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What to Expect During Pelvic Floor PT

Updated: Jan 17, 2023

By: Caroline Hodges, PTA of The Green Room Physical Therapy

To All Prospective Pelvic PT Clients:

I decided to write this blog post to be made available to all future pelvic floor rehab candidates because each time I meet a new patient for Pelvic Floor PT, I always pose the question, “What do you know about Pelvic PT?” and the answer is almost always, “Nothing.” or “Very little.” This is very understandable! Pelvic PT is a niche within physical therapy that is not practiced by all therapists and actually requires extensive continuing education in order to practice in addition to initial training and board certifications. Brace yourself for this article- it’s a long one!

If you’re scheduled for your first visit or wondering whether or not this is an option you’d like to explore, this post is for you to understand what to expect during our treatments.

Why would someone need pelvic floor rehab/what conditions do you treat and who needs it?

ALL people have a pelvic floor, therefore we offer specialized care to all people regardless of sex, gender identity, sexual orientation, race/ethnicity and any cultural or religious affiliations; however, we acknowledge that different anatomy and cultural backgrounds require specialized care and tailor our treatments accordingly.

We commonly treat within the following realms of care:

  • Prenatal & birth preparation

  • Postpartum rehab

  • Urinary & bowel dysfunction

  • Sexual pain & dysfunction

  • Pelvic organ prolapse

  • Pelvic/gential & abdominal pain

There are countless conditions within each of these areas, so if you’re wondering whether or not your specific set of symptoms or diagnosis applies, please call or ask or set up a free consultation! We will most likely be able to address your needs.

You’re Taking the Plunge Into Pelvic PT! Prior to Your Initial Treatment:

You will likely have a referral to physical therapy from one of your medical providers, but it’s not required for your first visit- direct access allows you to be seen for up to one month without a medical referral, which allows us to get a jumpstart on your healing process if you’re unable to get an appointment with your physician before you can see us, which allows us to make progress while you’re waiting to get the referral.

Regardless of whether or not you come with a referral, we will send you a lot of paperwork (sorry!) to be completed prior to our first visit in order to understand your concerns and medical history. A lot of this is standard healthcare information related to your health and insurance, but there will also be questionnaires specific to pelvic health. It can be time consuming, so please set aside a designated space in your schedule to thoughtfully complete the paperwork in order for our team to best prepare for your specific needs. You will be asked questions related to bowel and bladder function, history of pregnancy and birth, prostate health (if you have one), sexual function, back pain, medications, etc. These questions get pretty personal and may seemingly be irrelevant, but trust that all of this information is important and related to your pelvic health. If you are having a difficult time answering these questions or are unsure of the appropriate response, don’t worry! We will have time to clarify during our first meeting and for the entirety of your healing journey with us, but having these completed prior to our first meeting allows us to maximize our time together.

Welcome to The Green Room!

Once you arrive, we will move to a private room where we'll talk about your story, what brought you here, the challenges you have been facing, and your goals for treatment. You are always free and truly encouraged to ask any and all questions you may have- we talk about literally EVERYTHING up to your comfort level! From sexual dysfunction to constipation to incontinence, all of your health-related concerns are valid and valued by our team even if seemingly unrelated, like teeth grinding, old ankle injuries, and history of falls (because they are almost always connected!).

Let’s Learn Together

After the initial discussion, we’ll transition into some musculoskeletal, movement, and/or behavioral factors that may be affecting your function and symptoms. This is where we’ll dig a bit more into the involved anatomy and physiology, often using visual representations from posters to models to your own body in order to improve your understanding of what’s happening and connect the dots between symptoms and structure. People are often amazed that their TMJ and pain with intercourse, for example, are related! This is also a great opportunity for you to ask any questions you may have before we dive into the physical assessment.

The Physical Assessment

This may look a little different for everyone depending on your individual symptoms and conditions, but most will include at least a little bit of all of these:

  • Global movement and function: We will watch you walk, stand, sit, and move in many different directions; I typically just do this as you walk in because I want to see how you naturally present, not how you think you should move/behave. We’ll look at how your spine moves (from your neck down), your shoulders, hips, knees, and ankles. We also look at your balance and preferred postures, and breathing mechanics, which is possibly the most under-addressed area of dysfunction. During this, please let us know if any motions are challenging or painful.

  • Special testing: After the global movement screen, we may go through some specific tests. This can include tests to see how you transfer forces or control pressure through your pelvis by lifting a leg or moving in a certain way, tests to see how the nerves in your spine glide and move, or tests to see what structures are contributors to pain you may be experiencing.

  • Myofascial palpation: Next, we'll see what tissues are tender or not moving well around your abdomen, pelvis, or elsewhere if we need to. This includes gently touching the muscles around the belly, hips, and legs to see if anything feels uncomfortable, and may include lifting and moving the skin and tissues under the skin to see where there may be restrictions in tissue movement. Myofascial restriction can cause reduced mobility and therefore increase your pain levels, contributing to a number of symptoms.

  • Pelvic floor assessment: After that, we will look more closely at the muscles of your pelvic floor. Because the muscles of the pelvic floor live inside the pelvis, the best way to examine them is by doing an internal vaginal or rectal examination. For this exam, you would undress from the waist down and lie down on a mat table, covered with a sheet. We don't use stirrups or a speculum for our exams, as you may have experienced with an OBGYN (which most people are grateful for!). We start by looking at the outside tissues. We'll ask you to contract and relax your pelvic floor muscles, and gently bear down to see how your muscles move (Don't worry if you're not sure what to do, we can help teach you!). We may ask you to cough to see how the muscles move reflexively. Then, we often will lightly touch on the outside of the muscles to see if anything feels uncomfortable or sensitive to you. We may check how certain tissues move, if that applies to the problems you are experiencing. After that, we can examine the muscles in more detail by inserting one gloved and lubricated finger into the vaginal or rectal canal. We can then feel the muscles to see if they are tender or uncomfortable, assess the muscle strength and endurance, and assess muscle coordination. *NOTE: While an internal exam is a very valuable examination technique, some people do not feel quite ready for this, or would prefer not to have an internal exam. If that's the case, be sure to let me (or your pelvic PT) know, and we can offer some other options. Also, remember that our exam should not be a painful experience for you. Your pelvic PT should tailor the examination to your needs, so that you leave feeling confident and comfortable, not flared-up and in pain.

Bringing It All Together with a Game Plan

As we wrap things up, we should have a clear picture of what areas we can address to work together to help you achieve your goals. We will ask you if you have any questions that may have arisen over the course of treatment that you’d like to ask, but please feel free to ask as we progress through the session. We’re going to communicate with you my objective findings as they relate to your symptoms and try to give you an idea of how frequently I’d recommend us working together and an estimate of the rehab timeline, which can vary greatly from 1-3x/week and from 4-12 weeks long. This is a general estimate and varies greatly based on the individual and how your body responds to our treatments, so we may modify along the way if need be.

Homework :)

We may give you a bit of homework as soon as after the initial session! We commonly ask patients to complete a “Bowel & Bladder Diary” if it applies to your specific case where you record your eating, drinking, bowel, and bladder habits for 72 hrs or 3 days to help us understand your typical daily function and how things like chronic habits, medical conditions, work, stress, etc affect your body’s function. We have an online portal where we’ll funnel exercises for you to complete at home as well, called your “Home Exercise Program,” which may or may not be started immediately after the initial visit.

Are You Still With Me?

That was A LOT of information, so thank you for taking the time to read! We hope this helps you to feel more comfortable and more confident when coming in for pelvic PT and encourage you to reach out with any further questions or concerns. We hope to see you soon and get you back to loving your body and life!

Email us with your questions!

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