“Are you leaking when you run?”
Early in my career, I worked in a traditional sports medicine clinic, seeing patients for hip pain, back pain, and sports injuries. Time and time again, I’d have a patient who was months postpartum sitting in front of me for a completely unrelated ache, and when I finally asked that one question, the answer was almost always yes. It was almost always followed by, “Nobody’s ever asked me that before.”
The pelvis had been treated as a black box for too long, separate from the rest of the body, and separate from the conversation. That gap is exactly why I became a pelvic floor and orthopedic specialist, and why I built Holistically Well the way I did. In this post (and in episode 65 of the podcast), I’m pulling back the curtain on what a real pelvic floor PT evaluation and treatment session actually looks like, so you know exactly what to expect before you ever book.
Why the Pelvic Floor Gets Overlooked
In most orthopedic and sports medicine settings, the pelvic floor simply isn’t part of the exam. Patients recovering from a C-section are sent home without ever having that scar addressed. Athletes with leaking are told it’s just part of training hard. Meanwhile, that same pelvic instability is often quietly driving the hip pain, back pain, or tailbone discomfort that brought them in for care in the first place.
That’s why at our practice, we treat the whole picture, orthopedic and pelvic floor together, whether you’re working with us in our Sidney, Ohio office or virtually from anywhere.
What Brings Women to Pelvic Floor PT
There’s no single reason to book a pelvic floor physical therapy evaluation. Some of the most common stories we hear:
- Leaking urine when running, jumping, sneezing, or laughing
- A sudden, strong urge to go that’s hard to control (urge incontinence)
- Pain with tampon insertion or intimacy
- A heaviness or pressure sensation, a sign that could point to prolapse
- Preparing proactively for pregnancy, or wanting optimal support during pregnancy itself
- Healing after a tear in childbirth or episiotomy, and wanting to confirm everything is recovering well
- New changes in perimenopause or menopause, like vaginal dryness or achy joints
- Longstanding hip or back pain that hasn’t resolved with other orthopedic or sports medicine care
If any of this sounds familiar, whether you’re thinking ahead about preconception care, navigating pregnancy, or healing postpartum, we have a program built around exactly that season of life.
Inside Your First Visit
The Subjective Interview
We start with your story, in a comfortable chair in our boutique office (or from your couch, if you’re a virtual patient). No clipboard interrogation, just a real conversation about your symptoms, your history, and what you’re hoping to get out of care.
The Whole-Body Assessment
From there, we move to the table to check strength, joint mobility, and alignment, your rib cage angle, pelvic alignment, and leg length among them. A rotated pelvis puts uneven strain on the hips and can shorten some muscles while overstretching others. If stretching alone has only ever given you short-term relief, this is usually why.
Posture and Movement
Next, we watch how you actually move day to day: how you stand, squat, and hip hinge. Even something as ordinary as holding your baby on your chest all day can flare the rib cage and lock down the back muscles. Because this piece is entirely visual, it translates well over video, which is exactly how we’re able to offer this same evaluation virtually.
The Breath Assessment
This is one of the most telling parts of the whole evaluation.
We watch you breathe lying down, one hand on your chest, one on your belly. When the diaphragm drops properly, it should gently press down into the pelvic bowl, allowing the pelvic floor to lower and lengthen with each breath. Many women are instead breathing high into the chest, bracing through the shoulders and neck, which keeps the pelvic floor from ever fully relaxing. If that connection is hard to feel lying down, we’ll often move you into a child’s pose, which redirects the breath toward the low back, glutes, and pelvic floor.
Treatment Starts on Day One
Because we work outside of the insurance model, we’re not spending your visit checking documentation boxes. We’re free to treat you based on what you actually need, starting in that very first session, and you’ll leave with a clear home program that is emailed directly to you.
What About Internal Assessments?
Yes, we do offer internal assessments, but they’re rarely the first thing we do.
We prefer to understand the full picture, posture, alignment, breath, and lifestyle, before going there. That said, there are cases where it makes sense on day one. A patient who came in with a second-degree tear and localized pain, for example, found relief within that very first visit once we addressed the scar tissue directly. Every plan is built need by need, and you are never pressured into an exam you’re not ready for.
You Don’t Need to Feel Embarrassed
I’ve been on the other side of this. So have our team of orthopedic and pelvic health physical therapists.
I dealt with leaking through every high school cross country season and was told it was normal. I’ve had four children, including a home birth with an audience of midwives, a doula, and a birth assistant in the room. Any hesitancy around this part of the body tends to disappear pretty quickly after that.
This is a sacred, private part of you, and it’s also a part of you that deserves support when you need it, whether that support looks like your OBGYN, your midwife, or pelvic floor physical therapy.
Ready to Get Started?
If you’re local to Sidney, Ohio, we’d love to see you in our office. If you’re elsewhere in Ohio, we can see you virtually for physical therapy. And if you’re outside the state entirely, we offer holistic wellness consulting so we can still support your questions and goals.
Not ready to book? Grab our free postpartum recovery guide or explore the Holistically Well toolkit for our go-to supplement and product recommendations.
This topic goes even deeper on the podcast. Whether you’re a listener, a reader, or a watcher — there’s a version of this conversation waiting for you. Tune in on Apple, Spotify, or YouTube, and if it resonates, a review helps more women find their way here.
Listen on Apple | Watch on Spotify | Watch on YouTube
