What to expect at your first pelvic floor physical therapy appointment
Your physician just recommended that you schedule an appointment with a pelvic floor physical therapist. A myriad of questions quickly race through your mind. “What in the world is the pelvic floor?”, “How is physical therapy going to help me?”, “How is this going to be different from the OBGYN?”. These are all questions and fears that patients have shared with me on their first visit. Know that the feelings you are experiencing are totally normal! Pelvic floor physical therapy can feel daunting and confusing if you don’t know what to expect. Having a good idea of what your first visit should look like and what questions to ask your therapist can be helpful in navigating your first visit and deciding whether your provider is a good fit for you.
When you first walk into the clinic, after you check in, your physical therapist should greet you with a name and introduction. You should then be guided by the physical therapist into a private treatment room with a closed door. Once you are seated and comfortable, the physical therapist should ask you to share what brings you into physical therapy. This is a good time to communicate what has been bothering you, and if you have a referral from a physician, why the physician referred you.
What should I tell my physical therapist?
What symptoms you are having
How these symptoms impact your daily life
How often these symptoms are happening
What makes these symptoms better or worse
If you are having pain, and where your pain is located
What makes your pain better or worse
What types of physical activities you enjoy participating in
Your goals, or what you want to get out of physical therapy
This may also be a good time to share any concerns you have about pelvic floor physical therapy. Feel free to ask any questions about what to expect throughout the course of your treatment. Your physical therapist should take the time to answer any questions you may have. If you feel at any point throughout the visit that your questions were not answered thoroughly or appropriately, ask for clarification.
Next, your physical therapist will likely ask you a series of questions regarding your bowel, bladder, and sexual health. Your pelvis houses your bladder, rectum, and uterus for vagina owners. In people with a penis, your pelvis houses your bladder, rectum, and prostate. These systems all impact each other, and your physical therapist will likely want to get a good picture of how these systems are functioning together and independently.
Before the pelvic floor internal exam, your PT should explain each step of the pelvic floor assessment in detail, perhaps using a pelvic model. This is a good time to share with your physical therapist if you have a history of pain or trauma related to the pelvic floor muscles, if you have not done so already. Your therapist should make you feel validated and supported when sharing sensitive information.
Your therapist should also communicate to you that you are in control throughout the entire pelvic floor exam and any treatment provided in the office at any time. Your PT should collaborate with you in creating a plan to make you feel safe and comfortable. This should include a safe word or an intention to end the exam if you feel unsafe or uncomfortable at any point.
What does a pelvic floor evaluation look like?
The next portion of the physical therapy evaluation is either an internal pelvic floor assessment or an external assessment of your low back, pelvis, and hips and a general movement assessment. This can be decided between you and your PT at your first visit and what time allows for.
For the external assessment, the PT will likely as you to bend, squat, and observe your body in standing and with movement. Then they may touch your back, pelvis, hips to look for how things are positioned and what your muscles feel like. Your PT will perform some tests to look at your strength and range of motion and see if anything provokes or improves your symptoms.
The internal assessment will take place after your PT gets a clear picture of what your symptoms are, how your bowel, bladder, and sexual systems are functioning, and what your goals are. The pelvic floor internal assessment helps your physical therapist understand how your muscles are working, whether there is any overactivity (increased tension or tightness) or weakness in the muscles, how your pelvic floor muscles are communicating with your brain (and vice versa), and what interventions to employ moving forward.
What should I expect during a pelvic floor internal assessment?
Your PT should obtain verbal consent from you prior to the assessment and then again at each step of the assessment.
Your physical therapist will ask you to undress from the waist down, and instruct you which position to be in on the table. They should provide you with a sheet or gown to cover from the waist down, and should leave the room to give you privacy to undress.
our therapist should knock on the door and enter the room once given a verbal confirmation from you.
Once the therapist has entered the room, they should don gloves prior to performing the pelvic floor internal exam.
The therapist will ask to undrape you, and observe the tissue from the outside.
Next, the therapist may press around the outside of the vulva with one gloved finger to assess tenderness, pain, and muscle activity. If at any point, you feel any other than pressure, be sure to communicate this.
The therapist will then insert one gloved finger with lubricant and slowly move the finger internally in order to feel the internal pelvic floor muscles. If at any point, you feel pain or discomfort underneath the therapist’s finger, be sure to communicate this with them.
The therapist may instruct you to perform a number of pelvic floor exercises while their finger is inserted. These exercises could look like pelvic floor contractions (aka kegels), holding a pelvic floor contraction, bearing down like you are passing gas, or pairing movement in your pelvic floor with your breath.If at any point, you don’t understand the instructions, ask for clarification.The therapist should provide verbal or tactile cues to help you understand better.
Once the therapist has completed their internal exam, they should let you know that they will be removing their finger.
The therapist will then leave the room and allow you to change.
CONGRATULATIONS! At this point, you will have completed your first pelvic floor physical therapy session.
Once returning into the room, the therapist should communicate their findings of the internal exam with you. They should also communicate what they want you to work on prior to the next visit and a big picture plan moving forward. If you have questions about the findings, the instructions, or the plan, it is important that you ask your therapist for clarification.
We hope that you leave the session feeling encouraged, empowered, and comfortable with your treatment plan moving forward. In pelvic floor physical therapy, you will learn to connect with your body in a way that may feel new or different. This may come with a number of emotions or difficult feelings and these are all NORMAL. Know that with patience and courage in yourself, and with the guidance from the right therapist, you will come out feeling more confident and in control of your body.
If you are wondering if pelvic floor physical therapy is right for you, schedule an free consultation with a pelvic floor physical therapist at this link here.
