Are you putting up with a little leaking when you sneeze or laugh too hard? How about other conditions “down there,” like painful sex?

It’s amazing what we convince ourselves we can “live with.” Unfortunately, there’s a price to pay for just accepting the changes that occur to your body over time. So if it’s the bathroom you’re always seeking, or the bedroom you’re avoiding, there are solutions to your pelvic health issues – and they’re easier than you may think.

We talked to Virtua physical therapist Michelle Peshick, who specializes in female pelvic medicine, to learn how physical therapy (PT) can help you regain comfort and control.

Q. How and when is physical therapy considered for treating pelvic conditions like incontinence?

A. PT is often one treatment of several different therapies performed or recommended by a specialist. Or, it may be a good first step to see what can be accomplished in a non-invasive manner.

Q. What is the most common reaction that women have when they hear about this type of therapy?

Q. Isn’t PT for “women’s issues” mostly about Kegel exercises?

A. Actually, there’s so much more to it than that. We use a lot of different techniques depending on the condition, and the “Kegel” is just one exercise that’s recommended. If done properly, Kegels help strengthen the muscles that support the bladder and other organs. But Kegels done in isolation aren’t typically enough to solve established incontinence.

Generalized muscle weakness in the whole body actually affects the pelvic floor. We often work with people to improve their overall muscle strength and, in particular, the core muscles (abs, back, pelvis area, hips). We tend to work a lot on core stabilization, strengthening the muscles that support the hips, and even balance. With improved muscle strength, we can make a difference in someone at any age, even 80 or older.

On the other hand, some women may be very physically fit but doing the wrong exercises. Crunches, for example, can aggravate and worsen pelvic organ prolapse. As women get older, the traditional crunch is not the best exercise because it forces pressure down to the pelvic floor muscles.

One more note about Kegel exercises: I want to caution that it's possible to do Kegel exercises wrong, creating more problems. That’s why it’s best for a physical therapist to guide your care.

Q. What should women expect in an initial appointment?

A. Some women are a little skeptical at first. They often come in with notes from their physician explaining what to expect from a clinical perspective. They may be frustrated because they feel as though they’ve been dealing with their problems on their own for so long. Or maybe they’ve tried other treatments or medicine that didn’t work. Some women may be fearful of what their body is doing, and the anxiety can make everything worse because their muscles are tense. We remind them that they’re completely in control, and that no question is off limits. I get many questions about bladder and bowel function, and sex.

All consultations are done with the utmost privacy and discretion. After an evaluation, I tell them what their best options are for treatment and recommend a plan of care. I let them decide what they’re comfortable with. Again, they’re in control.

Q. What are some of other techniques that might be included in a plan of care?

A. For pelvic pain, we may use manual techniques. If patients feel a little awkward, they may prefer to do it themselves, and I can teach them how to do it. Over time, any awkwardness usually dissipates. We also may recommend biofeedback, which uses an internal vaginal or rectal sensor. The sensor identifies the muscles that are involved in a Kegel exercise, shows the strength of the exercise as a woman performs it, and helps indicate if she’s doing it correctly. That gives me objective data so I can retest periodically to measure progress and identify new therapy goals.

Q. How much interaction do you have with your patients?

A. Treatment is very one-on-one; I work closely with my patients. When we aren’t doing hands-on therapies, we’re in a gym, but working closely together. I put a premium on understanding my patients and building trust.

Q. How does a patient come to you?

A. They may call us directly, but we recommend that they first talk to their physician. A specialist in female pelvic medicine or urogynecology is the best place to start.