In recent years, pelvic health has become a more widely discussed topic in media and health care. Many women and individuals with symptoms of pelvic floor dysfunction are seeking out professional help from pelvic health physical therapists to assess and treat their pelvic health concerns. There are also many people without active symptoms of pelvic floor dysfunction who proactively desire learn the state of their pelvic floor muscle function as a means of minimizing pelvic health concerns down the road. For some, the idea of seeing a pelvic health physical therapist can feel intimidating due to the unknowns of what actually happens behind closed doors. I hope to reduce some of barriers of seeking out care by elucidating what to expect at your first pelvic health physical therapy session at Elevate Physical Therapy.
At Elevate, we are a team of trauma-informed doctors of physical therapy with specialization in treating women’s health and pelvic health conditions. Upon arrival at your first visit, you will be guided to a private treatment room by your physical therapist. Your physical therapist will then inquire about the symptom or concern has brought you in to Elevate. She will take an extensive history of your health by asking questions about your musculoskeletal function and symptoms, bowel and bladder function, and sexual function. The pelvic floor muscles play an important role in core stability, hip and spine function, breathing and coughing function, bladder and bowel emptying and sphincter control, as well as sexual arousal, sensation, pleasure, and climax, so your physical therapist’s inquiry about the function of these systems helps to paint a picture of the overall holistic function of your muscles and their integration with rest of the body. If at any point, these questions make you feel uncomfortable, you may decline answering.
Your physical therapist will also inquire about your social support and daily routines including professional, community, and household responsibilities and physical demands to have a greater understanding of all of the factors impacting your wellbeing. After discussing your history and concerns, your PT will initiate your physical examination. We are orthopedically-focused pelvic health therapists at Elevate and understand that your pelvic floor is just one component of a larger system working to stabilize your body as your move through space. Therefore, we like to assess the movement, stability, strength and range of motion of the whole body to understand how the coordination and timing of your muscle activity impacts your body and symptoms. Your PT will assess the way you walk into the clinic, how you move from standing to sitting, your posture, the mobility of your spine in all directions of movement, your balance strategies, your functional and gross strength, your flexibility and mobility of your joints, and lastly, will assess your abdomen for the presence of a diastasis recti (abdominal muscle separation).
After the full body examination is completed, your therapist will explain the process of the pelvic floor assessment and if you consent, she will step out of the room to allow you to undress from the waist down, lie down on your back on the treatment table, and cover your entire lower body with a cotton sheet. When she returns to the room, while still fully covered with the cotton sheet, a comfortable bolster will be placed under your knees (You will never be asked to place your feet in stirrups like a gynecological medical exam). At this time, your PT will lift with sheet enough to visualize your vulva (the external skin around your pelvic floor and perineum) and may feel with gloved fingertips externally along the muscles for any tenderness or increased or decreased tension in the muscles. If you consent to further examination, your physical therapist will gently open the labia (folds of skin or “lips” external to the vagina) and insert a single gloved and lubricated finger into the vagina to the depth of the first knuckle of the finger. She will again feel the muscles to assess for the tension or tenderness. Depending on the concerns bringing you in, she may ask you to try to squeeze around her finger, bear down like you are trying to pass gas, or cough, to assess how well you are able to coordinate these muscles. If you are concerned about prolapse of organs she may ask you to bear down while she visualizes the vaginal opening, or if you experience internal pain, she may feel the muscles and soft tissue a little bit deeper to try to identify the structure causing your pain. Throughout the entire examination, you are always in control and may decline any portion of the examination at any time. Your physical therapist will also be monitoring your face and overall nervous system response for any signs of trauma response or discomfort that would warrant discontinuing the examination.
After the pelvic floor muscle assessment, your physical therapist will explain her findings from the entire evaluation, use images and 3d anatomical models to demonstrate how this impacts the symptoms for which you are seeking care, and will explain how many sessions she recommends to achieve your goals. Our focus is to make each patient feel comfortable, heard, and supported during the evaluation and the duration of their care. After the examination and explanation of her professional assessment, the two of you will work collaboratively to determine a number and frequency of visits that best suits your needs and goals.