Women's pelvic health · Kauai
Pelvic floor physical therapy for women in Kauai, by video.
Pregnancy and postpartum recovery, bladder and bowel symptoms, prolapse, and pelvic pain. One-on-one with a Doctor of Physical Therapy who specializes in pelvic health, from home anywhere in Kauai.
- TRICARE, HMSA, and HMSA QUEST in-network
- No state referral requirement; some plans need one
- Usually seen within a week
Women's pelvic health
What this is, and who it is for.
About one in four women in the United States lives with at least one pelvic floor disorder, and most never see a specialist. The pelvic floor is a group of muscles at the base of the pelvis that supports the bladder, uterus, and bowel and works with the diaphragm and deep abdominal muscles every time a person breathes, lifts, coughs, or runs. Pregnancy, childbirth, surgery, menopause, and years of habit change how those muscles coordinate, and that shows up as leaking, heaviness, pain, or urgency.
Pelvic floor physical therapy treats those muscles the way orthopedic physical therapy treats a shoulder: assess how they are working, retrain coordination, strength, and relaxation, and build a short daily program the patient can keep up. Clinical guidelines recommend pelvic floor muscle training as first-line care for urinary incontinence and for pelvic organ prolapse, before medication or surgery.
Kauai has one small pelvic health clinic on the east side and long waits for everyone else, especially on the west side near PMRF Barking Sands and on the north shore. Video visits mean a specialist appointment this week, from home, with HMSA, QUEST, or TRICARE.
What we treat
Conditions we see in Kauai
Each condition has its own page with what it is, what the evaluation looks at, and how the program is built.
Pregnancy and after birth
- Postpartum recovery
- In France and much of Europe, pelvic floor rehab after birth is routine. In the United States, most women get a six-week check and...
- Pregnancy pelvic and back pain
- About half of pregnant women have pelvic girdle or low back pain, and most are told it is normal. It is common, but it is treatable, and...
- Diastasis recti
- Diastasis recti is a widening of the gap between the two halves of the rectus abdominis. It happens in most pregnancies, and physical...
- C-section recovery
- A cesarean is major abdominal surgery, and most women are sent home with no rehab plan at all. Scar care, core retraining, and pelvic...
Bladder and bowel
- Urinary incontinence
- 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...
- Overactive bladder, urgency and frequency
- Running to the bathroom ten times a day, waking twice a night, and the sudden urge that comes out of nowhere are the signs of an...
- Pelvic organ prolapse
- Prolapse is when the bladder, uterus, or rectum drops lower in the pelvis. About half of women who have given birth have some degree of...
- Constipation and bowel dysfunction
- Chronic constipation and straining are often a muscle coordination problem, not a fiber problem. When the pelvic floor tightens instead...
Pain and recovery
- Painful intercourse
- Pain with intimacy is one of the most common and least discussed pelvic floor problems. It is usually driven by muscles that have...
- Chronic pelvic pain
- Pelvic pain that has lasted more than six months almost always involves the pelvic floor muscles, whatever started it. Treating those...
- Menopause pelvic health
- Falling estrogen changes the pelvic floor, the bladder, and the vaginal tissue. The leaking, urgency, dryness, and heaviness that follow...
- Recovery after pelvic surgery
- Hysterectomy, prolapse repair, bladder sling, and endometriosis surgery all change how the pelvic floor and core work. A structured...
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.
All of Kauai is seen by video, including military families at Pacific Missile Range Facility Barking Sands.
How it works
How a virtual visit works
Most of pelvic floor physical therapy is education, breathing and pressure management, movement retraining, and a home program. All of it works on camera. During the evaluation, Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating with breath and movement. An internal examination is not possible by video; if a hands-on assessment would change the plan, she says so and helps the patient find local care.
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
Women's pelvic health questions in Kauai
Does pelvic floor physical therapy work over video?
Much of it is education, breathing and pressure management, movement retraining, and a home program, and all of that works on camera. During the evaluation Dr. Shalem guides a self-assessment so she can see how the pelvic floor is coordinating. An internal examination is not possible by video. If a hands-on assessment would change the plan, she will say so and help you find local care.
How many visits does pelvic floor physical therapy usually take?
Most plans run six to twelve visits over two to three months, with a short home program between visits. The evaluation sets the plan, and it is adjusted as things change.
Is it only for women who have had children?
No. Pelvic floor symptoms affect women who have never been pregnant, athletes, women in perimenopause and after menopause, and women recovering from pelvic or abdominal surgery.
What happens at the first visit?
A 60-minute video evaluation: a full history, a look at posture, breathing, and movement, and a guided self-assessment of the pelvic floor. You leave with a plain-language explanation and a first home program.
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.