, you can go to both when you experience pelvic girdle pain, pelvic issues or pelvic instability. Every pelvic therapist focuses on treating your pain – whether it’s in the pelvis or around it. They can also give you preventive advice. You can also visit the pelvic physical therapist before you even experience pelvic instability or pelvic pain. You can gain information that way and at the same time you are trying to prevent severe pelvic pain. You can also already do pelvic floor exercises. For that you can take a look at my pelvic floor exercises page or visit the Pelvic Store. You can find a lot of suitable exercises here. With that, you prevent your pelvic issues from becoming worse. 

The difference between a normal physical therapist and a pelvic physical therapist 

A pelvic therapist, like a pelvic physical therapist or a pelvic exercise therapist, is a fully recognized specialization. That means that these therapists are real specialist. To earn this title, graduated therapists need to go back into the study books for three more years. These are the ideal aid workers for when you experience pelvic issues. After getting this title, the pelvic therapist is also qualified to do internal examinations. They possess a variety of tools to be able to train or measure your pelvic floor strength. Check with your health insurance if those treatments are being covered at all, either with or without additional coverage. 

I know it doesn’t sound all too fantastic, but sometimes internal examination is necessary to be able to verify your issues. You always have the freedom to refuse, of course. An internal examination can measure the strength in your pelvic muscles. For the rest, there are options to use tools and equipment like: rectal balloon training, myofeedback, and electrical simulations. 

You can always walk into the office of a pelvic physical therapist or a pelvic exercise therapist, or, you can first go to your doctor to discuss your issues. Your doctor might refer you to a urologist, gynecologist, or sexologist. You can always get referred to a pelvic physical therapist or pelvic exercise therapist from a specialized doctor. 

What does a pelvic physical therapist do? 

Together with you, a pelvic physical therapist will look for the cause and solution for your pelvic pain. This treatment will start off with an extensive intake – we call this the anamnesis. You will get a lot of questions during this talk because the pelvic physical therapist wants to get a good image of your pelvic pain and will also check off some red flags. This is to find out if you are at the right pelvic physical therapist. Because of that, the first session will fully consist out of a conversation and maybe some physical examinations. 

The second session at the pelvic physical therapist will mainly consist out of physical examinations. This doesn’t mean that the physical therapist will constantly touch you, but they will observe and watch a lot whilst you perform a set of actions. The pelvic physical therapist will also apply pressure here and there, to see when and where you experience pain in the pelvic girdle. This can be vaginally when the pelvic pain causes vaginal pain, but this can also be anally if the pelvic pain causes anal issues. You can always tell the physical therapist that you’re not comfortable with it, but rest assured, the pelvic physical therapist is a real specialist and does this on the daily. 

After the first two sessions the pelvic physical therapist will have an idea about the severity and variety of your pelvic pain and pelvic girdle issues and a treatment plan will be made. In the treatment plan will be written what will happen and how long the treatment will approximately be. The treatment plan will give you a bit of an indication of things, you can agree with the plan or look further for a more suitable option. Not all pelvic physical therapists are the same. With some you’ll have a better treatment plan or a better connection than with the other. It’s about YOUR recovery, so think it through. 

Training the pelvic floor at a pelvic physical therapist 

The training will begin once you have agreed to the treatment plan. If your pelvic floor is weakened, your pelvic treatment will mainly consist out of a pelvic floor training. The muscles need to be strengthened. You’ll be at the right address with a pelvic physical therapist. 

Relaxing the pelvic floor at a pelvic physical therapist 

If your pelvic floor is too overactive and too tense, the treatment plan will mainly focus on relaxing. Relaxing your pelvic floor is a central point here, and you’ll learn how to relax and get control over your pelvic floor. A pelvic physical therapist is also very suitable for this matter. 

Furthermore, you can struggle with a prolapse or different types of incontinence. Depending on the right actions taken, you’ll train your pelvic floor, or learn how to relax. 

The costs of a pelvic treatment at a pelvic physical therapist 

The costs of a pelvic treatment at a specialized pelvic physical therapist are between the 60 – 90 dollars per half an hour, but this can vary strongly depending on the experience of the pelvic physical therapist and on the treatment you are getting, as some treatments can even cost around a few thousand dollars altogether. It’s important you check the fees with every office. After having done a lot of courses throughout the year, a therapist is allowed to increase their hourly fee. But experience doesn’t say it all, of course. A less experienced pelvic physical therapist did study for the latest and newest developments regarding the pelvic girdle. But what’s of most importance is the connection between you and your pelvic physical therapist. 

Does insurance cover pelvic treatment at a pelvic physical therapist? 

Most pelvic treatments are covered by private and government insurance, but the coverage can vary on your insurance and by state or country, and often a medically necessary referral is needed. Some insurances work with an annual cap of coverage, and some insurances work with an X amount of sessions that you will get covered. To make sure that your treatments will get covered, inform with your health insurer and take a good look at your insurance policy.  

How many treatments are needed for your pelvic pain? 

This really depends on the severity of your pelvic pain or pelvic issues. You can expect an average amount of 9-15 treatments. The first two sessions are already lost to an anamnesis and an examination, so 7 is the minimum. But discuss the amount of treatments you can have, coverage wise. The pelvic physical therapist will then keep this in mind and will perhaps even give some exercises you can do at home. 

How many treatments are needed for your pelvic instability? 

It takes about 2-4 months for you to recover from pelvic instability, though it’s an important matter that you’re being seen by a pelvic physical therapist for pelvic treatment to help you through this period. The pelvic floor exercises will also make you more aware. You can expect that you will need about 9 to 20 treatments, but this really depends on your needs and on your health insurance. Again, discuss the amount of treatments you can financially have with your pelvic physical therapist. They will keep your situation in mind and will adjust the treatments to it. Do a lot of work at home and inform yourself by reading about your condition and how to help it. Also have a read through the FAQ and answer those for yourself before you go to a pelvic physical therapist. 

What will a pelvic physical therapist ask? 

When you visit a pelvic physical therapist, you will get a grocery list of questions. 

These are the most frequently asked questions from a pelvic physical therapist when you first meet: 

• • Since when do you have the pelvic issues? 
  • How did they get caused? 
  • On which moments do you have those issues? 
  • Did pelvic instability get diagnosed or do you suspect you have it? 
  • Do you experience pelvic pain when you move? 
  • Do you experience pelvic pain when you rest? And especially when you are lying or sitting? How much do you suffer from your pelvic instability? 
  • If you’d give a score to your pelvic pain from 0, being no pain, to 10, being unbearable pain, what would it be? 
  • Since when do you have pelvic instability? 
  • When are you experiencing pelvic issues from your pelvic instability? 
  • What effect does the pelvic pain or pelvic issues have on your daily life? 
  • Are you perhaps pregnant? Or going into menopause? 
  • How is your menstruation cycle? 
  • Are you still working? How do you experience working with your pelvic instability? 
  • Is the pelvic pain the worst in the morning or at night? 
  • Do you experience more or less pelvic pain after exercise or moving? 
  • Do you exercise or practice a sport? 
  • Do you experience difficulties with going to the toilet? 

There will also be a lot of questions about a variety of organs because a lot of organs are in and around the pelvic girdle, for example the bladder, intestines, prostrate and uterus. Topics like menstruation, sexuality, toileting, childbirth, urinal pattern and the menopause will be talked about as well. For the rest it’s common to have to log a urinating dairy. You can already do this beforehand. The pelvic therapist will quickly see a pattern and if needs be, already come up with a treatment goal.  

Examinations you can expect at the pelvic physical therapist 

If you get referred to a pelvic physical therapist, then I can imagine you’ve already gone through some examinations. The pelvic physical therapist or pelvic exercise therapist will also examine you. Do tell them what you are or aren’t comfortable with, this is necessary because these therapists contain a lot of expertise. These therapists can discover new things, for example. But you won’t be immediately examined during your first meeting. The first appointment will mainly consist out of an intake. During this intake you will have to answer a lot of questions so the pelvic physical therapist can get a good understanding of your situation. A lot of questions will be asked about your issues, for example incontinence issues. Keeping a urinating dairy will also be recommended, and I can recommend you to already start doing it, a week before you start seeing your pelvic physical therapist of pelvic exercise therapist, if needs be. I call it a urinating dairy, but it can also be a stool dairy. 

During the second appointment the physical therapist will have a good image of your pelvic issues, but a physical examination will happen. You’ll need to do a variety of actions. An internal examination can also be done if you don’t have issues with it. This will give the physical therapist an even better image of your pelvic issues. After the examinations, the pelvic physical therapist will put together a treatment plan, in which will be noted what will be needed for your recovery.

What is an internal examination with pelvic pain or pelvic instability? 

What internal examination you will get depends on your specific issues. An internal examination can be done anally or vaginally. Anally happens a lot with issues of stool loss or not being able to hold back farts and ‘breezes’. For a male, the anus is very often the only possible opening for examination, for some this can be very shocking. For women it’s possible to have it done anally and vaginally. Vaginally is being done with issues like urinal incontinence, sexual issues, or eventual suspected prolapses. An internal examination can go hand-in-hand with a myofeedback examination. 

An internal vaginal or anal examination is being done to test the pelvic floor muscles. This is to establish if your pelvic floor muscles are too tight and with that too strong or too active. Or, if your pelvic floor muscles are too limp or loose which means that they’re too passive. 

What to expect during an internal vaginal examination 

An internal vaginal examination will be done in a lying or half-seated position. The first thing a pelvic physical therapist will ask during the examination is to tense up and relax the vaginal muscles. For the rest they will ask you to do some spontaneous actions, for example laughing or coughing. Some squeezing needs to be done as well. With those actions, the pelvic physical therapist or pelvic exercise therapist can have a good feel of the reactions of the pelvic floor muscles. These are also actions that increase the abdominal pressure. The abdominal pressure needs to be caught by the pelvic floor. If this isn’t the case, you have the possibility that the increased abdominal pressure gives extra pressure on the bladder, and if the pelvic floor muscles can’t catch that pressure you can experience urinal incontinence. 

The pelvic physical therapist will also inspect the labia for scar tissue. The vaginal opening will be examined more and the inside muscles will be tested. For the rest it’s important to feel if the vagina is tense or relaxed. Pay attention to any pain you could experience, and if you do, tell the therapist. 

What to expect during an internal anal examination 

With this examination, you can lay on your side, preferably relaxed. You can also lay on your back, but on your side is often more comfortable. Your rear also needs to be a bit spread apart. The pelvic physical therapist can do this themselves, but you can also be asked to give a hand. The physical therapist will first observe and also ask you to relax and tense up your anus. After that, the feeling will start. First the anus and the circular muscle will be looked at and then felt. An internal examination will follow. First the anus and the circular muscle will be examined, and after that the deeper layers in the anus and the pelvic floor. While the pelvic physical therapist or the pelvic exercise therapist examine, you’ll be consistently asked to relax and tense up your anus. Let them know when you experience pain, and the therapist will stop. 

During having an internal feel of your muscles, the pelvic physical therapist will have a good idea of the strength of your sphincter. You will also be asked to tense up your anus in different ways. Through this method it will be made clear what your problem exactly is. 

Normally, the internal examinations are painless, but do let your therapist immediately know if you do experience pain. The pelvic physical therapist and pelvic exercise therapist will guide you through the examinations. An internal examination by hand isn’t the only way, there are also balloon examinations or myofeedback examinations. Internal examination can be the first step in the exam phase. 

What to expect from a treatment from a pelvic physical therapist 

When all the examinations have passed, a treatment plan will be put together. This plan is fully adjusted to your issues and especially your goals and what you want to be able to do again. Now the treatment can finally start. 

A part of the treatment will always consist out of explanations. This can consist out of information about your issues, the functions and the meaning of your pelvic girdle, your toilet pattern, hygiene, food and drink patterns, the overall load and load capacity. The load and load capacity mainly have to do with when to add a resting moment and taking a resting moment after exercise. 

The following points are central during pelvic treatment: 

• • The tensing up and relaxing of the pelvic floor muscles and the other muscles in and around the pelvis. 
  • The exercising and learning how to control the muscles in and around the pelvis, pelvic floor, back and abdomen. 
  • The stabilizing and learning how to move with the newly gained information about the pelvis. 
  • Applying the learned exercises and given advises to your daily life. Daily movements will be simulated to see how you cope with the advises given, especially for repeated movements. Think about ducking, lifting, standing up and taking a seat. Those are movements that are burdening for your pelvic girdle. 

The most important thing is that you feel comfortable around your pelvic physical therapist. Look for someone you feel good with. It are some intimate matters after all. 

And lastly, are you looking for more information? 

Hopefully this information was useful to you! We’ve discussed multiple topics like the differences between a pelvic physical therapist and a pelvic exercise therapist, what those therapists do, the coverages, the treatments, the FAQ, and the examinations, and the points of focus during treatment. If you’re still looking for some more information, feel free to take another look around on the website. It’s filled with in-depth information, tips, a web shop and also exercises. I still have a lot of articles with lots of information about other symptoms and issues. Feel free to click on the blue words to take you straight to the right page.