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What to expect on your first pelvic floor appointment:
We’re delighted you are here and have made the call to schedule your first visit.
Going to a medical practitioner for the first time can be intimidating, particularly if you’re uncertain about what to expect during the appointment.
We’ll go over what you can anticipate during your initial pelvic floor physical therapy session, so you can feel confident and enthusiastic about embarking on this path.
Patient History:
The initial phase of your evaluation will consist of talking about your medical history with your physical therapist. This is your chance to share your story and communicate with your therapist about your concerns and objectives. You and your therapist will probably spend some time reviewing pelvic anatomy and discussing the areas that the therapist believes are most important to investigate first. Before conducting any hands-on assessment, your therapist will describe the procedure. For many people, this includes an internal evaluation of the pelvic floor muscles.
While “standard” physical therapy is done in an open space, with PT on the go, our pelvic floor therapist will come and treat you at the comfort of your home. All you will need to provide is a bedsheets, a towel and some pillows. Your physical therapist will start by talking with you to learn more about your condition and will ask you some more questions, related to the paperwork you have filled in prior to your appointment. Your PT will evaluate the muscle tone of your core, hips, and pelvis externally (and with clothes on). They may see if you can do a sit up, gently test the strength of your hips, and evaluate how you cough and sneeze.
Internal examination of the pelvic floor:
If an internal exam is deemed necessary, your therapist will provide you with a detailed explanation of what to expect. However, please keep in mind that internal assessments are always optional. You may choose to skip it altogether or discontinue the procedure at any point if you feel uncomfortable. Having said that, an internal assessment is the most direct way to determine the pelvic floor muscles involvement in your primary concerns. It enables the therapist to identify the most effective exercises and strategies for your specific needs. The internal assessment, whether vaginally or rectally, typically does not take long to complete, and we do not use stirrups or speculums, making it a gentler experience than a gynecological exam.
The therapist employs internal assessments to evaluate the muscles tone (how tight or loose they are) and assess their strength and endurance. We also assess the patient’s ability to control the pelvic muscles correctly, as well as identify any areas of tissue trauma and/or muscle spasms. This information is critical in comprehending the intricate relationship between the pelvic floor and your symptoms, enabling us to make the most effective recommendations.
What are common things my pelvic PT may find during an internal exam?
During an internal exam, we often find that people think they’re squeezing their pelvic floor muscles, but actually they’re pushing open. Other common imbalances are that people think, for example, they may be too “loose,” but in reality, their pelvic floor muscles are unable to relax and too tight, causing pelvic pain and discomfort. In these cases, people may feel discomfort like that of a tight muscle, similar to if you’re touching a tight trap near your neck. Other times, one side of the pelvic floor may be tighter than the other, or one side more tender. The generic cure-all for pelvic floor dysfunction, kegels, can actually hurt more than it helps, as some people are doing the exercise incorrectly or they may be too tight, in which case kegels could be contributing to more muscle tenderness.
Plan of Care
After your session, your therapist will explain the evaluation’s findings and recommend the most effective treatment options. Patient education and recommendations for changes in behaviors and movements are always a significant part of pelvic health treatment. Manual therapy, both internal and external to the pelvis, is typically included in the treatment plan.
Your first visit will conclude with a discussion of the next steps, including home exercises, treatment duration and frequency, and any questions or concerns you may have. It is common for questions to arise between visits, and you are encouraged to reach out to your therapist via email or text for clarification. We are committed to providing you with all the information and skills you need to achieve optimal pelvic health.
What if I’m on my period?
If you’re on your period, that’s no problem at all. As pelvic floor physical therapists, we have nitrile gloves on anyways, so it doesn’t matter! There will be a sheet over you, and if you are uncomfortable, discuss with your PT about external treatments or other options. Communication is the key with every appointment.
How will my postpartum PT visit be like?
If you have a baby vaginally, there’s probably a lot of stretch in your pelvic floor area. Your PT will check to see how your core and pelvic floor coordinate together. Even if you have had a c-section, your PT may still check the pelvic floor, especially if you pushed for a long time before delivering the baby, and definitely if you’re having any pelvic issues or dysfunction. They will also check your incision, teach you scar mobilization, and show you how to connect to that deep core again, just like you would after any surgery.
What if I pee during my internal exam?
It’s completely normal to be nervous. But we have gloves on, so even if the worst thing happens, we don’t really care!