Programmes and populations
Pelvic floor physical therapy
Leaking, pelvic pain, and recovery after childbirth or prostate surgery. Treated in a private room, by one clinician, with the door closed and nothing happening you have not agreed to.
Most people who come here for this have had the problem for years before mentioning it to anybody, and a fair number were told at some point that it was a normal consequence of childbirth or of getting older. Common is not the same as normal, and neither is the same as untreatable.
Supervised pelvic floor muscle training has strong evidence for stress incontinence in particular, and the operative word is supervised — the commonest reason it fails is that it is being done wrong and nobody has checked.
What the appointment involves, before you book
The first appointment is a conversation and an explanation. Nothing is examined that you have not agreed to, the reason for any part of the examination is explained before it happens rather than during, and you can decline any of it and still be treated.
It happens in a private room with the door closed. No student observes unless you have said yes, and you may bring somebody with you.
An internal assessment is the most accurate way to establish what the muscles are actually doing, and it is a choice rather than a requirement. There is useful work to be done either way and we will tell you honestly what we can and cannot establish without it.
Why doing it wrong is so common
A substantial proportion of people given pelvic floor exercises on a leaflet perform them incorrectly — bearing down instead of lifting, or recruiting the wrong muscles entirely. Done that way, the exercise is at best useless and can make some presentations worse.
It is not a failure of effort. The contraction is invisible, there is no obvious feedback, and checking it is precisely what a clinician is for. That is the single biggest thing this service adds over a printed sheet.
The range of what arrives here
Stress incontinence — leaking with cough, sneeze, laughing or exercise — which responds well to supervised training, and is the presentation with the strongest evidence base.
Urgency and frequency, where bladder retraining is as much of the answer as muscle work.
Pelvic pain, where the muscles are frequently overactive rather than weak, and where strengthening is exactly the wrong treatment. This is a common and consequential misdiagnosis.
Postnatal recovery, including abdominal separation, and a return to running or lifting done properly.
And recovery after prostate surgery, where pre-operative training measurably improves continence outcomes afterwards — which is worth knowing while an operation is still in the future.
What is not ours
Prolapse needing surgical assessment, recurrent infection, blood, pain with a red flag, or anything that has not been medically assessed and should be. We will say so and refer.
Physical therapy is not a substitute for a gynaecological or urological opinion, and where you need one we would rather you had it first.
Only a licensed therapist may evaluate you or change your plan. A licensed physical therapist evaluates you, writes your programme and changes it. A physical therapist assistant may carry out that programme under on-site supervision but is barred by law from evaluating you, interpreting anything or altering the plan. A physical therapy aide is unlicensed and may not provide physical therapy at all — an aide books appointments and cleans equipment. If you have ever been handed to somebody in a polo shirt who counted your repetitions while the therapist worked in another room, you have seen the thing this rule exists to stop.
Included as standard
How we treat this
A private room and one clinician
Door closed, no student unless you have agreed, and you may bring somebody.
Consent explained before, not during
The reason for any part of an examination is given beforehand, and you can decline any of it and still be treated.
The contraction actually checked
The commonest reason pelvic floor training fails is that it is being done wrong and nobody has looked.
Overactive muscles distinguished from weak ones
In pelvic pain the muscles are frequently overactive, and strengthening is the wrong treatment. This misdiagnosis is common and consequential.
Bladder retraining where urgency is the problem
Muscle work is not the whole answer, and for urgency it is not even most of it.
Referral where a medical opinion is needed
Prolapse for surgical assessment, recurrent infection, bleeding or an unexplained red flag. We would rather you had that opinion first.
When to make an appointment
Signs this is worth an assessment
- You leak when you cough, sneeze, laugh, lift or run.
- You plan your route around where the lavatories are.
- You have pelvic pain, or pain with intercourse.
- You have had a baby and running or lifting does not feel right yet.
- You have prostate surgery coming up, or have had it and continence has not returned.
- You were told this was a normal consequence of childbirth or of age.
Pelvic floor — how long a course usually takes
- A typical course. Supervised pelvic floor muscle training has strong evidence for stress incontinence, and it is a course of months rather than a technique you are shown once.8 – 16 visits
This is a typical number of visits for this problem, not a quote and not a promise. You get an estimate specific to you, in writing, at the first appointment, and we reassess against the same measurements at visit four rather than at visit ten — so a course that is not working gets changed or stopped instead of extended. What each visit costs is published on the pricing page: $190 for the initial evaluation and $140 for a treatment visit if you are paying yourself, or your plan's copay if you are not. We do not sell blocks of visits in advance.
Questions we are actually asked
Pelvic floor — frequently asked
What happens at a pelvic floor physical therapy appointment?
The first one is mostly conversation, history and explanation. Nothing is examined that you have not agreed to, and the reason for each part is explained before it happens rather than during. It takes place in a private room with the door closed, no student observes unless you say yes, and you can bring somebody with you.
Do I have to have an internal examination?
No. It is the most accurate way to establish what the muscles are actually doing, and it is a choice rather than a requirement. There is useful work to be done either way, and we will tell you honestly what we can and cannot establish without it.
Aren't pelvic floor exercises something I can just do myself?
You can, and a substantial proportion of people given them on a leaflet do them incorrectly — bearing down instead of lifting, or using the wrong muscles entirely. The contraction is invisible and there is no natural feedback, so checking it is exactly what a clinician adds.
Is leaking after childbirth normal?
Common, and not the same thing as normal, and definitely not the same as untreatable. Supervised pelvic floor muscle training has strong evidence for stress incontinence, and a large number of people have lived with this for years because somebody told them it was to be expected.
Can this help after prostate surgery?
Yes, and it is worth starting before the operation where there is time — pre-operative training measurably improves continence outcomes afterwards. If surgery is still in the future, that is the single most useful thing on this page for you.
Related conditions
Often seen alongside this
Older adults
Strength training works at eighty. It works at ninety. The dose that works is heavier than almost anybody is offered.
12 – 24 visits
Low back pain
The most common reason anybody walks through this door, and the condition where the gap between what sells and what works is widest.
6 – 12 visits
Hip pain
True hip pain is felt in the groin. Pain on the outside of the hip is usually a tendon, and it is made worse by exactly the stretch people are given for it.
8 – 16 visits
Persistent pain
For pain that has outlasted the injury. Not a cure, not a lecture about it being in your head, and not something we will pretend is quick.
12 – 20 visitsSixty minutes, one to one, with the therapist you chose
Book an appointment
The booking page shows each therapist's own diary rather than a generic grid, so a slot you can see is a slot that is genuinely free. Most people do not need a doctor's referral to start — New York's direct access law runs to ten visits or thirty days — though Workers' Compensation, No-Fault and Medicare each need one from the first visit. If you are not sure which of those you are, telephone and we will work it out before you book.