Your pelvic health physiotherapy appointment will begin with your therapist asking about your specific pelvic concerns. Many patients find it helpful to write down their main concerns and questions before they come in. Your therapist will also ask additional questions may be about bowel/bladder habits, GI concerns, pain, intercourse/sexual activity, physical activity, stress, and sleep. You may choose to disclose any past or current abuse or sexual abuse as it is helpful for your therapist to understand how your history may impact your pelvic symptoms. The discussion part of the appointment takes approximately 20 minutes, but is open to be extended based on your concerns and questions. It is important not to rush this part as your therapist will gain valuable information to individualize your treatment plan. At this time your therapist will work with you to determine your goals of treatment.
Depending on your concerns, your therapist may assess your back, hips and pelvis. This is done in standing and laying on the plinth. Your therapist may continue to ask questions about previous injuries and pain. The pelvic floor works closely with other muscles and systems like alignment/posture, abdominal wall and breathing. Your pelvic floor does not work alone and relies on many other systems to function properly. Your therapist may begin treating areas of concern while they assess. This may include soft tissue release and joint mobilizations.
While there are many similarities between a regular physio appointment and a pelvic floor appointment, there are a few differences. The biggest difference is the ability for your therapist to examine the internal structures of the pelvis, either through the vagina and/or rectum. A pelvic floor physical therapist has specialized training to perform internal pelvic exams both vaginally and rectally. Your therapist will describe what the exam will be like and discuss risks, benefits, and expectations. After this they will ask for your consent verbally and in writing; at Lakeview Physiotherapy, you will sign a laminated form which we keep handy in your chart.
It is important to remember that you are in control of the session the entire time and if you wish not to have this exam done or change your mind and withdraw consent at any point – you can. You will never be pressured to continue with any part of the exam or treatment that you are not comfortable with. If it’s helpful, you may bring your partner or support person with you to the appointment. While examining the internal structures can be very important for diagnosis and treatment, the internal exam can always be done at a later appointment. A common question we get is if a pelvic exam is done during your period. The answer is yes – but we totally understand if you are not comfortable with an exam during menstruation and the session can change directions to work outside of your pelvis to continue working towards your treatment goals.
Should you choose to go ahead with the internal exam component of the session, your therapist will leave the room while you undress from the waist down. Your head will be on the pillow and your feet at the end of the bed with your knees bent up and your body is covered up with a large sheet. The therapist starts with a visual exam of the tissues. Using gloves and lubricant, they use one or two fingers to assess the pelvic structures. Depending on your concerns your therapist will check for prolapse, laxity and mobility. They will assess muscle tone, tension and strength. They may find trigger points, scar tissue or restriction. Your therapist will cue you to contract and relax your pelvic floor.
It is appropriate to ask your physiotherapist questions at any time. We understand the assessment and treatment may be outside your comfort zone but we will work with you, at your pace, to achieve your goals.