Physical therapist recommendations?

Well, I didn't get any word-of-mouth referrals, but I went through the www.apta.org website (I don't know if this is the only US physical therapists' professional association, or if there are alternative ones.) They have several specialist certifications and just established board testing for a women's health one this year. So, though I don't know too well the basis for their women's health certification, I looked for physical therapists certified in women's health and preferably orthopedics (for the lower back issues), then looked at whatever I could find of them online for their approach. I found one that has most of the techniques I was impressed with --- ultrasound imagery to detect which muscles were activating, the possibility to work on reinnervating muscles. Though she's out-of-network for my insurance, hence largely out-of-pocket, I have an initial appointment for next Friday!

I feel like I have learned what I can about the surgery, and as far as surgery goes, it's pretty gold standard, aiming for natural reattachment and avoiding egregious known dangers, by a very highly peer-regarded, publishing, academic surgeon. I think there's a very good prognosis that it would fix what my surgeon considers the obvious structural problem (and he's shown me through a rough pelvic exam that exacerbating the rectocele can cause an agonizing episode). But even a well-implemented and designed vaginal surgery is very traumatic. And the link between the symptoms I can't cope with - the acute pain and weakness episodes - and the simple presence of the rectocele seems tenuous to me. Better to at least exhaust every possibility to deal with the pain symptoms directly, first by trying to improve any muscle imbalances that contribute, with good guidance. I have never really managed to make progress on repairing obvious muscle deficiencies, not after childbirth when my lower vaginal tone was totally lost and remained unresponsive to kegels, and not after the more recent back injury. At worst I will learn something about my body, and better evaluate the unspoken assumption that this is as good as it can get without surgery. And I feel the handholding will make me more confident about implementing the posture, and maybe some of the elements like firebreathing and nauli that seem utterly baffling and a bit scary to me now.

I also feel I should give my recent switch back to hormonal birth control a chance to settle in. My cycle had been getting more acutely crampy, more frequent, more breakthrough in between, and seemed to be precipitating these episodes. It's as if I was spewing out progestins in an open invitation for any malcontent muscles nearby to cramp and spasm . . . and the ones that responded most strongly were the most susceptible ones due to old injury, overfull bowel/rectocele, etc. Regulating that cycle may get rid of some of the egregious triggers. My body's often been known to have reactions far worse than what triggered them --- fainting, asthma attacks, many ways to get caught in escalating feedback loops that are only cured by a full reboot. I think these pain episodes may be like that, some self-reinforcing cascade that becomes a much bigger problem than anything that started them. Trying to limit the hormonal triggers and at least knowing I have one tool to break the cycle (vicodin, though I've only used it twice) gives me a lot more confidence to patiently explore an approach like physical therapy.

Thanks,
alphamom