Tailbone pain is a common symptom and is integrally related to the pelvic floor.All muscles of the pelvic floor attach at the tailbone.  When these are tight and irritated they can radiate or refer pain to the tailbone itself.  The vast majority of the time there’s nothing wrong with the tailbone itself.  It’s actually a pelvic floor issue masquerading as a tailbone problem.Because of all the attachment to the pelvic floor, a hard fall on the tailbone or injury during childbirth can also be the initial cause of pelvic floor dysfunction.In research we’ve done at PelvicSanity, we’ve demonstrated a significant fall on the tailbone (enough that you still remember it years later) is linked to pelvic floor dysfunction later in life.This also brings up the importance of working with a pelvic floor therapist who is qualified to perform a rectal evaluation and treatment.Issues like tailbone pain, constipation, pain or straining with pooping, SI joint pain, and more are much more easily assessed and treated rectally.  Unfortunately many pelvic floor therapists haven’t received training in rectal treatment, and if you’ve been going to pelvic PT and aren’t seeing results, it’s often because this area is being overlooked.PelvicSanityIf you're dealing with chronic pelvic pain, coccydynia or other pelvic health issues, we'd love to help!  If you're local to Southern California, we can treat you at our Orange County, CA clinic.If you're not able to make it in, we offer both remote consultations (www.pelvicsanity.com/remote) and a comprehensive Out of Town Program (www.pelvicsanity.com/out-of-town) where we work with you for two weeks (or longer).About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

In the third trimester the ‘sixpack’ abdominal muscles separate to allow room for the baby to grow.  Within the first three months postpartum, in about half of women these muscles come back together properly.  In the other half a separation remains, known as a diastasis recti.We hear about this often as an aesthetic issue.  It can create a ‘mommy pooch’ or it still might look like you’re pregnant.  And while that’s a totally fine reason to seek care, the issue goes much deeper (quite literally).A diastasis means something in your core system is compromised and is linked to low back pain, incontinence, prolapse and painful intercourse.  It can be an underlying driver of pelvic health issues.In this episode we go through a simple self-evaluation to determine if you might have a diastasis, but the gold standard is a thorough evaluation from a pelvic floor physical therapist.  Most people go directly to trying exercises they find off the internet.  But there’s no one size fits all approach for treating a diastasis.  A pelvic floor therapist will identify why the muscles haven’t closed up, manually work to address the issue, and only then will exercises be effective.No matter how long it’s been you can absolutely still resolve a diastasis (without surgery).  Whether your goals are aesthetic or functional, treating a diastasis can improve both.About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

The answer will surprise you!  The myth that acidity in the body or bladder is responsible for IC symptoms is one of the most harmful out there.In this 'sode we go through why the pH of urine has no effect on symptoms, how 'acid in' does not equal 'acid out', and what we should be doing instead.  We hope this 'sode helps to free you from 'food jail' and you can become more confident in what you eat!The Myth:  Ingesting acidic foods or beverages makes urine more acidic, irritating the bladder and flaring symptoms.The Truth:  While some acidic foods are common triggers for IC, the body is extremely complex and 'acid in' doesn't equal 'acid out.'  Many foods that contain acid are considered entirely 'IC-safe,' while some basic (meaning non-acidic) foods and drinks can also be major triggers.  Furthermore, acidic urine has been proven to be no more painful than neutral urine for patients with IC.  The two rules of diet changes with IC are simple: avoid your personal trigger foods and eat healthy.  It doesn't have to be any more complicated than that.PelvicSanity Remote ConsultationIf you're local to Southern California, we'd love to work with you to address the 'why' of your symptoms and help you find lasting relief!If you're not in SoCal, we can still help!  Check out our Remote Consultation Program (www.pelvicsanity.com/remote) for how our team can get you on the path to healing.About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

There's a wide variety of expertise when it comes to pelvic floor physical therapy.  Unfortunately many patients have to go to several different ones before finding a true expert.You might think that finding a pelvic PT who has a lot of experience means you'll be getting great care.  But that's not necessarily the case.In this 'sode we discuss why experience doesn't necessarily equal quality.  In fact, sometimes more experienced therapists are still using outdated techniques they learned 20+ years ago, while someone newer to the field was trained in more contemporary methods.So what should you be looking for to ensure you get the best care?  Really, you're looking for three things:Specialty Clinic:  You want to find a practice that specializes exclusively in treating pelvic health.  It means they have more experience with people like you and is much more likely they have specialty training instead of just 'dabbling' in pelvic health.Hour-Long Treatment Sessions: You want to work hands-on and 1:1 with your pelvic PT for a full hour.  No aides, no watching you exercise, no double-booked patients so they can't focus on you the entire time.  These conditions are complex and you need time with the actual specialist!Both internal and external treatment at every visit:  Often it's only one or the other.  Some pelvic PTs don't have the skills to work outside the pelvic floor, and they are just doing internal or using biofeedback the whole time.  Others just 'check' the pelvic floor once and then treat entirely externally.  You need the combination to see the whole picture.Local to Southern California?We'd love to work with you to completely resolve your incontinence and pelvic floor issues.  If you're local to Southern California, please give our PelvicSanity (www.pelvicsanity.com) team a call - we'll be happy to answer any questions and get you started!Whether we're your first call or you've been to multiple other pelvic PTs and physicians, you can absolutely find lasting relief!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Incontinence is certainly common.  More than half of people have incontinence after a baby, it can accompany pelvic pain, prolapse, low back pain or following a surgery.  But it’s never normal, and never something you have to live with.Sometimes this is normalized - we joke about it with friends, or hear about it from our mothers.  But we often don’t recognize the profound effect of incontinence on our lives.We often abstain from exercising (which has life-long health effects).  We don’t feel comfortable doing certain activities with our kids.  It dictates what we can wear.  Many people find they are making a lot of sacrifices because of their incontinence they didn’t even think about. Fortunately, it’s absolutely something that can be resolved by a qualified pelvic PT - and generally without Kegels!Fundamentally, incontinence is the inability of the pelvic floor muscles to perform their job of holding back urine.But this doesn’t mean they are weak!  In fact, many times incontinence is actually due to overly tight and irritated muscles incapable of performing their normal job.Incontinence is not normal and not something you have to live with.  I’ve never had a patient not find improvement with pelvic PT, and the vast majority can completely eliminate incontinence without surgery, medication or a lifetime of padsLocal to Southern California?We'd love to work with you to completely resolve your incontinence and pelvic floor issues.  If you're local to Southern California, please give our PelvicSanity team a call - we'll be happy to answer any questions and get you started!Whether we're your first call or you've been to multiple other pelvic PTs and physicians, you can absolutely find lasting relief!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

For many people (almost 90% of those diagnosed with IC) tight muscles in the pelvic floor irritate the nerves running through the area.  One of the most important of these is the pudendal nerve.  So what symptoms might be caused by pudendal nerve irritation?  One is urethral burning or pain.  One branch of the pudendal runs right to the urethra, so it is often responsible for urethral pain or burning.The pudendal can also be the cause of urinary urgency and frequency.  It connects to the bladder.  Usually these nerves are ‘silent’, but with IC they are often activated and continue to send signals to the brain.  When the brain interprets these as the urgent need to urinate, we get urinary urgency and/or frequency.(Just a note - Often when we hear ‘pudendal nerve’ we do a Google search and see information about pudendal neuralgia.  This is obviously a scary diagnosis.  But what we are talking about here is pudendal nerve irritation.  We actually compare it to something we’re more familiar with - sciatica)So it’s definitely possible pudendal nerve irritation is driving symptoms.  There are many other nerves in the area which can be causing symptoms as well, so that’s where a pelvic PT can both figure out what is going on and work to address the issue.This also explains why many people with IC-like symptoms are given bladder-focused treatments (bladder instillations, Elmiron, hydrodistensions, etc.) without benefit.Finding Pelvic Sanity Facebook GroupIf you haven't already, make sure you join the Finding Pelvic Sanity online support group (www.facebook.com/groups/findingpelvicsanity).  It's a supportive group and moderated by the PelvicSanity team, so you know you're getting high-quality information.If you're local to Orange County (or can come here for treatment), we would love to work with you directly!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Have you heard or been told you 'just need to Kegel'?  Here's why that's never the answer to pelvic health issues.Kegels (or the voluntary squeezing of the pelvic floor muscles) are often one of the only areas of pelvic health we’ve heard about.  It’s often surprising to people to learn Kegels are often ineffective, antiquated and can cause flares or actually exacerbate symptoms.  Here’s why they are rarely used at all at PelvicSanity.1)  The majority of people with pelvic floor symptoms already have overactive pelvic floor muscles.  This means we want to be working to calm down the pelvic floor.  Help it to relax and stretch out.  Not adding a bunch more work for it to do!  Not only are Kegels ineffective, but can often flare symptoms for those with an overactive pelvic floor.  This is why Kegels are never recommended for those dealing with pelvic pain.2)  Even if you are weak, Kegels aren’t the best way to strengthen the pelvic floor.  Even for the small subset of people who truly do have pelvic floor weakness, Kegels are only one small part of the pelvic floor.If your goal is to run without leaking, how is laying on your back and staring at the ceiling the best way to train for that?  We need to get you up off the table and get your pelvic floor working in a functional manner again.3)  Kegels don’t find or resolve the underlying ‘why’At PelvicSanity we’re always about trying to find and address the root cause of your issue so it doesn’t return.The underlying why is usually outside the pelvic floor - in how you’re moving, in your back, or glutes, or hips, or ankles.  Unless we find and resolve the underlying why, symptoms will either return or crop up in a different way in the future.So if your pelvic PT was only doing Kegels or biofeedback, make sure you find a great pelvic PT for a second opinion.  And if you haven’t been to pelvic PT yet, let this be your call to action!Local to Southern California?Our expert team in Orange County would love to help resolve your pelvic floor issues for good - without a bunch of Kegels or biofeedback!  Give us a call or send us a message and we'll be happy to answer any questions and get you started!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Why do most specialty pelvic health clinics see patients for a full hour, 1:1 with the therapist?Ultimately it’s so we have time to ‘find the why’ for actual relief.  If you aren’t working with a qualified pelvic PT to ‘find the why’, one of three things happens:You don’t improve at allYou see little, temporary improvements that don't 'stick' Symptoms do improve, but end up cropping up somewhere elseFor most patients in pelvic floor physical therapy, internal evaluation and treatment of the pelvic floor muscles is extremely important.  This takes time and can’t (or shouldn’t be) rushed.Then we have to evaluate and treat the external contributing factors.  In fact, most of the time the ‘why’ is found outside the pelvic floor.  So we have to have time to treat externally in each session as well.  This could be treating the low back, mid-back, neck, hips, knees or ankles, depending on where the issue is coming from.If your PT is only looking internally at the pelvic floor, or only looking externally at the orthopedic issues, they are missing half the picture.The reason many physical therapy clinics don’t see you for a full hour is so they can make more money from the insurance company.  Financially, it doubles the clinic's revenue to have a PT seeing two (or more) patients per hour.  They do this by using aides, having someone watch you exercise or adding billable time with ice or e-stim at the end of your session.  Most specialty clinics reject this model.  It might be helpful for simple orthopedic issues, but it certainly doesn’t benefit patients with complex pelvic floor dysfunction.  And even though it might be more lucrative to rush patients through the door every half hour, most experts aren’t willing to compromise on the quality of care.So if you’ve been seen at a clinic for less than an hour, or had your PT seeing multiple patients at the same time, don’t give up on pelvic floor physical therapy!  Local to Southern California?If you're local to SoCal, give our team a call and let us help you find lasting relief!  And if you aren't, we offer a remote consultation program to get a second opinion on your case.About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

If you (or someone you know) has had a C-section, make sure to listen to this full 'sode!  As anyone who has had one will attest, a C-section is a major surgery.  And in the US, almost 1 in 3 give birth via a C-section.  But we are so cavalier about recovery!After every other major surgery you are immediately referred to physical therapy to aid in the recovery.  Make sure the wound heals correctly.  Ensure the scar moves smoothly.  Get back your range of motion and strength in the area.Except for C-sections (and other pelvic and abdominal surgeries).  There we just tell you to try and 'take it easy' (while dealing with a newborn) until it heals and hope it does well.A C-section scar can be a major driving factor of pelvic floor and abdominal issues.  It sits right above the bladder; if your scar is 'stuck' or adhered, it can make filling the bladder more difficult and contribute to urinary urgency/frequency.   The muscles of the abdomen are intricately connected to the pelvic floor and the low back.  A history of a C-section can drive low back pain and ultimately pelvic pain.We believe every person who has a C-section should be seen by a pelvic floor physical therapist to ensure they have a full and complete recovery.The good news is that no matter how long it's been you can still get help!  If you have other symptoms, make sure your pelvic PT is checking your C-section scar.  It should move and feel almost identical to the tissue around it.  It shouldn't be painful to touch or move or numb.  And if you have an aversion to touching it (or even looking at it), definitely a sign to see a pelvic PT and get it moving freely again!Remote ConsultationIf you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward.  Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward.  Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

With recent evidence Elmiron can cause long-term eye damage, many people with IC are reconsidering their use of the drug.  In this ‘sode we dive into the evidence for Elmiron’s efficacy and safety to help you make an informed decision.Elmiron remains the only FDA-approved oral medication specifically for IC and many urologists prescribe it automatically because of this.However, it’s unclear how much of a positive effect Elmiron has.  There have been five randomized, controlled trials with Elmiron.Two showed a slight benefit (a 25% improvement) for a small percentage of patients (between 15-16% compared to placebo)Three showed no benefit at all compared to a placebo and the largest trial wsa stopped early because the drug wasn’t shown to be effective.From the data, we have to conclude either Elmiron has no benefit at all, or at best has a slight benefit from about 15% of people.  And we are left to weigh whether that upside is worth the risk.Researchers have discovered Elmiron use is linked to eye damage (though it doesn’t happen for everyone on the drug).  This link gets stronger the longer you’ve taken the drug and the more of it you’ve taken.  The FDA has put a warning label on the drug and the company is being sued over it.  If you are on Elmiron, make sure to be getting your eyes examined by a retinal specialist.Other side effects of Elmiron have been called ‘mild’, but for many patients are anything but.  Significant hair loss is common, as is GI upset and other issues.  With questionable efficacy in question and significant safety concerns, it would be hard to recommend anyone starting Elmiron with what we know today.  If you have been on the drug and find it helpful it’s often a more difficult decision and one to make in consultation with your physician.  As with any change in medication, always make sure you discuss thoroughly with your physician.Remote ConsultationIf you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward.  Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward.  Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

In pelvic physical therapy you’re dealing with dysfunctional tissue, reduced blood flow, increased inflammation and in an area the body is wired to pay close attention to.  But pelvic physical therapy should never hurt.  We can’t treat pain with more pain.  And the idea of ‘no pain, no gain’ not only isn’t true, it’s actively harmful.Now, it can be uncomfortable, but there’s a major distinction.  You shouldn’t be trying to ‘bear’ treatment.  The discomfort should ease during the session as the PT works on the tissue.  And your pelvic PT should be checking in to see how you’re doing if they’re working on a tender area.In this ‘sode we discuss how to communicate with your pelvic physical therapist if things are hurting or if you need to seek a second (or third) opinion.  Because there is a lot your physical therapist should be able to do if you are having pain in one area.They can just work somewhere else (there’s plenty to do!).They can relax your nervous system first.They can use a different technique.They can postpone working on that area until a different day.They can help you find medical management to decrease pain before working there.You should never be in pain during pelvic floor physical therapy.  It’s counterproductive and harmful to the overall process.  If you are, make sure you say something to your pelvic PT.  And be prepared to get a second opinion if necessary!Remote ConsultationsIf you're struggling to get answers from your local practitioners or aren't sure what's next, PelvicSanity offers remote consultations to give you a concrete action plan going forward.  Our expert team will evaluate your entire case and give you our honest, clear recommendations going forward.  Check out our Remote Consultation program (www.pelvicsanity.com/remote) for all the details!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

In short, yes!  There's a reason every other surgery - foot, ankle, knee, hip, shoulder, back, elbow, hand, and many more - automatically results in you going to physical therapy to recover.Physical therapists are the experts in guiding recovery.  Making sure you continue to move well.  Guiding your body's healing response.  Ensuring scar tissue doesn't stick or 'adhere' and create problems.And with the exception of pelvic and abdominal surgeries, you'll automatically be referred to physical therapy to get post-surgical help.  Except in the areas where your most essential bodily functions happen!These surgeries are huge risk factors for later instances of pelvic pain, urinary issues, bowel and constipation problems, painful intercourse, and more.  The good news - no matter how long it's been, seeing a pelvic floor physical therapist can help you get back your proper motion, clear up scar tissue and relieve symptoms.Here is a partial list of the surgeries pelvic PT can (and should!) help with.  Also, if you're considering a surgery, make sure you 'pre-hab' with a pelvic PT.  Often we can help you avoid the surgery entirely, but if not we can set you up for success and ensure you get the best possible outcome!Abdominal Surgeries:Gall bladderHernia repairAppendectomyBowel resectionTummy tuckBreast augmentationAbdominal wall repairAny surgery that leaves a scar on the abdomen or goes in through the belly button (even if it's just a small incision)Delivery Surgeries and WoundsC-SectionEpisiotomyTearing with delivery (any grade)Pelvic/Gynecologic SurgeriesHysterectomyEndo surgeriesProlapse repairBladder slingsUrethral surgeriesAny pelvic cancer surgeriesProstatectomy Fibroids and cystsGender affirming surgeryAnd anything else done 'down there!'While it's frustrating you likely weren't told about pelvic PT to help prevent or recover from these surgeries, it's never too late!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Not everyone with IC experiences the same condition.  Symptoms vary.  The way they manifest is different.  Some people respond to certain medications while others don’t.This led researchers to propose several different types of systems to break IC into sub-categories called ‘phenotypes’.  The entire point of a phenotype is it needs to be 1) easily identifiable and 2) able to guide your treatment options.Early attempts to phenotype IC failed these criteria.  There remain other proposed phenotyping systems out there but they remain unproven, and frankly unhelpful and confusing.In it’s most recent IC Guidelines, the American Urological Association (AUA) simplified this into three distinct IC sub-types:Hunner’s Lesions: These are patients with discernable damage (Hunner’s lesions) to the bladder lining.  This represents less than 10% of all people diagnosed with IC.  If you’ve had a cystoscopy and they did not find Hunner’s lesions (even if they said it was ‘a little red’ or ‘angry’), you don’t have this subtype.  Pelvic Floor:  These are people with pelvic floor dysfunction either contributing to or driving their symptoms.  This is found in 85-90% of people diagnosed with IC, so is by far the most common and likely issue.  Pelvic floor dysfunction can be diagnosed with a pelvic floor examination by a pelvic floor physical therapist (not necessarily your urologist or OB-GYN).  Widespread Pain / Central Sensitization:  This sub-type occurs when the condition has been going on long enough to cause the nervous system to go into ‘overdrive’ and turn up the volume.  This phenotype is characterized by symptoms of IC plus pain outside the pelvis, sensitivity to light, tough, or pressure, a history of anxiety, depression, trauma or PTSD and other associated issues.  Of the phenotypes there is a lot of overlap in how they should be treated.  Pelvic floor physical therapy should be recommended for all different phenotypes.  Those with Hunner’s lesions need to have those medically managed, and those with central sensitization need to both stop the pain signals from the pelvis (through pelvic floor physical therapy) and also work to relax the upregulated nervous system causing additional issues through the body.Remember to focus less on the label and more on finding the practitioner(s) who can help you find relief!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

In short, our answer is ‘yes’.  With all of the physical challenges of pregnancy, delivery and the early post-partum period, we believe everyone should get pelvic floor physical therapy.  But let’s dive into why that is!First, let’s recognize in America we are significantly behind the rest of the world with this.  In many places in the developed world pelvic floor physical therapy is automatically prescribed to every single person after having a baby.Here’s why this is so important: 1. Pregnancy is nine months of body changes.  Things seem like they’re changing every day.  You move differently.  Your center of balance changes.  You’re likely dealing with some discomfort or pain (especially if you aren’t going to a pelvic PT during pregnancy).  You have increased demand on your pelvic floor for nine months.  These are massive changes to the body!2.  Delivery (no matter how you delivered) is a major trauma.  Giving birth vaginally is a marathon event.  The body is taxed to it’s outer limits - and beyond - for anywhere from 4 hours to 2 days.  And a C-Section is a major surgery!  3.  Postpartum has it’s own challenges.  Once baby is here, your daily life changes overnight.  You’re lifting and carrying.  You’re holding the baby to your chest to breastfeed.  You are hoisting car seats and carriers.  This often creates issues not just in the pelvic floor but in your back, hands, feet or other areas.The vast majority of people who delivery a baby have post-partum issues like:Low back pain (77%)Incontinence (50%)Diastasis recti (50%)Prolapse (30-40%)Painful Intercourse (40%)C-Section Scar Healing (25-30%)General Pelvic Pain (10-20%)Like anything else, these symptoms don’t get easier to treat the longer they are ignored.  We want to make sure we’re able to resolve these before they get worse or start impacting other areas.No matter how long it’s been since your delivery, pelvic floor physical therapy can help.  You don’t have to live with post-partum issues or feel disconnected from your body!Local to Southern California?If you're local to Southern California, make sure to give our office at PelvicSanity (www.pelvicsanity.com) a call.  About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

It’s a question we get asked at PelvicSanity all the time - ‘how long before I’m better?’The answer?  It depends.  But let’s dive deeper and discuss some of the factors that make pelvic floor physical therapy so complex and what you can expect.  We’ll also give you some takeaways to think about when you’re in pelvic PT.One of the reasons we don’t know is there are so many variables that affect how long it takes to improve with pelvic floor dysfunction.  These include both what’s going on with your body and what’s going on with you as an individual. These include (but aren’t limited to):The severity of your current symptomsHow long your current symptoms have been presentHow long pelvic floor dysfunction has been ‘brewing’ in your historyHow much your nervous system is involvedYour willingness to make lifestyle changesYour capacity to commit to treatment and your support systemWhether you have a history of traumaYour baseline health and ageWhat other practitioners you’re working withThe skill of your pelvic PT (they aren’t all created equal!)With that, it’s very difficult to know how long things will take until we really start working with you and seeing how your body responds.  However, a few takeaways for you:This will be variable, but you should have great communication with your pelvic PT.  They should answer your questions, not be defensive and not blame you for not improving….but they also likely won’t give you an exact answer to a question that isn’t knowable upfront.See a difference in 3-5 visits.  This isn’t necessarily even an improvement or a wholesale change, but certainly a difference in your body, how you’re feeling or at least some of your symptoms.It’s likely longer than you’re expecting/hoping.  Most patients are discharged too early, before they’ve truly found lasting relief of symptoms.  We need to ‘find the why’ and make sure symptoms go away, stay away and that you can manage on your own.  That process takes time - but when you go through it, the changes last!Finding Pelvic Sanity GroupIf you're struggling with pelvic floor issues, make sure to join Finding Pelvic Sanity, the free and supportive group moderated by the PelvicSanity team!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Pelvic floor dysfunction can cause a wide range of symptoms, include many types of pain, bowel issues, urinary/bladder issues and sexual dysfunction.Many times patients feel like there’s so many different things wrong, when in reality it’s all stemming from the pelvic floor.  By addressing and treating the underlying problem, we can make a substantial difference in these symptoms.  Issues the pelvic floor can cause include:Pelvic Pain, including pain in the genitals, deep groin pain, pain in the glutes or piriformis and tailbonePelvic Girdle Pain, which includes low back pain, SI joint pain, hip pain, and pain in the inner thighs or down the legs (including sciatica)Sexual Pain in both genders, which includes pain with intercourse, insertion, arousal, post-orgasmic pain, pain with ejaculation or erection, and a flare of symptoms after sexual activity.Bowel Symptoms include constipation, pain with bowel movements, incomplete emptying, having to strain, hemorrhoids, fecal incontinence or fecal smearingUrinary Issues include incontinence, urinary urgency, urinary frequency, incomplete emptying, a slow or hesitant stream, having to go at night (nocturia), and recurring UTIs.Sexual Symptoms include a lack of arousal, under-stimulation or over-stimulation, inability to orgasm erectile dysfunction and premature ejaculationOther Symptoms include prolapse, feelings of heaviness or pressure, diastasis recti (often in post-partum) and issues during pregnancy.That’s a huge list!  The pelvic floor is complex, it sits at the crossroads of the body, it has a huge number of nerves running through it and it controls massively important bodily functions!The good news is working with a great pelvic PT can address the common denominator of these symptoms and help you find lasting relief!Finding Pelvic SanityIf you're local to Southern California (or could come out for an Out of Town Program), we'd love to work with you at PelvicSanity!  If you haven't yet, make sure you've joined our supportive Finding Pelvic Sanity online community - moderated by the PelvicSanity team, it's full of practical, positive information and 5,000+ supporting members!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

One of the most common questions we get asked is whether your symptoms are truly IC or are they pelvic floor dysfunction.  It’s important to know that ‘IC’ is a description of symptoms.  It just means you’re experiencing pain you perceive to be coming from the bladder and urinary urgency/frequency.  But it tells us nothing about the ‘why’ of your symptoms or what treatments to try.It’s also important to realize that IC is not a bladder condition.  It’s a pelvic pain condition.  More than 90% of people diagnosed with IC have no discernable problem with their bladder.  Even those who do have Hunner’s lesions are not ‘cured’ when those are removed.  Among those diagnosed with IC, nearly 90% have confirmed pelvic floor dysfunction.  And at PelvicSanity, we’ve literally never seen someone with IC symptoms who didn’t have a pelvic floor component.It’s often down to your physician whether you get an IC diagnosis.  Some urologists don’t like saying ‘IC’ to patients because it leads them down the bladder-centric road of Elmiron, instillations and focusing on the ‘IC diet’.  Others are more liberal with the diagnosis and use it for any patient who has the symptoms that qualify.Ultimately, if you’re diagnosed with IC many - if not all - of your symptoms are likely coming from the pelvic floor.  So there’s a huge overlap between these terms.  It makes sense to focus less on the label and more on finding the practitioners who can help!IC Roadmap CourseIf you've been diagnosed with IC (or suspect you may have it), we have a full-length online course with all of the information you need to understand the diagnosis and formulate your plan for recovery.  You can find The IC Roadmap course here (www.pelvicsanity.com/icroadmap)!And if you haven't already, make sure you join the Finding Pelvic Sanity online community!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

We know going to pelvic physical therapy can feel intimidating.  It may be a reason you’ve put off seeking care.  So we want to pull back the curtain and help you understand exactly what will happen at your initial pelvic physical therapy visit.Ultimately, we want you to know two things about your first pelvic floor physical therapy appointment:You should feel completely comfortable at every stage, understand what’s going on (and why) and agree together on whether you’ll do an internal exam.  An internal exam is absolutely not required if you’re not comfortable with it, and doesn’t have to be done on the first day.  However, it is the gold standard of care and if you’re not getting an internal exam you’re missing a huge piece of your puzzle.You should leave feeling much more knowledgable, having a better understanding of what is going on and with a solid plan to improve.  We want you feeling much more hopeful when you leave and excited to start improving!Once you arrive you’ll be escorted into a private treatment room.  You’ll sit down - still completely clothed - and talk with your physical therapist about what’s going on.   Your physical therapist will then explain a bit about the pelvic floor and let you know how the rest of the evaluation will take place.They will leave the room to allow you to undress and put on a patient gown so you’ll be covered as much as possible during the rest of your exam.The pelvic PT will usually start with doing a thorough external evaluation, seeing how you move, bend and stand.  This will (or should be!) all standing and off the table.They will explain exactly what’s going on, and then - as long as you’re completely comfortable - proceed to the internal portion of the exam.  It will involve a single gloved finger evaluating the muscles of the pelvic floor.  This should not be painful and your physical therapist will make sure you’re comfortable throughout the process.So you should be completely comfortable throughout the initial evaluation, have great communication with your pelvic physical therapist, understand what’s likely causing your symptoms and leave with a solid plan for how to move forward!Finding Pelvic SanityIf you haven't already, make sure to join the free and supportive online group - Finding Pelvic Sanity!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

Interstitial cystitis (IC) is a scary and incredibly misunderstood diagnosis.  You may have also heard terms like ‘painful bladder syndrome’ or ‘bladder pain syndrome’ as well.  We want to shed some light on what IC is, how it’s diagnosed and what you can do about it!Definition of IC:  Interstitial cystitis is defined by the presence of two symptoms in the absence of any other explanation (like a UTI or bladder cancer).  It’s:Pain or pressure we perceive to be related to the bladder, and Urinary urgency or frequencySymptoms of IC:  In addition to the hallmark symptoms of bladder pain and urinary urgency/frequency, people often have other related issues.  These can include painful intercourse, low back pain, having to go to the bathroom at night (nocturia), pain with sitting or exercise, constipation and other pelvic health symptoms. Do I really have interstitial cystitis?  IC is a diagnosis of exclusion, which means it’s only diagnosed by ruling out other things (like bladder cancer or a UTI).  There’s no test that can confirm you have IC (including a cystoscopy).  If you have the symptoms above - pelvic pain perceived to be related to the bladder and urinary urgency/frequency - you can be diagnosed with IC just by the symptoms.Importantly, the IC diagnosis doesn’t tell you anything about WHY you have the symptoms or WHAT the best treatment option will be for you!Physical Therapy for Interstitial Cystitis.  The muscles and nerves of the pelvic floor can be responsible for every symptom of IC.  They can cause the bladder pain and urinary symptoms.  They are also the cause of seemingly unrelated symptoms like painful intercourse, low back pain, hip pain or constipation.  It’s the reason symptoms are often worse when sitting or after strenuous exercise, and why they can get better after gentle stretching or a warm bath.Physical therapy is the highest recommended treatment (Grade ‘A’) by the American Urological Association.  It’s literally the first recommendation you should get from a urologist when IC is suspected.  We hope this gives you a good overview of the condition, and we want to leave you with the first lines of The IC Solution (link): “Thousands of people with IC live healthy, happy and pain-free lives - and so can you!”About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!

All pelvic PTs - like any other provider - are not the same!  There’s a wide variety of experience and expertise when it comes to pelvic floor physical therapy.  So how do you find the right physical therapist for you?Find a pelvic physical therapist who specializes in pelvic health and isn’t ‘dabbling’ in the field.  Here’s a list of how to find a great pelvic physical therapist:True specialty health practice.  You don’t want someone who is ‘dabbling’ in pelvic health, or where pelvic PT is just an ‘add-on’ to a bigger practice.Hour-long sessions.  You should be seeing your pelvic PT for a full hour-long session so they can have time to figure it out!No aides or biofeedback.  You want to be getting hands-on treatment from your pelvic PT, not from a high school aide or being hooked to a machine that has you doing Kegels.A dedicated pelvic health treatment space.  Look for a clinic focused on treating people like you - you shouldn’t have to walk past a group of high school athletes exercising in a gym to get pelvic physical therapy.  A true specialist. Make sure your pelvic PT actually specializes in treating pelvic health cases.  Many orthopedic clinics claim they provide pelvic therapy, but the person has taken a single weekend courseCombination of internal and external physical therapy.  You need someone who is seeing the entire picture.  If they are either working only internally or only externally, they are missing have of the picture.Hands-On, manual treatment. You should have someone who is actually working on your body.  With their hands.  Not having you do a set of exercises or Kegeling on a machine.At PelvicSanity, almost 70% of our patients have been to other pelvic PTs before finding relief.  It’s not that pelvic physical therapy didn’t work - it’s that you didn’t have the right pelvic PT.  If you’ve ‘failed’ pelvic PT before, we hope you give it another shot - it’s extremely rare pelvic PT can’t help alleviate your pelvic health symptoms! Finding Pelvic Sanity online groupMake sure to subscribe to this podcast and join the Finding Pelvic Sanity online group on Facebook.  Totally free, supportive and great information!About UsDr. Nicole and Jesse Cozean are the founders of PelvicSanity Physical Therapy (www.pelvicsanity.com) in Southern California. The clinic has helped thousands of patients in the Orange County, CA area and hundreds from around the world with a remote consultation and Out of Town Program.They co-authored The IC Solution and Nicole created The IC Roadmap online course to provide the most accurate, up-to-date information for those with interstitial cystitis. They run the Finding Pelvic Sanity Facebook group for a supportive online community for anyone dealing with pelvic health issues.Nicole has also created courses and trained thousands of pelvic PTs to provide better care through her work with Pelvic PT Rising (www.pelvicptrising.com). Subscribe to the podcastFollow @pelvicsanity for great info!Join the Finding PelvicSanity support group Check out www.pelvicsanity.com for additional help! And as always, we hope this has helped you find just a bit of pelvic sanity!