Pelvic floor dysfunction is extremely common - nearly 40% of people experience it in their lifetimes - but often goes undiagnosed. In a survey of patients receiving treatment at PelvicSanity, 45% had to find out about the pelvic floor entirely on their own, while another 45% felt that their doctor only mentioned pelvic PT as a 'last resort' after they had failed multiple other treatments. Less than 10% felt they had been referred correctly by the medical community.
Some patients are explicitly told by their doctor that they don't have pelvic floor dysfunction - without a thorough pelvic exam - or even by an inexperienced pelvic floor physical therapist.
In response, we set out to create a simple, easy-to-use screening questionnaire that could be used by both patients and their practitioners to diagnose pelvic floor dysfunction earlier. The hope is that this allows patients to receive treatment earlier, and before their condition worsens.
Out of surveys of our patients - who have confirmed pelvic floor dysfunction - we were able to create the 10-question Cozean Protocol, which correctly identified 91% of patients with pelvic floor dysfunction.
You can take the questionnaire online now by clicking here, or the printable version is below. If you check three or more boxes, pelvic floor dysfunction is likely and you may want to consult with a pelvic floor physical therapist.
For those interested in how the Cozean Protocol was developed, we sent a thorough questionnaire out to all of our patients with confirmed pelvic floor dysfunction. After we received the responses, we analyzed how much each symptom was correlated with pelvic floor dysfunction - which were more common, and which would be most likely to correctly identify a patient whose symptoms were related to the pelvic floor.
As you can see in the below graph, some of the most common risk factors were pelvic pain (greater than a 3 out of 10), urinary urgency/frequency, orthopedic pain around the pelvis (including low back, hip, groin, or tailbone), and symptoms that grew worse with prolonged sitting.
Other factors that were correlated included a history of a fall on the tailbone (even in childhood), pain with intercourse, and bowel dysfunction like constipation or IBS.
From these responses, we were able to generate the Cozean Protocol to correctly identify 91% of patients with pelvic floor dysfunction.
Feel free to print this questionnaire and check yourself for pelvic floor health or take it into your doctor to discuss. You can always call a pelvic floor physical therapist, who should be able to evaluate you, determine conclusively whether pelvic floor dysfunction is the underlying cause of your symptoms, and get you on the path to resolving these common - but not normal! - symptoms.
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.