Getting started with pelvic floor treatment is a journey. Many of you are already well into the journey of trying to advocate for yourself and actually get to treatment, while many others of you have been sent seeking a pelvic floor pt from your regular physician. However you reach this place in your journey, it can become a halting point when you reach the time to actually make your first appointment.
Many people become overwhelmed by the fears and anxieties prior to making the appointment, or as it draws nearer fear of the unknown can feel overwhelming. I’d like to try and help alleviate some of that stress, by giving you as much education and information as possible about what to expect at your first pelvic floor physical therapy exam, so that you can feel prepared and at ease for your upcoming appointment. We will make it there together!
THE APPOINTMENT WALKTHROUGH
First, I think it is so important to note, that your provider should get explicit consent before proceeding with any part of the examination to ensure that you always feel comfortable. I pride myself on my professional, research-based, gender-inclusive, and comprehensive practices. If at any point during your examination you start to feel uncomfortable, tell your provider that, tell them to stop. You absolutely do NOT have to do something that you are uncomfortable with.
Most providers will have their own individual processes or pathways through your appointment, however a thorough exam should include as many of the following steps as are possible, physically, for you to achieve.
STEP 1: Discuss your detailed medical history
STEP 2: External Examination
- Full examination of your thoracic and lumbar spine, sacroiliac joints, pelvis, hips, and all four abdominal quadrants.
- Full investigation of any scarring, how those scars move, any tenderness, and your range of muscle motion in all areas (contracting and relaxing).
- Your pt should also be trying to grasp “what is your understanding of this area of your body?” during the external examination.
STEP 3: Internal Examination
Again, your provider should explain exactly what they will be doing, and where they will be touching before and during the entire exam.
- You will lie down on your back, with your knees bent, and your provider will test your pelvic floor muscles for various ranges of motion, and sensory and sensation awareness.
- They may a ttempt to reproduce your pain in order to understand better what exactly is affecting you.
- For a thorough breakdown of how providers test the pelvic floor muscles, what type of experience to expect, where to expect to be touched during the exam, and other visual details, watch my full pelvic floor physical exam youtube video .
STEP 4: Overview of your plan of care
What happens during a pelvic floor physical therapy assessment?
This will depend upon whether you are going to an in-person appointment, or via telemedicine. In person appointments, you will undress from the waist down and lay on your back on a treatment table. From there your provider will follow the procedure outlined above. I use a q-tip to test sensation of the vulva, other providers may have other methods, but it should be something you are comfortable with. If the appointment is virtual, it will be a bit more cooperative. We will work together as a team, I coach you through some extremely simple ways to assess your own muscles. This is different for everyone, but very basically your provider should talk you through how to access your own range of motion and muscle tone. Don’t worry, it does not mean you will have to place your finger internally. We will always work together to find the solution that you are most comfortable with.
What do you wear to pelvic floor therapy?
You can wear anything that you feel comfortable in and allows you some mobility. I often ask people to do yoga poses, squat, bend forward, twist and turn, and it is best to come in clothes that you can move in so that we can test your full ranges of motion without splitting a seam!
What can I expect from pelvic floor therapy?
You can expect to have a somewhat lengthy intake questionnaire. We want to know it all! Where do you struggle vs. where do you succeed, your goals and barriers to success. What surgeries or treatments have you done, and what was your experience with those. You can expect physical examinations. You SHOULD expect your provider to take what you say, along with information found in the assessments, and deliver a plan of care that meets your schedule and needs, to get you back to health and wellness.
What happens at pelvic floor therapy?
This will depend on whether you are meeting in person, or virtually, with your provider. In person, generally they will perform some manual therapy, education, and movement exercises. Through telemedicine, the focus is primarily on education and movement. Adding in training to help you learn how to do the manual therapy techniques on yourself if needed.
What is manual pelvic floor therapy?
Manual pelvic floor therapy is utilizing hands or tools to move, massage, and manipulate your pelvic floor tissues. This works wonders at improving and optimizing tissue length, engagement, and movement patterns. Oftentimes manual therapy is used to help downregulate tissue tension and relieve pelvic pain.
FEELING PREPARED CAN HELP REDUCE YOUR ANXIETY
HOW TO PREPARE
- Remind yourself that you are the one in control. You can give and take away your consent at ANY time during the session and the provider must respect that. Processes can be modified to meet your needs and comfort level.
- Make sure that you have filled out all your information forms as thoroughly as possible. For example, in my practice we email these to you prior to your first session. Other practices may have forms available online or able to be picked up from the office prior to your appointment.
- If you are attending an in person session, and you are going to consent to an internal examination or treatment, many people find it helpful to shower the day of their appointment and additionally pack some baby wipes to clean up just before and/or after the session. Many people say that feeling clean helps put their mind at ease when welcoming another person to the party.
WHAT TO BRING
- Your completed information forms
- Write down and bring with you, a simple outline of your history and/or symptoms. This will help you to communicate clearly, as well as allow your provider an opportunity to look over it quickly and develop further questions. Cover topics such as: what medicines you are taking, when and what type(s) of surgery you have had, and what goals you hope to achieve.
- A list of any questions that you have. This will ensure that you do not forget something you wanted to discuss or ask about!
- Comfortable clothes that do not restrict your movement. This will allow for your provider to see how you move so that they can truly assess where you are restricted.
WHAT TO EXPECT
- The full consultation is 90 minutes. Believe me, we use all of that time! So it is helpful to show up 5 or so minutes early to make sure all those ducks are in a row.
- If it makes you feel more comfortable, I am always open to partners coming with. It is ultimately up to you if them joining makes you feel more comfortable.
- Regarding children: It is unfortunately very difficult to do therapy with kids present, if they are at an age where they require constant attention. If it is possible, leaving them at home is best. However, if you must bring them with in order to make the appointment, know that we may have to make some modifications to accommodate for that.
- A common concern that can cause anxiety for women is your menstrual cycle. You can 100% complete physical therapy during your period. It in no way bothers the provider, we are used to how bodies work and nothing harmful will happen if you complete physical therapy during your cycle.
If you have made it to the end of this article, then CONGRATULATIONS are in order!! You know what this means, right? You have ALREADY taken the first step on your journey. How exciting is that?! What is your Step 2 going to be? I’m excited to see what you do! See all my exclamation points?!!!!!