Pelvic Floor Rehabilitation
Specialized rehabilitation for bladder control, pelvic pain, and recovery after surgery
Pelvic floor problems are common, and we’re learning they are the root cause of several chronic urologic conditions that significantly impact everyday life. Bladder leakage in both men and women, frequent or sudden urges to urinate, and chronic pelvic/groin pain can affect your work, exercise, sleep, relationships, and confidence. We are also now understanding the vital role of the pelvic floor in optimal recovery after robotic prostatectomy. We are so excited to now be able to offer true pelvic floor rehabilitation within our actual office. Unlike many practices, it is usually covered by insurance and even when your deductible is very high, we can offer a cash pay price that is still well below the average in the area.
Understanding the Pelvic Floor
The pelvic floor is a group of muscles and tissue at the base of the pelvis. It helps help support the bladder, bowel, and pelvic organs and plays an important role in bladder control, bowel function, sexual function, and movement.
Like muscles elsewhere in the body, pelvic floor muscles can become weak, too tight, painful, or difficult to coordinate. When that happens, you may notice symptoms such as leakage, urgency, pelvic pressure, pain, or difficulty relaxing the muscles.
Pelvic floor rehabilitation focuses on understanding how your muscles are functioning and helping you improve strength, relaxation, coordination, and control. Treatment is individualized because pelvic floor problems differ for every patient.
Pelvic Floor Muscular Tightness
It is only recently that we have come to understand that pelvic floor muscular tightness or dysfunction is the root cause of so many chronic problems in men or women. In the past, before we came to this understanding, nearly everything associated with pelvic pain in women, including painful intercourse, would have perhaps been blamed on a very specific but very overused diagnosis of interstitial cystitis or chronic urethritis or endometriosis. Usually these diagnoses were poorly applied and lent themselves to the overuse of invasive tests or treatments such as laparoscopy looking for endometriosis, bladder dilations or instillations under anesthesia, or chronic sequential urethral dilations. Bladder dilation and urethral dilation would sometimes relieve chronic pain, but we now know this only as a reflex arc where dilation of the bladder or stretching of the urethra leads to pelvic floor relaxation. Now, we seek to relax the pelvic floor directly through pelvic floor rehabilitation.
Likewise, in men with chronic pelvic pain, urinary burning, or even chronic testis pain, one diagnosis was always given: chronic prostatitis. This led to severe overuse of antibiotics for a problem we now know was never infectious. We know now that it was the pelvic floor as the culprit, not the prostate. Similarly, men would undergo physical manipulation of the prostate for relief. Similarly, we now know this only relaxed the pelvic floor.
And for male incontinence, we know that after prostatectomy the opposite is true. Here, the pelvic floor is too relaxed, and with pelvic floor rehabilitation we seek to speed up the time until the pelvic floor muscles regain their preoperative tone.
A Patient's Experience
I am delighted to provide a testimonial regarding the program, which I found to be exceptionally well-designed and highly effective. Within just a few weeks of beginning the rehabilitation, I observed significant and tangible improvements in my condition, which has positively impacted my daily life. A key aspect that I found particularly valuable was the outstanding professionalism and expertise of your staff. Their friendly demeanor and deep knowledge were consistently evident, providing me with confidence and support throughout my treatment journey. I would enthusiastically recommend this program to any prospective patients. It truly stands out as a "Great Program" that delivers noticeable results through dedicated and knowledgeable care.
Pelvic Floor Rehabilitation for Men
Pelvic floor rehabilitation is often associated with women’s health, but it can also be an important part of care for men.
A common reason men need pelvic floor rehabilitation is before or after prostate surgery. Prostate surgery can temporarily affect bladder control, and pelvic floor rehabilitation can help patients relearn how to use the muscles that support continence more effectively.
When appropriate, rehabilitation may begin before surgery. This gives patients time to learn where the pelvic floor muscles are, how to activate them correctly, and how to perform exercises before they also have to deal with the normal challenges of recovery.
After surgery, rehabilitation can help them gradually improve muscle control and reduce urinary leakage as their body heals. Pelvic floor rehabilitation is not mandatory after surgery in Dr. Engel’s practice – it is purely voluntary. We may recommend it if our staff uncovers an inability to use these muscles. Many patients choose to do it to maximize their recovery in the shortest time frame.
Men may also be referred for chronic pelvic pain, groin or testicular discomfort, urinary urgency or frequency, painful ejaculation, difficulty relaxing during bowel movements, or symptoms associated with chronic pelvic pain syndrome. In some cases, these symptoms are related not to weakness but to overly tight or tense muscles.
Pelvic Floor Rehabilitation for Women
The pelvic floor can be affected by many changes throughout a woman’s life, including pregnancy, childbirth, hormonal changes, aging, pelvic surgery, and other medical conditions.
Pelvic rehabilitation may be helpful for women who experience bladder leakage when coughing, laughing, exercising, or lifting. It may also help with sudden urinary urgency, frequent trips to the bathroom, or difficulty controlling the bladder.
Treatment is based on a woman’s individual symptoms and goals. For some patients, strengthening is important. For others, the priority may be learning how to relax the pelvic floor and reduce muscle tension. Our therapist will help determine what each patient’s body needs rather than assuming that every pelvic floor problem should be treated the same way.
A Patient's Experience
As a reasonably fit 67 year old guy, after diagnosis, a considered discussion with my physician about treatment options and the choice of prostatectomy, my real cancer journey began. Incontinence & ED post-op, were life changing, life altering events and requiring daily attention and preplanning. Losing bladder control initially required 12-14 pads daily. It’s more than just monitoring and moderating fluid intake. Traveling with Depends, discarding them discreetly in social settings, at friend homes, during the workday or changing a Depends on a plane at 30,000 ft. is no joke. And checking an additional bag on an international flight and long trips - with IC supplies just to be sure you don’t run out -- is a thing. About a month and a half post-op, I went to a PT, fee-for- service, who put themselves out as an incontinence specialist, and 3 months and thousands of dollars later I had mastered about 10 of more than a dozen pelvic floor exercises, but had gained no more functional urinary control. I had discussed with my wife about various surgical interventions, from the urethral sling to the artificial sphincter. But I wanted to give it a year before making a commitment to something invasive. Dr. Engel, MD told be about an innovative pelvic floor rehabilitation program he was partnering with that held promise and he stated, “we are going to get you dry…” I began the PFR program in late August, 2026. Interesting enough they use exercise, technology, biofeedback, and STM to create a personalized, precision medicine approach to addressing male incontinence and ED. The PFR staff are amiable, professional and compassionate about their work. The in-office sessions are brief, discreet, pain free and very informative; you can actually track your progress from week to week. About four weeks into the program, I experienced a marked improvement in urinary retention & less linkage between urinations. It went from 8 + pads a day to four. But the program is no panacea, you have got to put in the work, and if you cheat - it shows. The real breakthrough was that passive leaking markedly improved. And I can now consider using underwear brief shields instead of being totally depended on “Depends.” The lead PFR technician Ms. Pfannenstein stated that the goal is to get down to “two pads” a day, in the initial series. Through my sixth treatment visit, I am virtually at that goal, eleven months post-surgery. Everyone’s personal and physiological situation is different, but the PFR program worked and has transformed my activities of daily living. I have regained greater bladder control and confidence, and residual & stress leakage is very manageable. I am better than 85%+ towards my goal or to put it another way 85% better than I was 3 months ago. And for me that is a gamechanger --- as a I continue my prostate cancer journey. Here’s wishing you all the best on yours.
Frequently Asked Questions
We understand that pelvic health concerns can feel very personal.
Before your first appointment, our technician, Shannon, will begin by talking with you about your symptoms, medical and surgical history, daily activities, and treatment goals. This conversation helps us understand not only what you are experiencing, but also how those symptoms are affecting your life and any financial considerations for your treatment program.
Your first appointment is private, respectful, and focused on helping you feel comfortable. Your evaluation may include looking at posture, breathing, movement, strength, and muscle coordination. Depending on your symptoms, your therapist may also recommend a more specific pelvic floor examination.
Pelvic floor rehabilitation is not a one-size-fits-all program. Your treatment plan will be based on your evaluation findings and the goals that matter most to you.
Treatment may involve learning how to correctly activate or relax the pelvic floor, improving breathing and movement patterns, strengthening supporting muscles, or using gentle hands-on techniques when appropriate.
Your technician may also discuss bladder or bowel habits and recommend changes that can help reduce symptoms. You will typically receive exercises or strategies to practice at home so the progress you make during therapy can carry over into daily life.
As you improve, we can adjust your treatment plan. The goal is not simply to complete a certain number of visits. It is to help you develop the strength, control, comfort, and confidence to manage your symptoms more independently.
Access to specialized pelvic rehabilitation can sometimes be difficult because many patients find that pelvic health services are offered outside of their insurance network.
By providing pelvic rehabilitation within our urology practice, we can accept many insurance plans. Please contact our office to learn more. Insurance benefits vary by plan.
Our team can help verify your rehabilitation benefits and explain the information your insurance plan provides before treatment begins. We want you to better understand your coverage and expected responsibilities as you plan your care.
There will be no surprises whatsoever, as we are dedicated to giving each of our patients a full understanding of their costs, if any, before they begin their pelvic floor rehabilitation program.
Physical therapy generally involves muscular exercises, whereas pelvic floor rehabilitation, which the literature suggests is far more effective, not only includes muscular exercises but is also highly physiologic and uses devices such as pressure monitors and nerve stimulators.
Meet Shannon, Director, Pelvic Floor Rehabilitation Program
Shannon Pfannenstein leads our Pelvic Floor Rehabilitation Program. She brings a unique combination of operating-room experience, medical device expertise, and specialized pelvic-floor training to the care of patients with incontinence, pelvic pain, and related pelvic-floor disorders.
She began her career in the operating room of a Level I trauma hospital, working in orthopedics. She later joined Stryker, supporting the Mako robotic system and then moved into urology and pelvic-floor diagnostics, selling the UroVal Bulbocavernosus Reflex System (BRS).
Through that work, she met Dr. Mike Bradley, founder of New Image Medical in Las Vegas, Nevada. Shannon completed her training and certification in the Pelvic Floor Rehabilitation Program at two of the largest urology practices in Las Vegas and has since guided hundreds of patients to successful completion.
At Urologic Surgeons of Washington, she oversees the full course of care—objective testing, individualized treatment planning, electrical stimulation, and home exercise—so patients receive a structured, non-surgical option.
A Synergistic Approach to Pelvic Health
Whether you are dealing with bladder leakage, pelvic pain, urinary urgency, changes after surgery, or another pelvic health concern, our goal is to help you feel more comfortable, capable, and confident in your daily life.
Contact our office to learn more, verify your insurance benefits, or schedule a pelvic floor rehabilitation evaluation.
