Pelvic Floor Physical and Occupational Therapy In Berkeley, CA

When first starting pelvic floor therapy, you can expect an initial evaluation with one of our physical and occupational therapistss. Your first appointment will be used primarily to collect information about your symptoms, medical history, prior diagnoses, and the treatments that have been attempted to resolve these issues. The pelvic floor specialist will then review their findings with you to create an individualized treatment plan.

While it is unrealistic to expect a total examination in one day, we do cover essential areas to collect necessary information before starting your physical and occupational therapy regimen. Your exam will include visual observation of your posture, movement patterns, and alignment, concluding with a manual examination of external structures. Common areas we observe during the initial evaluation are the inner thighs, abdomen, buttocks, and bony pelvis. When examining these areas, our specialists look for connective tissue restrictions, tight muscles, myofascial trigger points, joint dysfunction, imbalances from one side to the other, and other impairments surrounding your dysfunction/pain.

While conducting the internal pelvic floor examination, our experts are observing your trigger points, muscle tone, strength, and motor control. Some of the main symptoms that we look for are pelvic organ prolapse, dermatologic variations, skin lesions, and diastasis recti ( separating of organs in the midsection of your abdomen). We also screen patients for irritability of the peripheral nerves that are located in the pelvis along with the integrity of vaginal and anal tissue. Throughout the evaluation, short-term and long-term goals are written down for the patient to reach. Depending on the severity of your dysfunction, physical and occupational therapy treatments may last a few weeks, months, or longer. Our pelvic Berkeley pelvic floor specialists apply short-term goals to improve the consistency of progress while working towards the patient’s primary resolution. After the appointment has concluded and the patient is dressed, we review findings to help individuals understand their symptoms and how we can rehabilitate the issue(s). This also allows us to cooperate with any other medical providers in your healthcare team for truly comprehensive care.

During pelvic floor therapy treatments, our specialists will often use manual therapy techniques, including neuromuscular re-education, joint mobilizations, neural mobilizations, connective tissue manipulation, and internal/external trigger point release, based on the individual’s needs at that time. Treatments primarily encompass the pelvic floor muscles and girdle, but daily postures, behaviors, movements, and breathing patterns are incorporated as required. An example of this would be spending time with patients who frequently have constipation to inform them of the cause and help them address their impairment, as well as at-home techniques for improving their condition. Certain individuals may need a heavier focus on manual therapies, while others will need more assistance with neuromuscular control. Generally speaking, manual therapy is often part of a treatment session for people with pelvic pain whereas coordination and strengthening may be more involved in post-operative rehabilitation or for people with low-tone pelvic floor disorders. However, “hybrid” situations do exist and are treated accordingly.

Each treatment session is customized to benefit the needs of our patients and provide the clearest path to recovery. Our specialists hone in on the primary factors that are contributing to your limitations. This means that one treatment may incorporate more manual therapy while the next treatment may be focused on re-training your habits, postures, and movements. Typically, each treatment session requires some internal manual therapy or manual biofeedback since these conditions almost always produce some form of pelvic floor dysfunction and this is the best way to understand how your pelvic floor muscles are working.

Near the end of each appointment, we review what the patient is working on at home, why these are the areas of focus, and we may add new exercises or changes to their home program.

Your initial consultation with PHRC will begin with an evaluation, which our specialists use to conduct the patient interview. During this interview, we seek to better our understanding of your medical history and why you are seeking treatment with a pelvic specialist. The interview portion helps us gather background data, helps us understand the impact the problem has had on the patient’s life and their understanding of pelvic floor dysfunction. The interview also allows us to gain the necessary information to know the most essential areas of the body to evaluate as it is impossible to examine the entire person on day 1. The examination consists of a visual exam looking at posture, alignment, and movement patterns followed by a manual evaluation of the external structures. Typical areas of the body we palpate include the abdomen, inner thighs, bony pelvis (i.e. sit bones, pubic bones, hip bones, etc.), and buttocks. We are looking for myofascial trigger points, tight muscles, connective tissue restrictions, joint dysfunction, imbalances from side to side, and other impairments around the areas of pain/dysfunction. During the internal pelvic floor muscle exam, we are evaluating for muscle tone, trigger points, strength, and motor control. We examine for diastasis recti, pelvic organ prolapse, skin lesions, and dermatologic changes. Additionally, we are screening for irritability in the peripheral nerves of the pelvis, and vaginal and anal tissue integrity. Throughout the evaluation, short-term and long-term goals are written down for the patient to reach. Typically the duration of a physical and occupational therapy treatment plan can last between a few weeks to several months, or longer, depending on the severity of the situation. By using short-term, incremental goals as a focus during treatments, we are able to work towards achieving patient’s larger aspirations and their complete health. After pelvic floor physical and occupational therapy sessions have ended and you have had time to redress, your PT will discuss their findings. By ensuring that our patients understand findings and the proper course of action, we can create an accurate plan of action for addressing symptoms and collaborating with other medical providers you may be working with.

Every individual can benefit from pelvic floor therapy but there are highlighted symptoms that should spark extra interest. Anyone who is experiencing the following symptoms is recommended to schedule a pelvic therapy evaluation with our experts:

-male pelvic pain (Chronic Pelvic Pain Syndrome/male pelvic pain, Nonbacterial chronic prostatitis, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Tailbone pain/coccygodynia, Sacral pain, Abdominal and groin pain, Testicular pain, Perineal pain, Penile pain, Anal/rectal pain, Post-ejaculatory pain)

-female pelvic pain (Vulvodynia/Vestibulodynia, Interstitial Cystitis/Painful Bladder Syndrome, Pudendal Neuralgia, Endometriosis, Clitoral pain, Tailbone pain/coccygodynia, Abdominal pain, Sacral pain, Anal/rectal pain, Dyspareunia/pain with intercourse)

-bowel dysfunction (Constipation, Hemorrhoids/fissures, Difficulty evacuating, Dyschezia/painful bowel movements, Fecal Incontinence, Anal pain, anal burning, Pelvic Organ Prolapse)

-bladder dysfunction (Stress Urinary Incontinence, Urge Urinary Incontinence, Post-prostatectomy urinary incontinence, urinary urgency/frequency, dysuria, retention, hesitancy, nocturia, Associated pelvic pain diagnoses: Interstitial Cystitis, Chronic Pelvic Pain Syndrome/male pelvic pain, Pelvic Organ Prolapse)

-currently pregnant or postpartum

-going through post-surgical rehab (Pelvic reconstruction, Pudendal Nerve Decompression, Gender affirmation procedures, Laparotomy/laparoscopy, Prostatectomy, Cesarean section, Vestibulectomy, Hernia Repair)

-Pelvic Organ Prolapse

The initial evaluation will be one hour long, like every following appointment you will attend. Following the completion of your consultation session, appointments will start with your physical and occupational therapists answering questions you may have come across since your last visit. Once your questions have been addressed, your symptoms will be reviewed as well as any alterations you have made to your daily regimens, exercise patterns, or habits to track their impact on your progress.

The physical and occupational therapists will often have specific inquiries about current symptoms. For example, if the person has pain with urination, we will ask detailed questions about the nature of the pain, intensity, how long it lasted and if the treatment or exercise provided relief. The answers to these questions help us decide what to tackle during each session.

Manual therapy techniques including trigger point release externally, trigger point release internally, joint mobilizations, neuromuscular re-education, neural mobilizations, and connective tissue manipulation may be used in typical pelvic floor therapy sessions. Our specialists devote most effort towards the muscles in the pelvic floor and girdle, but also include movements, daily postures, breathing patterns, and behaviors to support well-rounded patient health.

For instance, if a patient has constipation, we will spend time teaching them why bowel movements are difficult for them, how we will help address the impairments, and what they can do at home to help. Some people will need more help with neuromuscular control and some people may benefit more from manual therapy. Generally speaking, manual therapy is often part of a treatment session for people with pelvic pain whereas coordination and strengthening may be more involved in post-operative rehabilitation or for people with low-tone pelvic floor disorders. However, “hybrid” situations do exist and are treated accordingly.

Pelvic Health Rehabilitation Center creates each treatment plan according to the patient’s needs and what will serve their best interest. Our specialists begin by evaluating the information given during your evaluation to formulate the best physical and occupational therapy regimen for your situation, working intelligently to resolve factors that are causing limited function or pain. This entails flexible treatments, which may result in manual therapy techniques during one session and a totally different treatment the next week, where we may focus on postures and movements or re-training habits. Manual biofeedback or internal manual therapy is usually part of each treatment session because they offer a window into the state of your pelvic floor muscles, which helps us treat the dysfunction.

To conclude your pelvic floor physical and occupational therapy session, we will discuss your at-home regimen, why we are devoting effort to that focus area, and integrate additional exercises as required in your home routine. As previously mentioned, the patient is a key player in the road to recovery so the things they do at home are just as important as the time they spend in the clinic.