This is a continuation of our education series on pelvic floor therapy. We’re interviewing Dr. Karla Wente, PT, DPT, WCS, CLT about how to find the right therapist, red flags to watch out for, what to expect in a session, and how long you’ll need to stay in therapy.
Nicole: You mentioned in Part 1 that finding a therapist depends sometimes on your location or your insurance. How does somebody know where to start or where to go?
Dr. Wente: I wish I could say “oh, just go here and you'll find the right person.” I have so many patients that come in to see me and they say, “I've seen other therapists or doctors before I got to you.” And that breaks my heart. It’s a reminder of why I do what I do because I'm like “well, you're here now, and I can't wait to work with you.” I wish there was an easy solution.
There are some internet resources:
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There are pelvic floor physical therapy directories so you can find somebody based on location. Those are available at the Academy of Pelvic Health Physical Therapy website. They have a PT locator, so you can put in your location and find providers around there.
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There is another one through Herman and Wallace rehab.
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There's another one through the Global Pelvic Health Alliance.
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There are Facebook groups for various conditions. There are a bunch of postpartum mom groups, people who have had mastectomies, or prostate cancer groups. I would strongly suggest to get connected with people like you and ask them who they recommend.
I would also suggest that you call practices and describe what you have going on. If they do not seem like they are very familiar with it, or if they cannot figure out somebody who can talk to you about it, that is a red flag.
Nicole: What are some qualifications people should look for?
Dr. Wente: It is a requirement that all physical therapists get a Doctor of Physical Therapy (DPT) degree to become licensed and practice. That degree is entry level, similar to a medical doctor (MD) degree where you can practice as a general physician, but you can not be a cardiologist right away. You have to do some further training. The same is true for pelvic floor physical therapy.
We have to take a significant amount of coursework to specialize. After I got my DPT degree, I went on and did residency for a year to specialize in pelvic floor physical therapy and women's health at Washington University in St. Louis. Another way to specialize is through taking continuing education courses.
The tricky piece is that you have to start somewhere, so a DPT might take one course and then start seeing patients to get some experience. After that, they can add more advanced coursework based on the patient cases they tend to see.
Some advice I have for a patient is, if you have a more complex case, or if you are feeling like you are seeing a therapist that does not have all the tools you need, I want to empower you to know it is okay to say, “Thank you so much for getting me this far, but I'm going to find someone else.”
Unfortunately, sometimes you have to try and see, because the one thing you really need to know is, do I connect with this person? We call this therapeutic alliance. It is the “I like you or I don't,” and that honestly significantly impacts the way you progress in physical therapy.
As the patient, you need to trust, like, and respect your physical therapist. You should feel safe and comfortable with them. If your therapist gets super offended by that or can not handle something you say or do, it’s also a big red flag.
Nicole: You mentioned two red flags so far. Are there any other red flags off the top of your mind that people should watch out for?
Dr. Wente:
🚩Red Flag: Clinicians are not willing to share their relevant experience.
Let's say that you find a practice that you might want to go to. Look at their website for their list of physical therapists and their biographies to get a sense of who they are. Look at what courses they have taken. You probably want to see somebody who enjoys and has a lot of experience in the area of your condition.
If you cannot find a bio, when you call to make an appointment and they say who you’ll be paired with, you can ask:
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Can you send me information about my therapist?
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Can you tell me what their background is?
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Can you tell me where they went to school?
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How much coursework have they taken?
You may be greeted with no’s and you may be greeted with annoyed front office people, but it is your right as a healthcare consumer to get the information that you need to make an informed choice.
If you can't get that information, that is a red flag. That's also something that you could ask on a first visit. You can say, “I'm really excited to see you. Can you tell me about your background? How many patients have you seen with my condition?”
I love when my patients ask me that because I can give an honest answer. A therapist should be able to tell you the coursework they have taken.
I am not saying this to recommend that patients not see somebody who is newer to pelvic health. I think it all depends on what the patient is comfortable with. We all have to start somewhere.
I train students – that's how we all start and learn. If you’re seeing a newer clinician, you could ask them, “Do you get mentorship from someone else?”
🚩Red flag: There is no privacy for the session.
We are working in a super intimate area; you need to be at a place that is private. If you are not placed in a room with a door, do not go to that clinic and tell your friends not to go there. That is inappropriate. There should be a private room with a door and they should be hopefully creating an environment that feels peaceful and puts you at ease.
Draping should be used, which means you are covered with a sheet or gown to your comfort level. I have patients who want a lot of privacy and I have patients who do not want any privacy. I'm not going to force draping on people who do not want it, but will always make sure it is available.
🚩Red flag: Bodily autonomy and consent are not respected.
Find a therapist who respects your bodily autonomy and who practices truly informed consent. Meaning, the therapist confirms that you actually understand what they are going to do, and that you are okay with it.
We perform various assessments and treatments and you are allowed to say “no, I don't want you to do that.” And we as the therapists have to accept that and provide you with alternatives.
If you are not given those options, that is a red flag. If you feel forced to do anything you do not want to do, that is a big red flag.
🚩Red flag: You are not progressing across sessions.
You should be progressing across the duration of your treatment (i.e. getting better over time). You should ideally have tools, exercises, strategies and more to work on at home in order to manage your own condition.
Nicole: What should people expect during pelvic floor therapy? What are you doing while in therapy and how does a patient know if they’re progressing?
Dr. Wente: While you’re in PT, you should be learning a lot about your body, about the pelvic floor, and about your condition. You should be learning ways to manage all these things and getting different activities most sessions. It should not be the exact same thing every single session.
You should also have a home program with some exercises. It can be basic things, but it should be geared towards your condition, written and spoken in words that you can understand.
Nicole: It likely depends on the condition, but around how long does it take until patients start seeing results? If they also keep up with their at-home exercises, obviously.
Dr. Wente: That's the million-dollar question. The first question is, how are we categorizing improvement or benefit?
Sometimes improvement is:
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I felt my pain less frequently, but it was still just as intense and long-lasting
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I used to have pain every single day and now I am having it every other day
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I am less aware of the problem area
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I know way more about my body and how to use it
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Many of my symptoms have improved, but some haven't
To me, I feel my patients have made huge improvements, but sometimes it is not felt as improvement in my patients’ minds, and I don't blame them. They want their pain and symptoms completely gone. I totally understand that. But, we have to start somewhere.
If you know a lot more about your body or feel more confident in your ability to manage your body, that can have a big impact. I think those are some of the first benefits that people will find in physical therapy, but again, it really depends on your condition and medical history.
Read Part 3 to learn more about pelvic health therapy and how it interacts with disabilities.