Finding Pelvic Sanity

What we're really looking for in a provider is the best value.  And there are two different components to value - results and cost.

After all, if we don't get the results we're looking for, it doesn't matter how low the cost is.

Results in this context are about 1) getting better and 2) staying better.  With pelvic rehab, we know what quality care looks like:

• Full hour with the specialist, not shortened appointments, working with an aide or student, or just being watched doing exercises.
• Internal + external treatment at every appointment, not someone only able to treat one or the other.
• Hands-on, practical treatment and not doing biofeedback or Kegels.
• "Finding the why" for lasting relief, not temporary symptom reduction.

Cost is about how much the service charges.  We often assume that a place that 'takes my insurance' is less expensive.  And sometimes that's true.  But if you have a high deductible, you'll be paying out of pocket no matter where you go.

And you might not realize your 'in-network' place is charging hundreds of dollars per session until you get a surprise bill months later.

Our local 'in-network' place, for example, charges nearly $650 for an initial evaluation if you have a deductible.

Where will I get the most value?

When we really understand the results and cost of physical therapy, we can make an informed choice about where we get the most value.

Local to Southern California?

We'd love to work with you!  Give our amazing team a call at PelvicSanity (www.pelvicsanity.com)  Or look into a remote consultation or our out of town program if you are able to travel for care!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

How do we build resilience in our body so symptoms not only can go away, but stay away?  At PelvicSanity, we do this by addressing both the muscles of the pelvic floor, but also the 4 Foundations of pelvic health.

The pelvis doesn't exist in isolation.  It's affected by the rest of the body and other major symptoms.  These often are major underlying causes of problems in the pelvic area.

We need to address the actual pelvic floor dysfunction, but we also have to build resilience in the system by improving these 4 foundations in order to make lasting change.

The four foundations of pelvic health are:

• Movement
• Sleep
• Nutrition
• Stress Management

Your physical therapist should not just be working on the muscles of the pelvic floor, but thinking about your overall global health as well.

Improving movement improves circulation and reduces inflammation in the tissues.

Increasing the quantity and quality of our sleep allows the body to heal as we rest.

Doing better with our nutrition reduces inflammation, gives us more energy and the building blocks for the body to recover.

And reducing stress can 'turn down the volume' on our nervous system, reducing symptoms and allowing the body to spend more time in the 'rest & relax' mode instead of 'fight or flight.'

This is a both/and situation....we need to address the immediate cause of pain or pelvic floor symptoms.  But unless we improve these four foundational systems, symptoms often return or manifest in a different way.

PelvicSanity

Local to Southern California?  We'd love to work with you - make sure to give our office a call at www.pelvicsanity.com

If you're able to travel for treatment, we offer an extensive Out of Town Program as well as Remote Consultations to review your case.  We would love to help you find lasting relief of pelvic health issues!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Pelvic PTs are the pregnancy experts - we want to help you have a more comfortable pregnancy, a smoother delivery, and prevent postpartum issues after delivery!

1.  Have a more comfortable pregnancy

Working with a pelvic floor physical therapist throughout your pregnancy can reduce or eliminate issues like back pain, hand or foot pain, painful intercourse, lightning crotch, pubic symphysis pain, swelling in the legs, and more!

You don’t have to just suffer throughout pregnancy.  And then act as if the marathon effort of delivery is going to help these symptoms?  They don’t just magically go away after the baby comes, they linger into postpartum.  And now you have a little one to pick up, nurse, carry and eventually chase around.

Nothing gets easier to treat the longer we let symptoms linger.  

2.  Prepare for labor

The muscles of the pelvic floor have to be able to relax and stretch to allow the baby to pass through.  If they are tight - because of how you’ve been moving, exercising, low back pain you’ve had, or other reasons - it will make delivery more difficult.

Your pelvic PT will work with you on things like perineal massage, finding the best labor positions for you, breathing and other birth prep techniques to ensure you’re ready for delivery.

3.  Prevent postpartum issues and establish care

We want to do everything we can to prevent postpartum issues from cropping up.  And by working with a pelvic PT before you deliver, you’ll already have someone who knows your body and can help you postpartum.

PelvicSanity Healthy Pregnancy Program (HPP)

At PelvicSanity, we have a full Healthy Pregnancy Program (HPP) our patients go through.  We recommend coming in early in your second trimester to get started.  We usually see patients about once a month through the second trimester and then more frequently as we move into the third.

We want to have completed birth prep by 37 weeks so you’re prepared if you go into labor.

Local to Southern California?

If you (or someone you know) is pregnant and local to Southern California, we would love to work with you!  Give our team a call (www.pelvicsanity.com) for the best pregnancy care and birth prep.

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Tailbone pain is a common symptom and is integrally related to the pelvic floor.

All muscles of the pelvic floor attach at the tailbone.  When these are tight and irritated they can radiate or refer pain to the tailbone itself.  The vast majority of the time there’s nothing wrong with the tailbone itself.  It’s actually a pelvic floor issue masquerading as a tailbone problem.

Because of all the attachment to the pelvic floor, a hard fall on the tailbone or injury during childbirth can also be the initial cause of pelvic floor dysfunction.

In research we’ve done at PelvicSanity, we’ve demonstrated a significant fall on the tailbone (enough that you still remember it years later) is linked to pelvic floor dysfunction later in life.

This also brings up the importance of working with a pelvic floor therapist who is qualified to perform a rectal evaluation and treatment.

Issues like tailbone pain, constipation, pain or straining with pooping, SI joint pain, and more are much more easily assessed and treated rectally.  Unfortunately many pelvic floor therapists haven’t received training in rectal treatment, and if you’ve been going to pelvic PT and aren’t seeing results, it’s often because this area is being overlooked.

PelvicSanity

If you're dealing with chronic pelvic pain, coccydynia or other pelvic health issues, we'd love to help!  If you're local to Southern California, we can treat you at our Orange County, CA clinic.

If you're not able to make it in, we offer both remote consultations (www.pelvicsanity.com/remote) and a comprehensive Out of Town Program (www.pelvicsanity.com/out-of-town) where we work with you for two weeks (or longer).

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

In the third trimester the ‘sixpack’ abdominal muscles separate to allow room for the baby to grow.  Within the first three months postpartum, in about half of women these muscles come back together properly.  In the other half a separation remains, known as a diastasis recti.

We hear about this often as an aesthetic issue.  It can create a ‘mommy pooch’ or it still might look like you’re pregnant.  And while that’s a totally fine reason to seek care, the issue goes much deeper (quite literally).

A diastasis means something in your core system is compromised and is linked to low back pain, incontinence, prolapse and painful intercourse.  It can be an underlying driver of pelvic health issues.

In this episode we go through a simple self-evaluation to determine if you might have a diastasis, but the gold standard is a thorough evaluation from a pelvic floor physical therapist.  

Most people go directly to trying exercises they find off the internet.  But there’s no one size fits all approach for treating a diastasis.  A pelvic floor therapist will identify why the muscles haven’t closed up, manually work to address the issue, and only then will exercises be effective.

No matter how long it’s been you can absolutely still resolve a diastasis (without surgery).  Whether your goals are aesthetic or functional, treating a diastasis can improve both.

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

The answer will surprise you!  The myth that acidity in the body or bladder is responsible for IC symptoms is one of the most harmful out there.

In this 'sode we go through why the pH of urine has no effect on symptoms, how 'acid in' does not equal 'acid out', and what we should be doing instead.  We hope this 'sode helps to free you from 'food jail' and you can become more confident in what you eat!

The Myth:  Ingesting acidic foods or beverages makes urine more acidic, irritating the bladder and flaring symptoms.

The Truth:  While some acidic foods are common triggers for IC, the body is extremely complex and 'acid in' doesn't equal 'acid out.'  Many foods that contain acid are considered entirely 'IC-safe,' while some basic (meaning non-acidic) foods and drinks can also be major triggers.  Furthermore, acidic urine has been proven to be no more painful than neutral urine for patients with IC.  

The two rules of diet changes with IC are simple: avoid your personal trigger foods and eat healthy.  It doesn't have to be any more complicated than that.

PelvicSanity Remote Consultation

If you're local to Southern California, we'd love to work with you to address the 'why' of your symptoms and help you find lasting relief!

If you're not in SoCal, we can still help!  Check out our Remote Consultation Program (www.pelvicsanity.com/remote) for how our team can get you on the path to healing.

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

There's a wide variety of expertise when it comes to pelvic floor physical therapy.  Unfortunately many patients have to go to several different ones before finding a true expert.

You might think that finding a pelvic PT who has a lot of experience means you'll be getting great care.  But that's not necessarily the case.

In this 'sode we discuss why experience doesn't necessarily equal quality.  In fact, sometimes more experienced therapists are still using outdated techniques they learned 20+ years ago, while someone newer to the field was trained in more contemporary methods.

So what should you be looking for to ensure you get the best care?  Really, you're looking for three things:

1. Specialty Clinic:  You want to find a practice that specializes exclusively in treating pelvic health.  It means they have more experience with people like you and is much more likely they have specialty training instead of just 'dabbling' in pelvic health.
2. Hour-Long Treatment Sessions: You want to work hands-on and 1:1 with your pelvic PT for a full hour.  No aides, no watching you exercise, no double-booked patients so they can't focus on you the entire time.  These conditions are complex and you need time with the actual specialist!
3. Both internal and external treatment at every visit:  Often it's only one or the other.  Some pelvic PTs don't have the skills to work outside the pelvic floor, and they are just doing internal or using biofeedback the whole time.  Others just 'check' the pelvic floor once and then treat entirely externally.  You need the combination to see the whole picture.

Local to Southern California?

We'd love to work with you to completely resolve your incontinence and pelvic floor issues.  If you're local to Southern California, please give our PelvicSanity (www.pelvicsanity.com) team a call - we'll be happy to answer any questions and get you started!

Whether we're your first call or you've been to multiple other pelvic PTs and physicians, you can absolutely find lasting relief!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Incontinence is certainly common.  More than half of people have incontinence after a baby, it can accompany pelvic pain, prolapse, low back pain or following a surgery.  

But it’s never normal, and never something you have to live with.

Sometimes this is normalized - we joke about it with friends, or hear about it from our mothers.  But we often don’t recognize the profound effect of incontinence on our lives.

We often abstain from exercising (which has life-long health effects).  We don’t feel comfortable doing certain activities with our kids.  It dictates what we can wear.  Many people find they are making a lot of sacrifices because of their incontinence they didn’t even think about. 

Fortunately, it’s absolutely something that can be resolved by a qualified pelvic PT - and generally without Kegels!

Fundamentally, incontinence is the inability of the pelvic floor muscles to perform their job of holding back urine.

But this doesn’t mean they are weak!  In fact, many times incontinence is actually due to overly tight and irritated muscles incapable of performing their normal job.

Incontinence is not normal and not something you have to live with.  I’ve never had a patient not find improvement with pelvic PT, and the vast majority can completely eliminate incontinence without surgery, medication or a lifetime of pads

Local to Southern California?

We'd love to work with you to completely resolve your incontinence and pelvic floor issues.  If you're local to Southern California, please give our PelvicSanity team a call - we'll be happy to answer any questions and get you started!

Whether we're your first call or you've been to multiple other pelvic PTs and physicians, you can absolutely find lasting relief!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

For many people (almost 90% of those diagnosed with IC) tight muscles in the pelvic floor irritate the nerves running through the area.  One of the most important of these is the pudendal nerve.  

So what symptoms might be caused by pudendal nerve irritation?  One is urethral burning or pain.  One branch of the pudendal runs right to the urethra, so it is often responsible for urethral pain or burning.

The pudendal can also be the cause of urinary urgency and frequency.  It connects to the bladder.  Usually these nerves are ‘silent’, but with IC they are often activated and continue to send signals to the brain.  When the brain interprets these as the urgent need to urinate, we get urinary urgency and/or frequency.

(Just a note - Often when we hear ‘pudendal nerve’ we do a Google search and see information about pudendal neuralgia.  This is obviously a scary diagnosis.  But what we are talking about here is pudendal nerve irritation.  We actually compare it to something we’re more familiar with - sciatica)

So it’s definitely possible pudendal nerve irritation is driving symptoms.  There are many other nerves in the area which can be causing symptoms as well, so that’s where a pelvic PT can both figure out what is going on and work to address the issue.

This also explains why many people with IC-like symptoms are given bladder-focused treatments (bladder instillations, Elmiron, hydrodistensions, etc.) without benefit.

Finding Pelvic Sanity Facebook Group

If you haven't already, make sure you join the Finding Pelvic Sanity online support group (www.facebook.com/groups/findingpelvicsanity).  It's a supportive group and moderated by the PelvicSanity team, so you know you're getting high-quality information.

If you're local to Orange County (or can come here for treatment), we would love to work with you directly!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!

Have you heard or been told you 'just need to Kegel'?  Here's why that's never the answer to pelvic health issues.

Kegels (or the voluntary squeezing of the pelvic floor muscles) are often one of the only areas of pelvic health we’ve heard about.  It’s often surprising to people to learn Kegels are often ineffective, antiquated and can cause flares or actually exacerbate symptoms.  Here’s why they are rarely used at all at PelvicSanity.

1)  The majority of people with pelvic floor symptoms already have overactive pelvic floor muscles. 

This means we want to be working to calm down the pelvic floor.  Help it to relax and stretch out.  Not adding a bunch more work for it to do! 

Not only are Kegels ineffective, but can often flare symptoms for those with an overactive pelvic floor.  This is why Kegels are never recommended for those dealing with pelvic pain.

2)  Even if you are weak, Kegels aren’t the best way to strengthen the pelvic floor.  

Even for the small subset of people who truly do have pelvic floor weakness, Kegels are only one small part of the pelvic floor.

If your goal is to run without leaking, how is laying on your back and staring at the ceiling the best way to train for that?  We need to get you up off the table and get your pelvic floor working in a functional manner again.

3)  Kegels don’t find or resolve the underlying ‘why’

At PelvicSanity we’re always about trying to find and address the root cause of your issue so it doesn’t return.

The underlying why is usually outside the pelvic floor - in how you’re moving, in your back, or glutes, or hips, or ankles.  Unless we find and resolve the underlying why, symptoms will either return or crop up in a different way in the future.

So if your pelvic PT was only doing Kegels or biofeedback, make sure you find a great pelvic PT for a second opinion.  And if you haven’t been to pelvic PT yet, let this be your call to action!

Local to Southern California?

Our expert team in Orange County would love to help resolve your pelvic floor issues for good - without a bunch of Kegels or biofeedback!  Give us a call or send us a message and we'll be happy to answer any questions and get you started!

About Us

Dr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.

They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.

Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com).

• Subscribe to the podcast
• Follow @pelvicsanity for great info!
• Join the Finding PelvicSanity support group
• Check out www.pelvicsanity.com for additional help!

And as always, we hope this has helped you find just a bit of pelvic sanity!