It can be difficult to find the right provider to help you when you’re struggling with pelvic dysfunction including bladder or bowel incontinence, pelvic pain
With any provider you want to make sure they are the right fit for you. It is important that you look for the following:
They take time to listen to your concerns and goals. If your doctor isn’t listening to you, then how can they even understand what you need. They may start treating something you didn’t even think was a problem.
They work with you to create a treatment plan; taking into account your personal beliefs and practices. If a provider tells you to “eat healthier”, but you don’t have time to cook every night then it’s probably not going to happen! Plus, what does “eat healthier” can mean something different for each person. Some will cut out carbs, others add vegetables, others eat at home instead of fast food. You need a specific plan designed for you and your life so that you can be successful with any treatment recommended.
They have the skills to treat your condition. You don’t go to the gynecologist for help with knee pain. Gynecologists are valuable for other conditions such as PCOS, menstrual irregularities or vaginal dryness. Sometimes it’s obvious what specialist can help with your needs and at other times it’s more difficult. For example, pain with sex can be due to hormonal changes, pelvic floor tension, or fear and beliefs about sex. (These are not all the causes, just a few). Without knowing the cause you might go to the gynecologist first. That’s totally reasonable. And if they find something that doesn’t seem right, they’ll let you know and recommend a treatment. But what do you do when they tell you nothing is wrong. Remember they are trained to assess organs, vaginal health and hormones. They typically aren’t trained to assess the muscles, but Physical Therapists (PTs) are trained in this and would be able to help. It may take a few different specialists to get you the answers and correct treatment you need. That leads me to number four.
If they don’t have the answer they get you to someone who does have the right answer. The gynecologist may not see something wrong with hormone levels, the uterus or vagina but they may see that fear of pain with sex is causing muscle tension and pain. In this case a referral to a Psychologist trained in sex therapy and a Physical Therapist would be the best way they can help you.
Who should you see for urinary incontinence, urgency, retention or pain?
Urogynecologist (for people with a vagina)
Urologist (for people with a penis)
These doctors specialize in the urinary system and can test for infections that may be causing your symptoms. They’ll also be able to order tests to determine if your kidneys, ureters, bladder or urethra are not working optimally. If surgery is needed a Urologist or Urogyn will be able to perform the surgery.
Pelvic health PT
These doctors specialize in treating the whole person and will evaluate your pelvic floor, hips and abdominals for changes in muscle coordination and strength. We’ll also discuss dietary factors, stress and anxiety, and toileting habits that affect your bladder function.
Who should you see for bowel incontinence, urgency, or constipation?
Gastroenterologist - Better known as a GI doc. These specialists focus on the Gastrointestinal system from the esophagus to the anus. If you have heartburn, GERD, pancreas or liver problems, blood in your stool, vomiting, diarrhea or constipation the problem is likely in the GI system.
Colorectal Surgeon - Now we’re focusing on the intestines. Prolapse, resulting in heaviness and pressure in the pelvic region may require surgery. You’d also see a colorectal surgeon for a colonoscopy, rectal cancer, fecal incontinence, and fissures or hemorrhoids.
Pelvic Health PT is an important part of improving GI function. We will assess the pelvic floor mobility and strength as well as the mobility of the organs, abdominals, and the back. We’ll assess your eating habits and nutrition and how it affects your bowel routine. Any bowel habits that are interfering with normal functioning will be assessed and addressed.
Who should you see for pubic, coccyx, hip or back pain?
Orthopedic Surgeon - The surgeon will likely order radiographs (x-rays) or an MRI. This can be helpful if you’ve had physical trauma such as a car wreck or help the surgeon anticipate what surgery will be needed.
OBGYN - If you’re pregnant or recently gave birth you might reach out to your OBGYN or midwife to ask about these as many occur during pregnancy. Don’t be discouraged if you get told that your back pain is just part of pregnancy. Ask for a referral.
Pelvic Health PT - I will assess the muscles, joint and nerves in order to determine where the problem has occurred and recommend an appropriate treatment specific to your goals.
This isn’t an exhaustive list. You can always go to your PCP who will refer you to one of these specialists. There are also Integrative Medicine Practitioners, Doctors of Osteopathic Medicine and others. I want you to understand that if you are looking for answers and the first provider you see doesn’t have them, you can and should get a second opinion. Sometimes that may be within the same specialty and sometimes it is a different specialty.
Pelvic Health PT can be an important step in finding the right provider. Not only do we look at the whole person including emotional, mental and physical health, but we see how the systems interact and can offer an alternative treatment approach.