WHAT HAPPENS AT YOUR INITIAL EVALUATION FOR PELVIC FLOOR DYSFUNCTION (PFD)

EMH Physical Therapy is optimized for your comfort along your healing journey. When you arrive, you’ll be welcomed with calming music, fragrant aromatherapy of essential oils and our warm, expert office staff in our light filled reception area.  Our spacious nature-designed treatment rooms affords full privacy during your individualized session with your DPT (Doctor of Physical Therapy). Our gym is in a light filled  greenhouse glass space with a beautiful NYC skyline view. We feature the new Pilates equipment, Guillotine Tower, that is excellent for exercising the deep pelvic/hip/core muscles.

Our DPT Staff is well versed in their professional knowledge of pelvic and orthopedic therapies and all have a gentle, caring, healing energy. We listen to you, take time to educate and answer questions and tailor your treatment program every step of the way for your optimum  healing and function.

At EMH Physical Therapy, you will be seen by the same licensed DPT at the  Initial Evaluation (one hour)  and at each follow up  treatment session ( 45+ minutes).  Your DPT is with you and only you during your session.  Many traditional  practices have staff PT’s treating 3 to 4 patients simultaneously in an open gym like setting and treatments can be administered by non licensed Aides or licensed PT Assistants. Not at our practice.  Having the same DPT overseeing your care from start to successful discharge, facilitates trust and improves your DPT to adjust treatment as you change so you achieve your goals more efficiently.  All patients are  closely monitored by the President of the practice, Evelyn Hecht, PT, ATC, who actively guides her staff so you receive the  best treatment possible.

The Initial Evaluation is time set aside so you and your licensed DPT can discuss, learn, share information, do tests and measurements, hear treatment solutions and plan for your full recovery.  It includes the following: History, Education, Physical Examination, Discussion of Findings, Instruction in Relief Technique, Scheduling Follow up Treatments. See below following our Conditions Treated for details of Initial Evaluation Steps.

What is Pelvic Floor Dysfunction (PFD)

PFD is a term used to describe pain and disruption of bladder, bowel &/or sexual function due to restrictions of the muscles and nerves of the pelvis.

The pelvis is a bowl-shaped bony structure which holds the organs of digestion, elimination (bladder & bowel) and sexual function. The pelvic floor muscles (PFM) are located at bottom of the bowl, attaching like a hammock from the front pubis to the back coccyx bones. The PFM supports the viscera, maintains continence (bladder and fecal), assists in core/trunk stability and enhances sexual function. The pudendal nerve and its branches also travel through the PFM.

What happens at my first visit?

1) HISTORY

The Initial Evaluation first involves a detailed history/discussion of all your symptoms related to the pelvic floor.  Your DPT will listen to your main concerns. then will ask questions about specific complaints of lower back pain; hip pain; abdominal pain/bloating; surgeries that may have resulted in increased scar tissue/adhesions.  Questions will be asked about bladder symptoms such as leaking, urgency, “key in lock”, hesitancy. Questions about bowel symptoms such as constipation, fecal incontinence  manual disimpaction; if you spend more than 5 minutes straining on the toilet.  Questions about sexual symptoms such as painful intercourse, erectile dysfunction, perineal pain, fear of penetration and difficulty with orgasm.   It very common that patients may be referred to PT with one  pelvic floor diagnosis, and during our history taking, we realize that there are some other pelvic floor symptoms.  For example, a woman may have a diagnosis of “Stress Urinary Incontinence” and we discover there is a concurrent symptoms of constipation and dysparuenia.

2) EDUCATION

After our detailed history taking and answering your questions, your DPT will educate you on anatomy of the pelvic bones and muscles using our anatomical model. This helps you visualize and understand the structures your DPT will be examining.  We believe that education is empowering, so we spend time to review the anatomy, review the purpose and step by step of our pelvic floor physical examination.   When you are ready to commence with the physical examination, we will ask for your permission.   We understand the need for privacy, comfort, respect and patient’s involvement in their return to full pelvic floor health.

3) EXAMINATION

You will be comfortably positioned and draped before your DPT visually inspects the external pelvic region for skin color, tissue alignment while at rest.  After the visual inspection, your DPT will ask you to perform some pelvic floor movements,.  Such as asking you to contract or tighten your pelvic floor (sometimes known as “Kegel”). Then your DPT will ask you to relax the pelvic floor, observing the quality of the movement, then to “bear down” .  Your DPT  observes the excursion, hestitancy or inability to perform these movements.  Many patients may not know how to do one or all of these movements and this is a common response especially when the pelvic floor muscles are in spasm, or weak or uncoordinated.  Next, your DPT will palpate or feel the skin, connective tissues and muscles of the external hip, thigh, abdomen and pelvic floor regions to note for  pain, mobility, restrictions, banding, referred pain to other regions.

With your permission, the internal exam follows.  The internal exam is where the DPT inserts her gloved (non latex), lubricated  (K-Y or astroglide gel) index finger intravaginally or intrarectally up to the level of the pelvic floor muscles, which is approximately 1 inch from the anal or vaginal opening.  Your DPT will palpate or feel for tissue excursion, if one side is more flexible vs the other side,  again noting pain, adhesions, trigger points and if her palpation over specific muscles reproduces your symptoms (a good sign).

Muscle strength testing of the pelvic floor follows with the DPT’s index finger remaining internally to feel for quality of muscle contraction.  Your DPT will  measure how strong your pelvic  floor muscles are, how long can your muscle maintain that strong contraction up to 10 seconds and can this be repeated up to 10 repetitions.

Biofeedback testing may be next. “Bio” means body and “Feedback” means receiving information about a physiological activity. Biofeedback measures the electrical activity of the muscle and transmit that information to either a range of numbers and/or sounds.  The patient sees the numbers and learns how to retrain their pelvic floor muscles with the guidance of the physical therapist.  Your DPT will either insert either a vaginal sensor (width and length of a female index finger) intravaginally  or use a rectal sensor (width and length of a female pinky finger) which is inserted intrarectally slowly, and with concious use of breath. The internal sensors have small metal strips to pick up the electrical activity of your pelvic floor muscles.   For children/teenagers patients, we do not use internal sensor, rather small round surface electrodes are placed externally on the skin near the anus for most accurate reading of pelvic floor muscle activity.   Your DPT  will  measure the electric voltage (microvolts) that your pelvic floor muscles elicits  during rest, during slight contraction, during  full contractios. We will measure if your muscle  returns to full baseline rest following contractions, whether your muscles have good  endurance etc.  Biofeedback training is utilized during follow up physical therapy treatments to help you learn how to either relax or  recruit your pelvic muscles and regain normal function.

4) DISCUSSION OF FINDINGS

DPT’s are specifically educated (7 -8 years in total education from college to a 3 year DPT program at accredited university)  to examine all the musculoskeletal, neurological aspects relating to pain, movement patterns and we’ve learned wide range of therapies to correct these dysfunctions.   We’ll discuss our finding and tests results with you and discuss our treatment plan for your optimum return to healthy pelvic floor/core.  Treatment can include manual techniques such as myofascial release, visceral mobilization, connective tissue massage (skin rolling), trigger point massage. These techniques release intramuscular tension, mobilize the nerves,  improve mobility of connective tissue, and improve the mobility of organs that lie beneath the skin and muscles.   We will also teach you a tailored therapeutic exercise routine to improve flexibility, strength, balance and coordination.

5) INSTRUCTION IN PELVIC FLOOR RELIEF TECHNIQUE

You will be taught a specific posture, body awareness technique, self-massage, or given a stretch so you can immediately incorporate all that you have learned in the Initial Evaluation and start on your road to recovery.

6) SCHEDULING FOLLOW UP TREATMENT

Your DPT will guide you on  the best frequency of treatment.  After 17 years of healing thousands of patients, it is our experience that consistent weekly therapy treatments along with our patients performing their tailored home exercise program results in faster gains in their return to pain free normal function.   Skin, connective tissue, muscles and joints that have been in faulty movement patterns for weeks, months and years (we see many patients with 10 to 20 years of pelvic floor symptoms) requires time to reduce spasm, adhesions, restrictions and require regular, gentle manual guidance by our trained hands to reverse these patterns.  It is common for our patients to “clear their busy schedules” to attend PT 2=3 times a week consistently for the first month or so of care.  With our regular scheduled re testing, we will guide you on when you can lower your frequency of care and be more independent.

Whether you’ve experienced symptoms for two months or 20 years, we can help you find relief, decrease pain, and return to normal function.

Conditions treated:

Women

  • Painful intercourse (Dyspareunia)
  • Provoked/Unprovoked Vaginal/Vulvar Pain (Vulvodynia)
  • Vestibulodynia (Provoked/Unprovoked Pain at the Vestibule)
  • PGAD (Persistent Genital Arousal Disorder)
  • Urinary Urgency
  • Endometriosis
  • Interstitial Cystitis
  • Pelvic Organ Prolapse
  • Urinary/Fecal Incontinence
  • Diastasis Recti Abdominis, DRA (Pre/Postpartum)
  • Gastrointestinal pain
  • Abdominal Bloating
  • Low back pain
  • Hip pain
  • Chronic Pelvic Pain
  • Coccyx/Tailbone Pain
  • Osteitis Pubis (Pubic Bone Pain)
  • Constipation
  • Irritable Bowel Syndrome (IBS)
  • Pudendal Neuralgia
  • Sexual Dysfunction
  • Core Weakness
  • Post Cancer Surgery Recovery
  • Post Hysterectomy Recovery

Men

  • Chronic Prostatitis
  • Post Prostatectomy Recovery
  • Erectile Dysfunction
  • Testicular Pain
  • Penile Pain
  • Incomplete Voiding (Bladder)
  • Constipation
  • Abdominal Bloating
  • Rectal and/or abdominal pain/pressure
  • Irritable Bowel Syndrome (IBS)
  • Chronic Pelvic Pain
  • Pudendal Neuralgia
  • Sexual Dysfunction
  • Rectum/Anal pain
  • Prolapse (Rectum)
  • Interstitial Cystitis
  • Urinary Urgency
  • Urinary/Fecal Incontinence
  • Post Cancer Recovery
  • Core weakness

Children

  • Bedwetting
  • Constipation
  • Daytime Urinary/Fecal Accidents

CALL TODAY:

(212)288-2242 or email info@emhphysicaltherapy.com to schedule a PT appointment or ask a question to our director, EVELYN HECHT, PT, ATC


FOR MORE INFORMATION, PLEASE SEE:

Pelvic Floor Home          How Physical Therapy Treats PFD          EMH PDF Treatment          Pelvic Track App