Questions to Ask Your Pelvic Floor Physical Therapist

Pelvic floor physical therapy is one treatment option for managing the pain and symptoms of endometriosis. But, where do you even start?! As an endo warrior, you may wonder what questions to ask a pelvic floor physical therapist or what to expect at your first visit. Today, our advocates share the topics and questions they would recommend asking when considering pelvic floor PT.

From Jessica

“As an endo health coach, I often come across clients who have seen a physical therapist who isn’t specialized in pelvic floor health and pelvic pain conditions. As a result, sometimes the wrong information is provided to my clients, and they have been tightening an already tight (hypertonic) pelvic floor, leading to a worsening of symptoms!

So, my advice would be to always ensure you see a physio who is fully trained in pelvic floor health for people with vaginas and who is aware of endometriosis and the conditions it commonly presents with, such as interstitial cystitis and vaginismus. I would check whether they commonly work with similar patients and ensure they are comfortable with taking the treatment at your own pace. This is because some people may need to do more external work until they’re physically able to tolerate internal examinations. A good physio therapist should be happy to wait until you are ready and comfortable before they attempt any internal work.”

From Jessie

“I would ask a pelvic floor physical therapist whether the treatment would involve any type of pain and how invasive it is. I would also enquire whether I should attend the sessions on a particular date of my cycle, or whether I should avoid doing any physical therapy sessions on my period.”

From Keri

“I’ve seen 2 pelvic floor specialists. They’ve been so helpful that I think pelvic floor PT should be a standard part of treatment for endo. But all pelvic floor therapists are different. Some can do spinal work, and others are more geared toward teaching you exercises to do at home for tightness. It’s important to know what kind of PT you’re getting.

I'd suggest asking: Do you treat people with endometriosis often? What symptoms can pelvic floor PT help with? Can you ease my sex pain during and after intercourse and orgasm? I’ve had anxiety, depression, or trauma in my past. How does that affect my pelvic floor muscles? How often do I need to do my pelvic floor exercises at home? How do I know if I’m doing my exercises right? Will I need pelvic floor PT off and on forever? Or do I just go for a set number of sessions? What are the symptoms of pelvic floor tightness and weakness? How do I know the difference? It feels like I have to pee all the time. Can you help with that? Do you treat spinal or nerve problems? Can you do visceral manipulation for any bladder or muscular problems? Do you know how nerves from the spine affect the pelvic floor? How do tight muscles cause pain near my ovaries? How will I know if pelvic floor PT is helping?”

From Kimerbli

“Pelvic floor therapy is something I have been wanting to give a try but have been scared to. My biggest concern is: Will it make my symptoms and pain worse? Because everyone of us is different and also have different illnesses we may be dealing with – do they take that into consideration? Another important question is insurance. Does my insurance cover it – all of it? If not, how much would it be to go? I think a few other topics that would be important to ask are what illnesses are they familiar with? Are they actually familiar with endometriosis? What about adenomyosis or interstitial cystitis? How many people have they worked with that have any of those illnesses? Is there a chance some of the exercises or moves can cause more inflammation and make things worse?”

From Laura

"I would ask how PFT could help me with cramping and correlated GI upset and irritable bladder. I would also be interested in the way PFT could potentially benefit low back/sacral pain and hip pain. I think those with endo should consider all symptoms and issues impacting their pelvic area and ask how PFT could either benefit or otherwise impact those areas (low spine, hips, GI, bladder, etc).

I would also perhaps also make sure to get fully tested/examined and rule out other issues before coming up with a treatment, such as a pelvic exam, a pelvic ultrasound, urodynamics testing, and a cystoscopy. I once visited a urogynecologist's office when I was having a lot of bladder issues (pain, frequency, sometimes leaking) and without a thorough exam, they ruled I had a weak pelvic floor. They told me to do 50 kegel exercises a day. My issues then went from bad to way worse. I went to get a second opinion, and the second PF specialist ordered testing and determined I had a spastic bladder and my pelvic floor was in constant spasm. Rather than strengthening exercises, which exacerbated the problem, the PFT I received then focused on relaxing my PF muscles, which in turn, led to significant relief and improvement."