Physical therapists undergo advanced post-graduate education in pelvic floor anatomy and physiology to help meet the pelvic health needs of patients. Considering the field of physical therapy as a whole, pelvic floor physical therapy is a more recent, but quickly emerging field and we are excited to be part of it. While we have advanced training in pelvic health we are first and foremost physical therapists that take the entire body and mind into consideration.

We can help people recover from symptoms that stem from impairments in the musculoskeletal, nervous, reproductive, urologic, and gastrointestinal systems. Pelvic health symptoms generally fall into a few categories: bladder, bowel, and sexual dysfunction and pelvic pain. The symptoms may develop for many different reasons, including injury, trauma, surgery, medication-induced, pregnancy, and menopause, to just name a few. We recommend checking out the rest of our website for more specific information on the symptoms listed below. 

Symptoms

Bladder Symptoms

  • Urinary urgency, frequency, hesitancy and pain in the absence of infection
  • Weak urinary stream
  • Leaking urine (incontinence)
  • Urethra and bladder pain
  • Pain before, during or after urination
  • Nocturia (nighttime urination)
  • Pediatric bed wetting (nocturnal enuresis)

Bowel Symptoms

  • Straining to evacuate stool
  • Adult and pediatric constipation
  • Need for excessive toilet paper
  • Fecal and/or gas leakage and incontinence
  • Hemorrhoids and fissures
  • Pain before, during or after bowel movements
  • Anal/rectal pain, burning or itching

*Male Sexual Symptoms

  • Erectile dysfunction: poor quality, inability to achieve erection, inability to maintain erection, premature ejaculation
  • Decreased force or inability to ejaculate
  • Climacturia (incontinence with orgasm)
  • Post ejaculaory pain: tip and/or shaft of penis, perineum, scrotum
  • Discoloration in penis/scrotum/perineum

*Female Sexual Symptoms

  • Inability or decreased ability to lubricate
  • Pain upon vaginal penetration, with deep penetration only, and/or continuous pain with penetration
  • Clitoral pain, hypersensitivity to touch
  • Pain and/or burning after sexual contact
  • Inability to orgasm, diminished orgasm
  • Urinary incontinence during sexual activity
  • Climacturia (incontinence with orgasm)

*Male Pelvic Pain Symptoms

  • Burning, itching, aching, or other types of pain in the penis, scrotum, testicles, perineal and/or anal area
  • Pain with sitting, certain types of exercises, and certain types of clothing
  • Post ejaculatory pain in the penis, scrotum and/or perineum
  • Gastrointestinal distress, bloating, and/or constipation
  • Symptoms can be provoked, such as in response to ejaculation or exercise, or unprovoked and spontaneous
  • Symptoms may be intermittent or constant

*Female Pelvic Pain Symptoms

  • Burning, itching, aching or other types of pain in the vulva, vagina, perineal, and/or anal area
  • Pain with intercourse, hypersensitivity when wearing pants and/or underwear, and pain with sitting
  • Exercise may provoke or exacerbate symptoms
  • Abdominal bloating, gastrointestinal distress, and constipation
  • Symptoms can be provoked, meaning with penetrative intercourse or tampon insertion, or unprovoked and spontaneous
  • Symptoms can be intermittent or constant

Transgender Pelvic Health Symptoms

  • Pain from surgical scars
  • Pain with vaginal penetration
  • Inability to achieve vaginal penetration
  • Difficulty or inability to achieve orgasm
  • Urinary dysfunction including urgency, frequency, hesitancy, incontinence and spraying
  • Pelvic and low back pain

Symptoms

Bladder Symptoms

  • Urinary urgency, frequency, hesitancy and pain in the absence of infection
  • Weak urinary stream
  • Leaking urine (incontinence)
  • Urethra and bladder pain
  • Pain before, during or after urination
  • Nocturia (nighttime urination)
  • Pediatric bed wetting (nocturnal enuresis)

*Male Sexual Symptoms

  • Erectile dysfunction: poor quality, inability to achieve erection, inability to maintain erection, premature ejaculation
  • Decreased force or inability to ejaculate
  • Climacturia (incontinence with orgasm)
  • Post ejaculaory pain: tip and/or shaft of penis, perineum, scrotum
  • Discoloration in penis/scrotum/perineum

*Male Pelvic Pain Symptoms

  • Burning, itching, aching, or other types of pain in the penis, scrotum, testicles, perineal and/or anal area
  • Pain with sitting, certain types of exercises, and certain types of clothing
  • Post ejaculatory pain in the penis, scrotum and/or perineum
  • Gastrointestinal distress, bloating, and/or constipation
  • Symptoms can be provoked, such as in response to ejaculation or exercise, or unprovoked and spontaneous
  • Symptoms may be intermittent or constant

Bowel Symptoms

  • Straining to evacuate stool
  • Adult and pediatric constipation
  • Need for excessive toilet paper
  • Fecal and/or gas leakage and incontinence
  • Hemorrhoids and fissures
  • Pain before, during or after bowel movements
  • Anal/rectal pain, burning or itching

*Female Sexual Symptoms

  • Inability or decreased ability to lubricate
  • Pain upon vaginal penetration, with deep penetration only, and/or continuous pain with penetration
  • Clitoral pain, hypersensitivity to touch
  • Pain and/or burning after sexual contact
  • Inability to orgasm, diminished orgasm
  • Urinary incontinence during sexual activity
  • Climacturia (incontinence with orgasm)

*Female Pelvic Pain Symptoms

  • Burning, itching, aching or other types of pain in the vulva, vagina, perineal, and/or anal area
  • Pain with intercourse, hypersensitivity when wearing pants and/or underwear, and pain with sitting
  • Exercise may provoke or exacerbate symptoms
  • Abdominal bloating, gastrointestinal distress, and constipation
  • Symptoms can be provoked, meaning with penetrative intercourse or tampon insertion, or unprovoked and spontaneous
  • Symptoms can be intermittent or constant

Transgender Pelvic Health Symptoms

  • Pain from surgical scars
  • Pain with vaginal penetration
  • Inability to achieve vaginal penetration
  • Difficulty or inability to achieve orgasm
  • Urinary dysfunction including urgency, frequency, hesitancy, incontinence and spraying
  • Pelvic and low back pain

Treatment:

How We Can Help You

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If you suffer from any of these symptoms, getting a pelvic health physical therapy evaluation is the right step towards recovery. During the evaluation, the physical therapist reviews your history and symptoms with you, what you have been diagnosed with in the past, the treatments you have undergone and how effective or not effective these treatments have been. Importantly, we understand what you have been going through and that most people are frustrated by the time they get to see us. During the physical examination the physical therapist examines muscles, tissues, joints, nerves, and movement patterns. Once the examination is complete your therapist reviews your findings with you. The physical therapist creates an assessment which explains how you developed your symptoms and creates short and long-term goals for your treatment plan. Typically, the frequency of physical therapy treatment is one to two times per week for roughly 12 weeks. You are given a home exercise program to compliment your in-person sessions, and your physical therapist will help to coordinate your recovery with the other members of your treatment team. We are here to help you recover and live your best life! 

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Treatment:

How We Can Help You

Frequently Asked Questions

What is pelvic floor physical therapy?

Within the practice of physical therapy, there are specialty focuses that aim to accurately treat patient symptoms. One of the most important areas of focus is pelvic floor physical therapy, which has been increasingly recognized for its value to patients in many applications. Generally, pelvic floor specialists will apply their focus to the pelvic floor girdle and muscles that cause pain and dysfunction.

What to expect from pelvic floor therapy?

When first starting pelvic floor therapy, you can expect an initial evaluation with one of our physical therapists. 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 therapy regimen.Your evaluation will include a physical examination of muscles, tissues, nerves, and joint and may include motor control and movement analysis. Common areas we examine 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 tissues. Throughout the evaluation, short-term and long-term goals are discussed. Depending on the severity of your dysfunction, physical therapy treatments may last a few weeks, months, or longer. Our 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.

What do they do in pelvic floor physical therapy?

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. 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.

Jillian Giannini, DPT

Jillian was born and raised in Los Angeles, CA. She graduated from the University of Southern California with a Bachelor’s Degree in Human Performance and found her love for physical therapy through spending countless hours working with the USC football team. She received her Doctorate in Physical Therapy from California State University, Northridge, along with becoming both yoga and Pilates certified. She aspires to be a conduit to people’s healing and to bring a trauma-informed approach to health care. In her free time, she loves to draw, dance, and spend time with family.

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Alexa Savitz, PT, DPT

Alexa received her Bachelor’s degree in Kinesiology from Temple University in Philadelphia. She went on to dance professionally while traveling the high seas on cruise ships and nationally on tour. Following her dancing days, she earned her Doctorate of Physical Therapy from the University of Southern California. She was introduced to pelvic health prior to graduate school as a rehab aide and ever since then she has been passionate about increasing awareness of the field. She is a member of the American Physical Therapy Association and Academy of Pelvic Health. She aspires to provide education and a collaborative space to improve quality of life and well-being. In her free time, Alexa enjoys traveling, hiking, spending time with her family and dog, dancing, and finding the best pizza in LA.

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Jamie Landrum

Jamie is originally from San Jose, CA, and moved to the LA area after graduating from the University of Utah with a musical theater degree to continue her career as a professional actor, singer, and voiceover artist. She is so thrilled to be working with PHRC and knows firsthand the excellent level of care that is provided, as she started as a patient to help with her endometriosis. Jamie enjoys spending time with her partner and friends, going to Disneyland, and watching trashy TV.

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Jandra Mueller, DPT, MS

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Office information

PHRC expanded to Encinitas in 2019, spearheaded by Jandra when she moved from West LA to San Diego County. In addition to her doctorate degree in Physical Therapy, Jandra also has her Master’s Degree in Integrative Health and Nutrition. She offers in person and virtual services in these areas. There is free parking for our patients in the attached parking lot.

Office information

PHRC expanded to Encinitas in 2019, spearheaded by Jandra when she moved from West LA to San Diego County. In addition to her doctorate degree in Physical Therapy, Jandra also has her Master’s Degree in Integrative Health and Nutrition. She offers in person and virtual services in these areas. There is free parking for our patients in the attached parking lot.