What questions should I ask a pelvic health therapist to assess their qualifications, experience with pelvic conditions, and treatment approach?

What to Ask a Pelvic Floor Therapist About Their Expertise

Before beginning treatment, verify that your pelvic floor therapist has specific training in anorectal dysfunction (not just urinary incontinence), uses equipment that provides real-time biofeedback during simulated defecation, and can demonstrate competency in internal examination techniques—because many therapists are trained primarily for urinary problems and lack the specialized skills needed for complex pelvic floor disorders. 1

Essential Qualifications to Verify

Scope of Practice and Training

• Ask whether the therapist is trained and experienced in treating anorectal disorders specifically, not just urinary incontinence, as many pelvic floor physical therapists receive more training in urinary dysfunction than in defecatory disorders 1
• Confirm that the therapist performs internal digital examinations to assess pelvic floor muscle function, as this is an authorized activity that cannot be delegated to physiotherapy assistants 2
• Verify that the therapist has received formal instruction in pelvic floor assessment and treatment, as proper technique instruction from trained healthcare personnel is essential for optimal outcomes 3

Equipment and Treatment Capabilities

• Ask whether the therapist has equipment that provides simultaneous feedback on abdominal push effort AND anal/pelvic floor relaxation during simulated defecation, as this is critical for treating dyssynergic defecation but often lacking in standard physical therapy settings 1, 3
• Confirm the therapist uses anorectal probes with rectal balloons to simulate stooling during biofeedback sessions, which is essential for providing proper feedback during attempted defecation 1, 3
• Verify availability of real-time visual feedback systems (such as EMG surface electrode feedback or voiding curve displays) that allow you to see when you are properly contracting or relaxing pelvic floor muscles 3

Critical Questions About Clinical Experience

Condition-Specific Expertise

• Ask how many patients with your specific condition (dyssynergic defecation, fecal incontinence, pelvic pain, etc.) the therapist has treated, as experience with your particular diagnosis matters for treatment success 1
• Inquire whether the therapist treats both urinary AND anorectal problems, because therapists who focus primarily on urinary incontinence may lack expertise in bowel dysfunction 1, 2
• For dyssynergic defecation specifically, ask if the therapist focuses on pelvic floor relaxation training rather than strengthening exercises, as the pathology involves paradoxical contraction, not weakness 3, 4

Treatment Approach and Protocols

• Ask what the typical treatment protocol involves: effective programs should include 1-2 sessions per week initially, combined with mandatory daily home exercises, for a minimum of 3 months 3
• Verify that the therapist will teach you a structured home exercise program with specific parameters (6-8 second contractions or relaxations, 6-second rest periods, 15 repetitions twice daily), as home practice is essential for success 3
• Confirm the therapist measures objective outcomes such as post-void residual volume, flow rates, and symptom diaries to track progress 3, 4

Red Flags and Common Pitfalls

Inappropriate Treatment Approaches

• If you have pelvic floor tenderness or pain, confirm the therapist will NOT prescribe Kegel strengthening exercises, as these worsen symptoms in patients with pelvic floor hypertonicity; manual trigger point release is the appropriate treatment instead 3
• Be wary if the therapist recommends the same strengthening protocol for all pelvic floor conditions, as approximately 50% of healthcare providers incorrectly believe Kegel exercises are appropriate for all presentations of pelvic floor dysfunction 2
• Question any therapist who claims internal examinations can be performed by assistants, as 90% of healthcare students incorrectly believe this is permissible when it is not 2

Inadequate Assessment Capabilities

• Ask whether the therapist will assess ALL pelvic compartments (bladder, bowel, and reproductive organs), as pelvic floor abnormalities frequently involve multiple compartments simultaneously and require comprehensive evaluation 3, 4
• Verify the therapist will address behavioral and psychiatric comorbidities concurrently, as anxiety and fear often perpetuate pelvic floor symptoms and impair treatment adherence 3, 4
• Confirm the therapist has a plan for managing constipation aggressively and long-term, as this is often discontinued too early and may need maintenance for many months 3, 4

Insurance and Access Considerations

Coverage and Billing

• Ask whether the therapist accepts your insurance and verify coverage for biofeedback therapy specifically, as Medicare covers it but some private insurers do not, and coverage varies by state and indication 1
• Clarify who will be performing the biofeedback sessions, as recent billing code changes restrict who can provide certain types of biofeedback therapy under physician supervision 1
• Inquire about the total number of sessions typically needed and whether your insurance limits the number of covered visits per year 1

Treatment Setting Options

• Ask whether home-based biofeedback options are available, as home-based therapy is significantly more cost-effective with similar efficacy to office-based treatment, though devices for constipation are currently lacking 1

Expected Outcomes and Success Rates

Realistic Goals

• Ask what success rates the therapist achieves with patients similar to you, as comprehensive biofeedback programs can reach 90-100% success rates for appropriate candidates 3
• Verify the therapist defines success objectively through improvement in voiding/bowel diaries, flow rates, post-void residual measurements, and frequency/severity of symptoms 3
• Understand that biofeedback therapy yields success rates exceeding 70% for pelvic floor dyssynergia and is considered the gold standard treatment over laxatives 3

Prognostic Factors

• Discuss whether you have favorable prognostic indicators: intact continence, willingness to engage in therapy, lower baseline constipation scores, and absence of severe psychiatric comorbidities all predict better outcomes 3
• Understand that your commitment to daily home exercises is essential, as comprehensive programs that include home training achieve markedly higher long-term success than clinic sessions alone 3