Finding Pelvic Sanity

We know going to pelvic physical therapy can feel intimidating.  It may be a reason you’ve put off seeking care.  So we want to pull back the curtain and help you understand exactly what will happen at your initial pelvic physical therapy visit.

Ultimately, we want you to know two things about your first pelvic floor physical therapy appointment:

1. You should feel completely comfortable at every stage, understand what’s going on (and why) and agree together on whether you’ll do an internal exam.  An internal exam is absolutely not required if you’re not comfortable with it, and doesn’t have to be done on the first day.  However, it is the gold standard of care and if you’re not getting an internal exam you’re missing a huge piece of your puzzle.
2. You should leave feeling much more knowledgable, having a better understanding of what is going on and with a solid plan to improve.  We want you feeling much more hopeful when you leave and excited to start improving!

Once you arrive you’ll be escorted into a private treatment room.  You’ll sit down - still completely clothed - and talk with your physical therapist about what’s going on.   Your physical therapist will then explain a bit about the pelvic floor and let you know how the rest of the evaluation will take place.

They will leave the room to allow you to undress and put on a patient gown so you’ll be covered as much as possible during the rest of your exam.

The pelvic PT will usually start with doing a thorough external evaluation, seeing how you move, bend and stand.  This will (or should be!) all standing and off the table.

They will explain exactly what’s going on, and then - as long as you’re completely comfortable - proceed to the internal portion of the exam.  It will involve a single gloved finger evaluating the muscles of the pelvic floor.  This should not be painful and your physical therapist will make sure you’re comfortable throughout the process.

So you should be completely comfortable throughout the initial evaluation, have great communication with your pelvic physical therapist, understand what’s likely causing your symptoms and leave with a solid plan for how to move forward!

Finding Pelvic Sanity

If you haven't already, make sure to join the free and supportive online group - Finding Pelvic Sanity!

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!

Interstitial cystitis (IC) is a scary and incredibly misunderstood diagnosis.  You may have also heard terms like ‘painful bladder syndrome’ or ‘bladder pain syndrome’ as well.  We want to shed some light on what IC is, how it’s diagnosed and what you can do about it!

Definition of IC:  Interstitial cystitis is defined by the presence of two symptoms in the absence of any other explanation (like a UTI or bladder cancer).  It’s:

1. Pain or pressure we perceive to be related to the bladder, and 
2. Urinary urgency or frequency

Symptoms of IC:  In addition to the hallmark symptoms of bladder pain and urinary urgency/frequency, people often have other related issues.  These can include painful intercourse, low back pain, having to go to the bathroom at night (nocturia), pain with sitting or exercise, constipation and other pelvic health symptoms. 

Do I really have interstitial cystitis?  IC is a diagnosis of exclusion, which means it’s only diagnosed by ruling out other things (like bladder cancer or a UTI).  There’s no test that can confirm you have IC (including a cystoscopy).  If you have the symptoms above - pelvic pain perceived to be related to the bladder and urinary urgency/frequency - you can be diagnosed with IC just by the symptoms.

Importantly, the IC diagnosis doesn’t tell you anything about WHY you have the symptoms or WHAT the best treatment option will be for you!

Physical Therapy for Interstitial Cystitis.  The muscles and nerves of the pelvic floor can be responsible for every symptom of IC.  They can cause the bladder pain and urinary symptoms.  They are also the cause of seemingly unrelated symptoms like painful intercourse, low back pain, hip pain or constipation.  It’s the reason symptoms are often worse when sitting or after strenuous exercise, and why they can get better after gentle stretching or a warm bath.

Physical therapy is the highest recommended treatment (Grade ‘A’) by the American Urological Association.  It’s literally the first recommendation you should get from a urologist when IC is suspected.  

We hope this gives you a good overview of the condition, and we want to leave you with the first lines of The IC Solution (link): “Thousands of people with IC live healthy, happy and pain-free lives - and so can you!”

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!

All pelvic PTs - like any other provider - are not the same!  There’s a wide variety of experience and expertise when it comes to pelvic floor physical therapy.  So how do you find the right physical therapist for you?

Find a pelvic physical therapist who specializes in pelvic health and isn’t ‘dabbling’ in the field.  Here’s a list of how to find a great pelvic physical therapist:

1. True specialty health practice.  You don’t want someone who is ‘dabbling’ in pelvic health, or where pelvic PT is just an ‘add-on’ to a bigger practice.
2. Hour-long sessions.  You should be seeing your pelvic PT for a full hour-long session so they can have time to figure it out!
3. No aides or biofeedback.  You want to be getting hands-on treatment from your pelvic PT, not from a high school aide or being hooked to a machine that has you doing Kegels.
4. A dedicated pelvic health treatment space.  Look for a clinic focused on treating people like you - you shouldn’t have to walk past a group of high school athletes exercising in a gym to get pelvic physical therapy.  
5. A true specialist. Make sure your pelvic PT actually specializes in treating pelvic health cases.  Many orthopedic clinics claim they provide pelvic therapy, but the person has taken a single weekend course
6. Combination of internal and external physical therapy.  You need someone who is seeing the entire picture.  If they are either working only internally or only externally, they are missing have of the picture.
7. Hands-On, manual treatment. You should have someone who is actually working on your body.  With their hands.  Not having you do a set of exercises or Kegeling on a machine.

At PelvicSanity, almost 70% of our patients have been to other pelvic PTs before finding relief.  It’s not that pelvic physical therapy didn’t work - it’s that you didn’t have the right pelvic PT.  If you’ve ‘failed’ pelvic PT before, we hope you give it another shot - it’s extremely rare pelvic PT can’t help alleviate your pelvic health symptoms!

Finding Pelvic Sanity online group

Make sure to subscribe to this podcast and join the Finding Pelvic Sanity online group on Facebook.  Totally free, supportive and great information!

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 floor dysfunction is both incredibly common and poorly treated by our medical system.  It’s misunderstood and underdiagnosed.  Many patients struggle with symptoms for years before truly understand what’s going on and how to find relief.

We created this podcast to share practical, positive information about the pelvic floor with all of you!  We believe everyone with pelvic health issues deserved accurate information and a chance to get on the road to healing.

The pelvic floor is critical because it’s responsible for three of the most important bodily functions - peeing, pooping and sex.  Our body is hard-wired to care about this area, making pelvic floor dysfunction even more challenging to treat.

When the pelvic floor isn’t working well, we get the following types of pelvic floor symptoms:

• Pelvic pain, including diagnoses like interstitial cystitis, endometriosis, vulvodynia, pudendal neuralgia, piriformis syndrome, chronic prostatitis and more.
• Postpartum pelvic issues like incontinence, painful intercourse, diastasis recti, low back pain and prolapse
• Sexual pain and dysfunction in both men and women.
• Pregnancy issues like pubic symphisis pain, SI joint and low back pain, and pelvic floor muscles that aren’t ready for delivery
• Urinary symptoms like incontinence, urinary urgency and frequency, recurring UTIs and more
• Bowel health problems like constipation, pain or straining with bowel movements, hemorrhoids, fecal incontinence or smearing and incomplete emptying
• Prolapse and symptoms like pelvic pressure and heaviness

While these issues are common they are NOT normal and not something you just have to live with.  We hope each episode brings you just a little bit of pelvic sanity.

Finding Pelvic Sanity Group

If this was helpful, make sure to 1) subscribe to the podcast for all the newest 'sodes and 2) join the free online Finding Pelvic Sanity group.  It's a supportive community of more than 5,000 people, moderated by Dr. Nicole and the PelvicSanity team.  A great place to get practical, positive information and support!

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!