Are physical therapists doctors?

At this point most PTs in the US are doctors, meaning that they have earned their clinical doctorate degree in PT. There are many PTs treating under a Masters degree (MPT) or even a bachelor's degree, who have equal education and more experience than those of us with a doctorate, but who received their training and license before the structure was changed to allow PTs to be autonomous clinicians. A doctor of physical therapy is a doctor whose expertise is in musculoskeletal conditions and movement. We are not physicians, and can not prescribe pharmaceutical treatment, so co-treatment with your MD (and other providers, such as eastern medicine, dieticians, and mental health providers) is often recommended.

I already saw someone for my knee pain, but it still hurts. So PT didn’t work, right?

Not necessarily! Persistent conditions like knee pain, hip pain, back pain, shoulder pain, are often the result of direct injury or overuse, and in many (even most) of those cases, any skilled PT should be able to help you. As with any provider though, finding the right fit is important, and treatment styles are as variable as flavors of ice cream or Crayola crayons. If you have a knee injury that didn’t get all the way better with your PT or other treatment, consider going to a specialist clinic, such as Bottoms Up!, to see if your chronic pain can be improved with other methods. Particularly in the hips and low back, treatment should always include a visit to a pelvic floor specialist, since you can’t comprehensively treat the hips or low back without assessing the pelvic floor.

What do people go to pelvic floor therapy for?

Lots of things! All the things! Ranging from urine leakage at the gym to hip clicking to frequent headaches, the pelvic floor influences so much of your movement, habits, and sensory experience. If you're not sure, ask me or your physician if pelvic floor PT could be useful for you.

What is incontinence?

Many of us think of urinary incontinence as the inability to hold our urine, resulting in messes, laundry, and embarrassment. The truth is that incontinence is any loss, large or small, of urine, feces, or gas, that you are unable to control. If you pee a little when you do jumping jacks at the gym, dribble on your way to the bathroom, can't make it to the porta-potty on a run, or ever find urine spots or feces in your underwear, that qualifies as incontinence and IS treatable. Please be aware that colorless or white vaginal discharge and menstruation are normal, fluctuate with menstrual cycles or hormone changes, and are usually not a sign of a pelvic floor dysfunction.

Isn't it normal to leak when you get older?

NO! RESOUNDINGLY, ADAMANTLY, FORCEFULLY, and kindly...NO! It is a very common thing to experience urinary incontinence at stages of your life - severe illness, during pregnancy or after having kids (yes, even by c-section), and as we age. But this is NOT a normal body function! Just like it's more difficult to maintain fitness and health as our bodies change, it is more difficult to keep our pelvic floor muscles and other tissues functioning optimally, but that does not mean that failure of the pelvic floor is normal, or should be accepted. 

Isn't it normal for people with vaginas to have pain with sex or gynecological exams?

Again, the answer to this is that it's amazingly common, and many of my younger patients have been misled to believe that it's supposed to hurt, or even bleed. While it is normal to experience discomfort and bleeding when becoming sexually active or with trauma, pain or displeasure should not persist and should not ever be present with consensual external touch* or normal toileting. There are many things that can contribute to heightened pain both externally and internally, and even in the belly, tailbone, hips, or back. These include physical trauma such as a car accident, abuse; shame or lack of education about your normal anatomy are common factors; all of which can and will be addressed with a good provider.

*Consensual pain and BDSM are the exceptions to this rule, and you will not be judged here for the choices you and your respectful, loving partner make together. However, it may be in your best interest to pause certain activities while in treatment to allow your body to redefine its interpretation of stimuli.

Do I need a referral to see a PT?

Oregon is a Direct Access state, meaning you are entitled to pursue treatment in PT (and the PT is legally able to treat you) with or without the PCP referral. Many clinics will require referrals because insurance may refuse to pay for services without one, but Bottoms UP! has no such requirement, so you can walk through these doors with as few obstacles as possible.

When and how often should I see a pelvic floor PT?

It's my personal (admittedly biased) opinion that everyone should see a pelvic floor PT at three stages in life: when they become sexually active, when/if they get pregnant, when/if they encounter menopause. Of course this is in addition to when/if they are having any pelvic floor problems. Seeing a PT or trusted and educated professional as a teen or young adult helps us learn about our bodies in ways most of us don't as children or young adults, no matter how active and fit we are. What is normal, ok, or problematic? How do I talk to this part of my body? Pregnancy and menopause are times of great change to the body, and are bound to throw you, and it, for a loop! And early on with any problem or challenge is always better than later. For patients learning about their bodies or in normally progressing pregnancies, 1-2 visits should be adequate, while addressing pain and dysfunction can take several weekly visits.

This is all so embarrassing, how do I bring it up with my physician?

Your physician is a professional, whose whole job it is to help you when your body isn't working right. If that doesn't help, you should know that you don't have to talk to anybody about this that you don't want to - but you should talk to somebody. Your first stop can be your sister or best friend, or someone whose career it is to talk about the TMI subjects (like a pelvic floor PT) but whatever you do, don't spend your life leaking or in pain because the subject feels icky to discuss. For my part, I will do everything I can to help you feel as comfortable as possible talking to me about your most private concerns.

Is there anything I can do before my first visit to get started?

YES! First, breathe deeply, nourish and hydrate healthfully, and get good sleep. Then, follow me at @bottomsuptherapy for pearls and general knowledge about the pelvic floor, check out my blog on this webpage, and in general keep moving your body in ways that feel good to you!