What is the Patient’s Role During Pelvic Floor PT?

In Pelvic Floor Physical Therapy by Stephanie Prendergast and Elizabeth Rummer14 Comments

patients role

We’ve talked a great deal over the past year on this blog about the PTs role in treating pelvic pain/dysfunction, now it’s time to turn the spotlight on the role of the patient in his or her treatment. This is an important post because pelvic floor PT is most successful when patients are active participants in their treatment. Period. There’s no getting around it. And if you think about it, it makes perfect sense. Typically, PTs are with patients one, at the most two hours per week. That’s out of 168 hours in a week.

After much discussion amongst ourselves and with a handful of patients, we came up with five important tenants that describe the patients’ role during pelvic floor PT. Take a look at our list, and if you can think of any others to add, please do so in the comment section below!

Communicate Communicate Communicate!

While it is the job of the PT to work to educate patients about their conditions and the therapeutic methods they are using during PT, for a variety of different reasons, patients may not get all of the info they need to fully understand what’s going on with their treatment.

Plus, the dynamic between PT and patient can sometimes be tricky. Oftentimes, patients are hesitant to question their PTs for fear of insulting them or disrespecting their expertise. Therefore, they may feel too intimidated to speak up when they have questions or concerns about their treatment.

This lack of communication can be detrimental when it comes to pelvic floor PT for many reasons, not the least of which is that for some patients, successful treatment will require a major time and emotional commitment. So if a patient is confused or frustrated about treatment, he or she might ultimately decide to throw in the towel and discontinue PT even though therapy may in the long run be the best treatment option for them.

For another thing, full understanding about the treatment process results in less anxiety surrounding PT and symptoms in general. Not to mention that research shows that educating folks about the ins and outs of their pain actually plays a role in healing.

Indeed, in their book, Explain Pain, authors David Butler and Walter Moseley explain that learning about pain physiology reduces the threat value of pain, which in turn reduces the activation of all of our protective systems: sympathetic nervous system, hormones and compensatory movement patterns. This in turn helps restore normal immune function; therefore, inflammation decreases.

When it comes to PT for pelvic pain, its vial that patients understand both what is going on with their pelvic floors and their PT’s treatment approach. So at any time during the process, if you as a patient have a question or concern, definitely bring it up with your PT. Any PT worth his or her salt wants you to be a participating member of your treatment team, so he or she will welcome your desire to be totally in the loop.

Another important area of communication between patient and PT involves patient feedback. Patients must be sure that during their treatment they are providing their PTs with necessary and important feedback. For example, if what the PT is doing is providing relief, it’s important that the patient share that with the PT. Conversely, if treatment is causing increased pain, it’s important for patients to speak up and to describe in as much detail as possible exactly what they’re experiencing.

This type of feedback helps PTs evaluate their patient’s progress as well as helps them to determine if they need to make any treatment modifications.

Lastly, it’s important that patients inform their PTs of any relevant occurrences between appointments, and that they answer their PTs questions to the best of their ability. Again, this information enables the PT to evaluate and modify his or her treatment plan throughout the treatment process.

“Home Treatment” is a Must

Typically, patients will see their PTs for one-hour appointments each week. That’s four hours a month— four hours out of approximately 720 hours a month! So in order for a patient’s treatment to be as successful as possible, he or she must take matters into his/her own hands.

This will mean different things to different patients. As a patient, your job is to figure out what “home treatment” means for you. For instance, some of our patients regularly use dilators at home. Others learn how to manually treat themselves internally and externally. Still others bring their partner to a PT session so that they can learn how to administer connective tissue manipulation on the patient at home.

It’s important that you as a patient talk to your PT about what you can be doing at home to compliment the PT you’re receiving. And this is a conversation that you should be having throughout treatment because the answer might change depending on where you are in the treatment process. And we recommend if you’re going to be doing either internal or external work on yourself, that you ask your PT to take some time during an appointment or over a few appointments to show you exactly how to self-treat. (This is one of the reasons that we keep a hand held mirror in our treatment rooms.)

While each home treatment program is different, over the years, we have come up with a few rules of thumb that we’d like to share with you regarding self-treatment.

• If manual, internal treatment is a good fit for your home treatment program, use non-latex gloves and a lubricant that will not irritate your skin. We recommend Slippery Stuff
(blue label).
• If you are not getting relief from your home treatment techniques or if they are making your symptoms worse, discontinue and reassess with your PT.
• Using increasing sizes of dilators is good if you are working to desensitize tissue, however, they can (not always) be counterproductive if you have impairments such as
trigger points, fissures, tissue that is lacking in estrogen (for female patients), or muscles that have increased tone.
• The therawand, which is different than the above-mentioned cone-shaped dilators, can because of its curved shape and somewhat pointed tip, serve to treat trigger points and help lengthen tissue internally.
• Tennis balls are a great tool for self-administering connective tissue manipulation on the legs, thighs and buttocks.
• A foam roller is a useful tool for tight back, leg, and buttock muscles.
• Working up a sweat is great for connective tissue impairments.
• Meditation is wonderful for quieting the central nervous system.

In addition, your PT will likely give you certain at-home exercises or stretches to do, such as pelvic floor drops. Do them. Doing your homework will hasten your healing. That’s a guarantee.

In fact, when it comes to pelvic floor PT for incontinence, if you don’t do the home treatment program that your PT recommends, your symptoms will not improve. It’s that important.

Become a Pelvic Floor Expert

On this blog, we’ve gone to great lengths to paint a realistic picture of how pelvic pain is currently diagnosed and treated. But, to reiterate: the reality is that it’s a challenge for patients to get treatment that is consistent. Therefore, if you are a pelvic pain patient, in order to best advocate for yourself, you must educate yourself.

This means becoming informed on the anatomy of the pelvic floor and all of the different treatment options available to you. Thanks to the Internet, there are many great resources now available on the topic of pelvic pain. Take advantage of them, and arm yourself with all of the knowledge you’ll need to be your own best advocate.

Ask for Support

This one may seem a no-brainer. But, if you’re a patient reading this blog post, you know all too well how as time goes on, those around you tend to forget that you are in pain. After all, you’re dealing with a pain condition that is invisible to those around you. So, often patients fall into a trap where they’re left to soldier on.

Ultimately, this will catch up with you. So instead of giving into temptation, and ignoring your reality, be honest with yourself and those around you by asking for help and support, as you need it. As with all of the other items on this list, this one will help to hasten your healing.

Take Good Care of You

In addition to home treatment, self-care is vital during pelvic pain PT. And as with home treatment, this will mean different things for different patients. For some, it will mean taking a hot bath after a long day at work to help those pelvic floor muscles to relax. For others it will mean avoiding certain foods and beverages that you know aggravate your symptoms. For some, it will mean sitting on a cushion. And for others, it will mean going to a yoga class or getting out and taking a walk. Take the time to figure out all of the different ways you can take care of yourself and follow through as if you were taking care of any of your loved ones.

We hope this blog is helpful. If you have anything to add to this super-important list, please leave the info in the comments section below. We’d love to hear from you!

All our best,
Liz and Stephanie



Are you unable to come see us in person? We offer virtual appointments!

Due to COVID-19, we understand people may prefer to utilize our services from their homes. We also understand that many people do not have access to pelvic floor physical therapy and we are here to help! The Pelvic Health and Rehabilitation Center is a multi-city company of highly trained and specialized pelvic floor physical therapists committed to helping people optimize their pelvic health and eliminate pelvic pain and dysfunction. We are here for you and ready to help, whether it is in-person or online. 

Virtual sessions are available with PHRC pelvic floor physical therapists via our video platform, Zoom, or via phone. The cost for this service is $75.00 per 30 minutes. For more information and to schedule, please visit our digital healthcare page.

In addition to virtual consultation with our physical therapists, we also offer integrative health services with Jandra Mueller, DPT, MS. Jandra is a pelvic floor physical therapist who also has her Master’s degree in Integrative Health and Nutrition. She offers services such as hormone testing via the DUTCH test, comprehensive stool testing for gastrointestinal health concerns, and integrative health coaching and meal planning. For more information about her services and to schedule, please visit our Integrative Health website page.


  1. Hello–I always learn something from your blog and really, REALLY appreciate your dedication and commitment to the CPP population. I am a patient of Rhonda’s. I am also a yoga teacher and feel I must make one comment about that. At the end of this post you suggest taking a yoga class. Yoga can be great. But I also spent years increasing my pain and symptoms. It was only when I went thru a Yoga Therapy training program that I unraveling all the chronic patterns of compensation in my yoga practice that kept me in pain. Changing my practice changed my pain. Just as the right PT can help PP and the wrong will not bring about healing, the same is true for yoga. Someone with PP has to work with a Yoga Teacher with a good deal of knowledge and a keen eye.

    1. Cathy, thank you for this fantastic comment! We agree wholeheartedly!

      Cathy, I would love to chat with you for a blog post based on your experience working to figure out how to tailor yoga to your rehab and avoid having it be detrimental to your rehab. Would you be up for that? We could either use your name or not, whatever you are the most comfortable with.

      All my very best,

      1. I would LOVE to be a part of educating about CPP. I have a commitment to being part of the conversation about this. The first years I suffered in silence and when I finally started talking I couldn’t believe how many are suffering. In my Yoga Therapy practice with clients the focus at first is so much on what NOT to do, physiological quieting, noticing the gripping in the legs, belly etc. My main challenge is the PT component. Because it takes a team, a Village 🙂 Rhonda is a 4 hour drive each way for me. I had another PT from Iowa City Iowa, Kate Cardamon, that I told her about your workshop out east several yrs. ago and she went, but then she moved away. If we could find a PT in Iowa interested in this work! Whatever you want from me, I’m there. I studied with Liz Koch three yrs. ago and her daughter ended up coming to your clinic. That came about by me telling my story at her workshop and her saying, “OMG, that’s what’s going on with my daughter!”


        1. Cathy, how much has yoga helped since you were able to tailor it to your needs?

          I just recently added pelvic floor disfunction to my IC symptoms, and have just begun to research my options.

          Hopeless in Seattle,

  2. I have PN and no cushion works for
    Me, and now the pain begins when lying down, not just sitting. Position doesn’t seem to matter. What can I do?

    1. Dear Robin,

      I would recommend that you see a qualified pelvic floor physical therapist.

      All my best,

  3. Do you have blogs for men with scar tissue and pudendal nerve problems.
    Can a MRI show scar tissue or adhesions

    1. Dear Henry,

      Currently there is no solid evidence showing that scar tissue can cause pudendal nerve problems in men or women.
      that said, an MRI may be able to show “scar tissue,” however, the finding cannot be assumed that the defect is the source of a patient’s problems. The history, other physical findings, and aggravating and alleviating factors are more important than imaging for making a diagnosis.

      As far as blogs for men with either scar tissue or pudendal nerve problems, please read our “Demystifying PN series”

      https://pelvicpainrehab.com/726/how-do-i-know-if-i-have-pn-or-pne/ and

      As well as our blog on male pelvic pain: https://pelvicpainrehab.com/460/male-pelvic-pain-its-time-to-treat-men-right/

      Please feel free to write in with any additional questions you might have!

      All my best,

  4. My pelvic floor physical therapist has been performing her own type of psycho therapy. Last time I was there I was tired from having nightmares the night before. She got in my face and said in a very stern voice “you’re so negative.” So someone hurt you, what are you going to do? Huh? What are you going to do about it? She was extremely angry and after months of going there we still haven’t started with anything internal yet. It’s insults and control even telling me I wasn’t allowed to get a kitten. I’m finished. She does not have a degree to be doing psycho therapy but insisted to wait to do pelvic floor massage until I did what she wanted me to do in personal and private areas of my life. Does anyone have any suggestions? I got really sick with anxiety and am not going back.

      1. Is it possible to distinguish a nerve Problem from a muscle Problem in the pelvis? And with the right treatment is it likely that the nerve will make a full recovery? I got my pelvic pain from bareback riding

        1. It is common for people with symptoms of neuralgia to also have pelvic floor muscle hypertonus. Sometimes the muscle tightness is a cause of neuralgia and in other cases they coexist together. The right treatment can result in full recovery.

  5. Such a great article and I agree that self treatment is so necessary. I guess I will need to splurge and buy the TheraWand as I have heard great things about it.

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