I have problems with constipation and I have found if I push too hard, sometimes I am left with a very painful and deep pain in the pelvic region for weeks. There are times it is excrutiating. The PT is internal. No dialiators. I have gone briefly...perhaps 3 or 4 times each bout. I probably would have considered more visits if I had better insurance for this. Combined w/ medication, it is helpful. I wouldn't spend and inexorbitant amount of money on it though. There are back strengthening exercises you can do at home that also help a little and each time the pt reminded me what to do at home. (I forget each time...have to be reminded, etc.) They help the lower back and lower pelvis. The heating pad, for some reason, is soothing for me. The valium helps, but makes me tired. The episodes tend to not last (for me) more than about 3-4 weeks (thank goodness, because I do find them very tiring physically and emotionally). Ironically, diarreah can also trigger this problem, but not to the same extent as constipation. I have learned to be very aware of my "bathroom" needs, etc. and to be very quick with using a heating pad and relaxing my pelvic muscles if I have even the slightest bit of pelvic pain and/or tension.