Does Insurance Cover Pelvic Floor Treatments?

Issues with the pelvic floor are common in many people with a uterus. In fact, up to 24 percent of genetically female individuals will experience a pelvic floor issue during their lifetime. The cost of pelvic floor treatment ranges widely, from a few hundred to a few thousand dollars, and most treatments are covered by insurance. 

Although Mira does not currently cover pelvic floor treatments, you can use our services to offset the cost of pelvic floor treatment and to pay for medications. With access to lab tests, prescriptions, and urgent care visits for just $45 per month, Mira can save you money while you undergo pelvic floor treatment. 

Pelvic Floor Treatments - What are They?

The pelvic floor is a group of muscles that support the organs in the lower part of the abdomen. The pelvic floor includes the bladder, uterus (or womb), and bowel. These muscles allow for control over releasing urine and feces. The muscles of the pelvic floor can be weakened in the following circumstances:

• Giving birth
• Going through menopause
• Having gone through surgery in the pelvic area
• Having an ongoing cough
• Having a history of doing a lot of heavy lifting
• Being overweight
• Having a long term history of straining on the toilet

People who have a weakened pelvic floor can develop issues such as fecal or urinary incontinence, which means that they can no longer control their bowel or bladder movements, respectively. Pelvic floor dysfunction can cause people to have a frequent need to urinate or an inability to empty their bowel or bladder fully. 

Nearly 1 in 5 genetic females will undergo surgery to treat pelvic floor dysfunction in their lifetime. Despite being very common, pelvic floor dysfunction is not discussed often, complicating an already unpleasant condition. 

Treatment of Pelvic Floor Dysfunction

If you think you may be suffering from pelvic floor dysfunction, a family medicine physician may refer you to providers who can assess symptoms and recommend treatment. OB/GYN physicians (those that specialize in women’s health) typically treat pelvic floor dysfunction, but some OB/GYNs specialize in pelvic floor and bladder issues, called Urogynecologist. These physicians may refer a patient to a physical therapist for ongoing treatment and exercise.

The symptoms of pelvic floor dysfunction are highly uncomfortable and can severely impact one’s quality of life. Luckily, there are quite a few ways to treat pelvic floor dysfunction:

Physical Therapy and Exercises

Some individuals with pelvic floor dysfunction will be treated using a series of exercises to strengthen the pelvic floor. If the person wants to attempt treatment using physical therapy, they will need a referral from their physician. Treatment by a physical therapist often includes:

• Kegels
• Bridge position
• Split tabletop position
• Squats
• Squeeze and release

These exercises alone can be used for people who have mild pelvic floor issues, while those with more severe dysfunction will likely need to add one of the following methods of treatment. 

Another treatment that the physical therapist may suggest is biofeedback, a mind-body treatment that uses sensors to monitor the body’s reaction to specific stimulations. Biofeedback is very useful in treating pelvic floor dysfunction and has been shown to help up to 75 percent of people with pelvic floor dysfunction. Other treatments include therapeutic massage and relaxation techniques. 

Medication

There are a variety of medications that may be helpful to those suffering from pelvic floor dysfunction. Some people benefit from stool softeners (such as Miralax or Benefiber), but botox injections to the bladder muscle can also be helpful. Some medications can help people control their bowels, such as Lomotil or Amitriptyline. Finally, medications such as Cymbalta can help with bladder control.

Non-surgical Treatment

If medication and physical therapy are not helpful, there are a few other non-surgical approaches to treat pelvic floor dysfunction. The most common method is to use a device called a vaginal pessary. There are a few types of pessaries, often small, donut, or ring-shaped devices inserted into the vagina. They hold the pelvic organs in place and help relieve those suffering from pelvic muscle dysfunction symptoms. 

Surgery

The final treatment option for pelvic floor dysfunction is surgery. Pelvic floor surgery options range from minor keyhole surgery such as a sling procedure to more extensive surgeries. The procedure will depend on the severity of the dysfunction and the symptoms, and other demographic factors such as the patient’s age and treatment goals. Surgery is usually performed by either an OB/GYN or a Urogynecologist, although sometimes performed by a Urologist (a physician who is trained in bladder issues).

Insurance Coverage of Pelvic Floor Treatment

Given that pelvic floor dysfunction is a serious medical issue, public and private insurance widely cover treatment. However, it should be noted that physical therapy costs are often not as well covered as other medical costs. For example, while Medicare does cover physical therapy for pelvic floor dysfunction, there is a $1,900 per year cap. 

In other words, some Medicare patients will end up paying out-of-pocket physical therapy costs when treatment exceeds $1900. Additionally, some private insurers limit the number of sessions people can have with a physical therapist or even require proof of improvement to continue covering treatment.

The following table summarizes the average costs of the various methods used to treat pelvic floor dysfunction and whether they are covered by insurance:

Pelvic Floor Therapy Cost and Coverage

Sources: ResearchGate, AJMC, AAFP, Thervo

*The cost of the medication will vary based on which drug, or combination of drugs, is being used. For example, the recommended dose of Cymbalta usually costs around $598 per month without insurance. 

Pelvic Floor Treatment Frequently Asked Questions (FAQs)

Because pelvic floor dysfunction is not well-discussed, we have compiled some answers to the most common questions relating to pelvic floor treatments to help you better understand this topic.

Are pelvic floor problems only seen in people with a uterus?

No. In genetically male individuals, the pelvic floor muscles play an important role in sexual function. If these muscles are not working correctly, people may have erectile dysfunction or issues with ejaculation. In these individuals, physical therapy can be a helpful method of treating pelvic floor dysfunction. Still, because it can be easily confused with an infection of the prostate gland called prostatitis, it is essential to see a physician first to get the correct diagnosis. 

What does pelvic floor dysfunction feel like?

Because the issue is internal and thus, invisible to the eye, it can be challenging to identify. Some common symptoms and indicators of pelvic floor dysfunction include:

• Needing to urinate frequently
• Constipation
• Straining to have a bowel movement, or needing to use your hands to help remove stool
• Leaking urine or feces
• Pain with urinating
• Lower back pain that is not caused by something else or that lingers

If you are affected by any of the above or a combination of these symptoms, it might be time to consider seeking treatment from a trusted provider.

What is the difference between pelvic floor surgery and vaginal rejuvenation surgery?

While pelvic floor surgery to treat dysfunction is likely to result in an improved appearance of the vagina, this is not the primary goal of the procedure. On the other hand, vaginal rejuvenation is usually performed to enhance the cosmetic appearance of the vagina and does not relate to its function. Additionally, while pelvic floor surgery is generally considered medically necessary and covered by most insurers, vaginal rejuvenation is unlikely to be covered. 

Bottom Line 

Pelvic floor issues are prevalent and can be expensive to treat. Luckily, insurance covers many available options, including medications, pessaries, physical therapy, and even surgery. Usually, a gynecologist and a physical therapist will work together to help treat pelvic floor dysfunction. 

While all of these costs can add up, Mira can help you obtain prescriptions at up to 80 percent less. Mira can also help offset your healthcare costs by giving you access to urgent care, primary care, telebehavioral health, and lab screenings, all for just $45 per month. Try Mira today!