Women's pelvic health · Hawaii Island
Physical therapy for urinary incontinence in Hawaii Island
Leaking with a cough, a sneeze, a jump, or on the way to the bathroom affects about one in three women at some point. It is common, it is not a normal part of aging, and pelvic floor muscle training is the first-line treatment in every major guideline.
- TRICARE, HMSA, and HMSA QUEST in-network
- No state referral requirement; some plans need one
- Video visits anywhere in Hawaii Island
About the condition
Urinary incontinence: what is going on.
Stress incontinence is leaking when pressure rises: coughing, sneezing, laughing, lifting, running. Urge incontinence is leaking after a sudden strong need to go, often triggered by a key in the door or running water. Many women have both. The usual cause is a pelvic floor that is weak, poorly timed, or, surprisingly often, too tight to work well, combined with bladder habits that have drifted over years.
Pelvic floor physical therapy addresses all of those. It is recommended before medication or surgery by the American Urological Association, the American College of Obstetricians and Gynecologists, and international continence guidelines.
Common experiences
What people with urinary incontinence often describe
These are the patterns Dr. Shalem hears most often. Any of them is a reason to book a discovery call.
Leaking with coughing, sneezing, or laughing
Leaking during running, jumping, or lifting
A sudden urge that is hard to hold
Going to the bathroom more than eight times a day or more than once at night
Wearing a pad just in case
Planning outings around bathrooms
Treatment
How physical therapy addresses it.
The evaluation finds out whether the pelvic floor needs strengthening, relaxing, or better timing, which is why generic Kegel advice so often fails. The program then pairs pelvic floor training with bladder retraining, fluid and habit adjustments, and pressure management during the activities that cause leaking. Impact training is added for runners and athletes.
What a video visit looks like
Dr. Shalem guides a self-assessment of pelvic floor contraction and relaxation on camera, reviews a short bladder diary, and builds the program from there. Follow-ups track leaks, urgency, and progress toward the patient's own goals.
Coverage in Hawaii
Insurance and pricing
Bring your plan name to the discovery call and we confirm your physical therapy benefit before the first visit.
TRICARE
In-network (TRICARE West). TRICARE Select members can book directly with no referral. TRICARE Prime members need a referral from their primary care manager, and we tell you exactly what to ask for.
HMSA
In-network with HMSA PPO and HMO plans. Some HMSA plans require a referral from your primary care provider; we check yours before the first visit.
HMSA QUEST
In-network with HMSA QUEST (Hawaii Medicaid). We confirm coverage before your first visit.
Private pay
Available for any other plan. HSA and FSA cards accepted.
Referrals
Hawaii allows you to start physical therapy without a physician referral. Your insurance plan may still ask for one (TRICARE Prime and some HMSA plans do), and we check that for you before the first visit.
Every district of Hawaii Island is seen by video, from Hilo and Puna to Kona, Kohala, and Kau.
Questions
Questions people ask about urinary incontinence
How it works
How a virtual visit works
Dr. Shalem guides a self-assessment of pelvic floor contraction and relaxation on camera, reviews a short bladder diary, and builds the program from there. Follow-ups track leaks, urgency, and progress toward the patient's own goals.
Discovery call
15 minutes, free, by phoneA short call to hear what is going on, explain how visits work, and check insurance or pricing. No pressure to book.
Evaluation
60 minutes, by videoDr. Shalem takes a full history, watches how you move and breathe, and guides the self-assessments she needs to build a plan.
Your plan
Same visitYou leave the evaluation with a plain-language explanation and a short home program, usually a few minutes a day.
Follow-ups
45 minutes, every 1 to 2 weeksProgress checks, program updates, and techniques you can do yourself, for as long as they are useful.
For a video visit you will need
- A phone, tablet, or laptop with a camera
- A private room
- A mat or towel
- About an hour
Questions
Urinary incontinence questions in Hawaii Island
Are Kegels enough?
Only when the pelvic floor is weak and the person is doing them correctly, which is less common than people think. Many women with leaking have a pelvic floor that is overactive and needs to learn to relax first. The evaluation tells us which.
How long until leaking improves?
Most programs run eight to twelve weeks. Many women notice change within the first few weeks, and continued practice is what makes it last.
Can physical therapy help after menopause?
Yes. Pelvic floor training is effective at every age, and it is often combined with other options the patient's physician may suggest.
Do I need a referral for physical therapy in Hawaii?
Hawaii allows you to start physical therapy without a physician referral. Your insurance plan may still ask for one (TRICARE Prime and some HMSA plans do), and we check that for you before the first visit.
What insurance do you take in Hawaii?
TRICARE: In-network (TRICARE West). TRICARE Select members can book directly with no referral. TRICARE Prime members need a referral from their primary care manager, and we tell you exactly what to ask for. HMSA: In-network with HMSA PPO and HMO plans. Some HMSA plans require a referral from your primary care provider; we check yours before the first visit. HMSA QUEST: In-network with HMSA QUEST (Hawaii Medicaid). We confirm coverage before your first visit. Private pay: Available for any other plan. HSA and FSA cards accepted.
Your physical therapist
Dr. Elana Shalem, DPT
Doctor of Physical Therapy, University of St. Augustine for Health Sciences, Miami. Licensed in Hawaii.
Dr. Shalem treats pelvic health for women and men, from pregnancy and postpartum recovery to bladder, bowel, and pelvic pain conditions and recovery after prostate or pelvic surgery, and general orthopedic conditions of the back, neck, hips, knees, shoulders, and feet. Visits are one-on-one and unhurried, and she explains what she is seeing in plain language.
More about Dr. ShalemPrefer to write? Send a message.
Questions about insurance, pricing, or whether physical therapy is the right next step? We reply within one business day.
Start with a free 15-minute call.
Tell us what is going on, hear how Dr. Shalem would approach it, and decide from there.