What to Expect at Your Very First Pelvic Floor Physical Therapy Appointment.
“I have never heard of pelvic floor physical therapy!”
I hear this all the time, which is usually followed up with “how did you get into this type of physical therapy?”. That answer is for another blog post. As a pelvic floor therapist I assess the muscles, joints, ligaments, and nerves that make up the pelvic floor area. Many people don’t realize that as a pelvic floor therapist, I can treat any part of the body. I’m just one of a speciality group of physical therapists who took additional training to be able to assess the pelvic floor muscles.
As a physical therapist, I specialize in the musculoskeletal system and am an expert in movement analysis. By doing a thorough assessment, I can determine what may be causing your pelvic floor issues.
Common pelvic floor complaints:
Urinary incontinence
Constipation
Pelvic pain/Pain with penetration
Pelvic organ prolapse
Pregnancy related issues
Postpartum recovery from a vaginal or Cesarean delivery
And so many more!
I understand that many of these issues are difficult to talk about and you may never have shared them. But I want you to know that none of these are considered normal. I’m going to break down your very first visit to help ease some of the fear or anxiety around making that first appointment.
Information Gathering
The very first thing I do is ask you questions, lots of questions. These questions will be related to the main reason you are here, what makes it worst and what makes it better. Then I need to know how all of the systems in the pelvis are functioning. This includes asking questions about bowel, bladder, and sexual function. I may ask you about fluid intake, food choices, how is your sleep, any pregnancies, any past trauma, and do you have an exercise program?
This all helps to guide the assessment, set goals, and establish a treatment plan specific to your needs.
The External Assessment
The pelvic floor really isn’t isolated. There are so many things that can contribute to the issues you are experiencing. After I collect all the information you share, I’ll take a look at the following:
Posture including ribcage and pelvis alignment
Breath mechanics and pressure management
Hip and leg strength
Coordination of deep core muscles
Feeling your abdominal wall for tender spots
Checking for a diastasis rectus AKA abdominal wall separation
Assessing scar mobility whether from a Cesarean or other abdominal surgery
Observing your body mechanics especially if you have a kiddo or like to lift weights
Internal Pelvic Floor Assessment (with your consent)
The next step is looking at your pelvic floor muscle with your consent. Initially you may be positioned on your back, but don’t worry there are no stirrups or speculum. This is very different than a gynecologic assessment. I’ll look at your vulva to see how you are contracting your pelvic floor and relaxing it. I can feel some of the tissue externally for tender spots and decreased mobility.
Your pelvic floor muscles have two access points, the vagina and the anus. Each access point tells me something different. Usually with the first visit, the focus is on assessing through the vagina, but know that it can be very informative to assess the back wall of your pelvic floor through the anus. With a gloved and lubricated finger, I am looking for function, tone, and tenderness of your muscles.
Assessing the same muscles in various positions (standing, squatting, with movement, etc) will give me more information to how your pelvic floor is responding to various positions and activities.
The internal assessment is ONLY performed with your consent. You may consent to all of it, part of it, or none of it. You may also request to have it done at a later appointment. Remember that I only want to do what you want to do.
Treatment
After the assessment, I will share my findings with you and give you my physical therapy diagnosis. You’ll receive education and exercises to help you achieve your goals. We’ll schedule follow up appointments to ensure you are staying on track.
I Am Here For You!
The first visit can be very overwhelming. This may be a lot of new information and slight changes in your routine.
Most importantly, my goal is for you to feel heard, comfortable, and respected. Together we can improve your quality of life and get you back to the things you have been missing out on.
