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Feature Friday--Pelvic Floor

Updated: Nov 20, 2020

I am so excited to share this with you all! A fabulous and very well respected local Physical Therapist has written the following information about pelvic floor dysfunction. I personally have had many patients request her and recommend her by name. She has shared some great information with me...and has graciously agreed to share it all with you!

Pelvic floor dysfunction is very real, for MANY PEOPLE!!

...until next time


Dear Future Pelvic Floor PT Patient,

My name is Hayley Kava and I am a pelvic floor physical therapist. Many men and women’s quality of life is significantly impacted due to pelvic floor dysfunction.

Unfortunately, there are a few barriers to treatment in this area.

1. There are too few Pelvic Floor PT’s

2. Often people don’t feel comfortable discussing symptoms caused by pelvic floor dysfunction with providers (bowel, bladder or sexual dysfunction)

3. Even if they do find a PT and discuss these concerns with a provider – the actual pelvic floor “exam” and the unknown that comes from that appointment stops people from calling and getting help

I have attached the Cozean Pelvic Dysfunction Screening Tool to help you better understand if Pelvic Floor PT is right for you!

Once you know if you would benefit from pelvic floor PT it is still not uncommon to be worried or confused about what is going to happen at a pelvic floor PT evaluation and I wanted to write this summary to you to help provide you with as much information as possible to help you feel as comfortable and prepared in order to have the best experience as possible with any pelvic floor PT. Often not knowing is the worst part!

As a physical therapist with special training in the pelvic floor I work with all sorts of different types of people and conditions. Our pelvic floor has many really important functions, that help support our activities of daily living as well as high performance movements. The pelvic floor is like “sling” of muscles from our tailbone on the back to our pubic bone on the front and our “sit bones” on each side. These muscles are critical for:

Support (of our pelvic organs)

Stability (of our bony pelvis and skeleton)

Sphincter control (bowel and bladder control)

Sub-Pump (blood flow/circulation)

Sexual function (achieve/ maintain arousal/orgasm).

Peeing, pooping, having sex, and keeping our organs inside of us are pretty important functions don’t you think? Our pelvic floor also can play a huge role in back pain, hip pain, pelvic pain, abdominal pain due to their relationships in our body. I encourage anyone with longstanding back or hip pain, thst has not responded to “traditional” PT to seek out a PFPT as the symptoms may be caused by pelvic floor muscle problems!

Our pelvic floor really is our “foundation” and they work together in system with the rest of our body. I don’t like to think of these muscles in isolation, but how they interact and optimize the rest of your body’s function.

I always want to make it abundantly clear that you may stop this assessment at any time or refuse any assessment/movement you would not like to. Your therapist will be constantly checking in with you throughout to ensure your informed consent.

You are always entitled to a “Chaperone” to sit in the room when with a health care provider in a private room if that is what you would like. You may provide your own or one can be provided for you.

Next, I will to go over every aspect of an evaluation (as I would do it) so you know what to expect at this first visit. – Many therapist will follow a similar pattern


You may notice that the history form that you received was very detailed and asked a lot of personal questions (about bladder, bowel, sexual function, pregnancy, stress, diet, water intake ect) . I know this may seem overwhelming or uncomfortable to fill out. Feel free to put as much or a little information into these forms as you would like. We will always discuss more when you arrive and when/if you feel comfortable.


When you arrive and forms are complete you will come back into a private office and often you will review items from your intake form as well as many others. While we always want you to feel comfortable, and you have every right not to share, often symptoms related to the bladder, bowel or sexual function seem embarrassing. It is often helpful for patients to know that in this speciality we have heard it all! Often the symptoms you are experiencing are very common and we hear them ALL. THE TIME.

As always, as long as you are comfortable, I encourage you not to hold back. *

*There are circumstances in which I as a healthcare provider am obligated to report items told to me by a patient. In cases of active physical or sexual abuse or imminent suicide I am obligated to reports to the appropriate authorities. I always share this with clients so you can choose if you are ready to disclose this information to me or not.


This part of the exam you will be fully clothed.

Global Movement Exam: Since our body is a system we begin by looking at how you move. Sometimes, depending on your history we will also assess various functional tasks like squatting to jumping to running.

Special Tests: We will then assess some more specific mobility and strength tests of your global muscles and joints as well as some special tests to help us understand your unique patterns/compensations

Palpation: We may feel your abdomen and rib cage to assess thoracic and abdominal mobility as well as your breathing patterns.

We often can gain plenty of valuable information from this much of our exam. If this is all we have time for or all you are comfortable with the first day that is 100% ok!


At this section of the exam if you would like to proceed, you will undress from the waist down and will be provided with a sheet for over your waist and will lay on a soft table covered in a sheet. We don’t use stirrups (which people are often happy about)!

The therapist will then look at the muscles and the outer structures of your pelvis. They may ask you to contract, relax or gently bear down with these muscles to assess their mobility. They will then lightly touch the outside muscles on the surface to see if they are tender or in pain and how certain tissues move.

Next, they can assess these muscles in more detail by inserting a gloved lubricated finger into your vagina and or rectum (with consent) in order to assess for tenderness, pain, as well as the strength, endurance and coordination of these muscles. This internal exam should NOT be painful. We gather a lot of helpful information from this internal assessment but some people are not ready for this and that is OK. The goal is for you to leave this appointment confident and comfortable, not in pain.


After the assessment your therapist should have a fairly good idea of the areas we need to work on in order to help you reach your goals. We often providing education to you all along the assessment but we will use this time to discuss any further questions you have. We will also discuss your PT activities which you will complete on your own which are very important!

We will then discuss how often you will need to see your PT and start to estimate how long it will take to meet these goals. Sometimes our timelines and our expectations change but this provides us a rough guide.

If you are in Moore County: Sandhills Sports Performance, Appalachian Physical Therapy and Pinehurst Surgical all offer Pelvic Floor Physical Therapy

If you are not local to Moore County, below are two great resources to locate pelvic floor PT’s

Hayley Kava, MPT

· Hayley Kava is a pelvic floor PT and mother of 2 boys in Moore County

· She is currently working on projects outside the clinic while on maternity leave with her second child

· She co-hosts a podcast called “Don’t Beat Around the Bush Podcast” – on apple podcasts, spotify, and all popular podcast networks!

· She is active on her social media accounts- uploading up to date pelvic floor content in a fun, lighthearted way

· Facebook “Hayley Kava Physical Therapist and Instagram @hayleykavapt

· Can also be reached at

· Website (currently in development – stay tuned!)

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