What is a pelvic floor PT?

Q&A with Rachel Jalanivich

It's important to decide while navigating pregnancy what kind of experience and care you want. You will be building a team of support for the pregnancy, labor, and postpartum journey...so who are you going to have on your team? Some examples could include: OBGYN, Midwife, doula, lactation specialist, physical therapist, chiropractor, etc. It can extend to other areas too like a meal train coordinator, house sitter, dog sitter, care giver for other children, and the list goes on. 

Today we wanted to focus on the role of the physical therapist. Through another female founder, I got connected to Rachel Jalanivich.  Rachel is a physical therapist focused on the pelvic floor. I sat down with Rachel to hear first hand about her practice, the role of a pelvic floor PT, and a little bit about her philosophy.

As an aside, I can tell you from my personal experience that my pelvic floor PT changed my life. I am forever grateful for her and her care. 

I started with the most basic of questions...

What is a pelvic floor physical therapist?
A pelvic floor physical therapist is a Doctor of Physical Therapy who has taken additional training to specialize in treating pelvic conditions. We help you find relief from leaking, pelvic/ hip/ low back pain, abdominal separation, prolapse, chronic UTI’s, difficulty with bowel movements or urination, frequent urination, and so much more!

Christine: How did you decide to get into this line of work? 

Rachel: Oh this is quite a long story, but in a nutshell, I was a failed patient and wanted nothing to do with becoming a pelvic PT. Even when I was initially in my doctorate program, I wanted to work with amputees; until I took the prosthetics course and hated it! A few months later, I was sitting with some very well educated friends one day and they were talking about laughing and peeing; I told them, “Hey, you know that’s not normal, right?” They rolled their eyes at me and said, “You just wait. You’ll be just like us once you have babies.” In that moment I realized two things: 1) If these highly educated intelligent women believe this, that means messaging that "incontinence is normal" must be a systemic problem. And 2) I was destined to become a pelvic floor PT.

Christine: How are pelvic floor PTs a part of the pregnancy, birth, and postpartum journey? 

Rachel: We are so integral! I help progress the the patient through a pain-free pregnancy (or help decrease or eliminate pain/discomfort that arises). I teach birth positions, make sure they know how to relax the pelvic floor in each position, help them choose birth positions they tolerate best, teach perineal stretching, and teach them the best way to push to avoid tearing.

Postpartum, I like to see patients at 2 weeks (of course, no internal work at this point.) I teach them how to reconnect to their pelvic floor, how to lift the baby without creating prolapse, discuss lactation and their breastfeeding journey, discuss cesarian scar healing if applicable, and give them gentle movements that are safe at this phase. After their two week appointment, I will see them to help them return to their fully functional life and help them return to their favorite activities and sports!

Christine: Would a pelvic floor PT replace another caregiver in the pregnancy and birth journey? 

Rachel: Not even a little bit! I may have some overlap with other professions but what I help with is so unique and different from doulas, midwives, personal trainers, and your OBGYN.

Christine: What are the things expecting mamas should think about when selecting pelvic floor PT?  

Rachel: Definitely know your goals. I want to hear about what kind of birth you want, where you are planning on birthing, who is already on your birth plan, what kinds of physical activities are you already doing/what have you stopped doing/ and what would be your postpartum goals to get back to! 

As far as selecting a postpartum PT, the number one thing is going to be personality fit. What we do is so intimate that you MUST feel safe and secure with the PT to maximize your healing. You’ll want to select someone who is knowledgeable about progressing you from pregnancy to birth and from postpartum to full function. It would be great to find someone in your local area, but don’t discount how much we can accomplish through Telehealth if you can’t find the right fit in your city.

Christine: What are common confusions women/couples have about pelvic floor PT? 

Rachel: That all we do is kegels!! :(

The thing is, kegels are great for some people, some of the time. And can make matters worse for some patients. Your pregnancy journey probably isn’t the time to focus on these, as we really need to train your pelvic floor how to relax. Pelvic floor physical therapy is SO MUCH MORE than kegels!

Christine: What are some of the common concerns or diagnosis that you treat? 

Rachel: The most common diagnoses I treat are stress incontinence (leaking urine with laugh/cough/sneeze/jumping), urinary urgency/frequency, and pain with intercourse (dyspareunia). As a reminder, NONE of these are normal! ;)

Christine: What's the cost of a Pelvic Floor PT- covered by insurance?

Rachel: Pelvic Floor PT’s vary in cost but are typically $130-220 per visit. You might find one covered by insurance in your area, but you will typically only receive 30-40 minutes with them each visit, which isn’t much time when it comes to birth prep and recovery. I chose to stay out of network with insurance so that I can give patients the care they deserve: a full hour, without handing patients off to an assistant for part of the visit, and I have the time to find root causes of the pain or symptoms so they get better faster! I’m even able to help patients get reimbursement through their insurance and I can accept HSA and FSA cards as well! I am also direct access, which means you do not need a referral to see me! My rates are listed publicly on my website www.empowered-physicaltherapy.com!

Christine: Anything else you want to share? 

Rachel: The best time to see a PT is before your symptoms begin or become chronic (chronic is 3 or more months!) But even if your symptoms are chronic, even decades long, there is still hope! Leaking, pain, and discomfort are never normal, and you are not meant to live this way!