what happens during a pelvic floor physical therapy assessment?
I frequently have clients looking like deer in the headlights when they come to their first pelvic floor physical therapy appointment.
Sometimes they show up with a change of clothes thinking that I am going to have them exercising for the full hour that we are together. Don’t get me wrong, we usually do some form of exercise. But it is not always what the stereotypical physical therapy appointment looks like. So what exactly happens during a pelvic floor physical therapy evaluation?
At Flora, before you even step through our door we send you a comprehensive intake form to get a better idea of who you are, your medical history, what pelvic floor symptoms you are experiencing, and what your goals are. That way when you come in for your initial evaluation we are able to briefly review your intake form and get right into the assessment so I can send you home with things to work on (this is the exciting part where you get to start focusing on steps towards reaching your goals and being able to do the things you want to get back to!).
Before I ever put my hands on a client, I am always asking for consent and talking you through every step of the process so you know what I am doing and why I am doing it. It is your body. I always try to use educational resources like pelvic models to show clients what certain assessments or techniques may entail and what they may feel before we do anything hands on. This gives you time to decide if it is something you feel comfortable moving forward with and gives you the ability to provide informed consent (as well as to give an informed no!).
I always try to do a brief musculoskeletal assessment with every client at the low back, hips, and sacroiliac joints to make sure that your symptoms aren’t originating from outside of the pelvic floor. If we don’t get to this during your first assessment, it usually occurs during one of your next follow-up appointments. This includes range of motion, strength, joint mobility, special testing at each of the joints, and looking at your flexibility.
Another area I frequently like to assess is the abdomen. We may look at your abdominal or core strength through a few exercises, as well as screen the integrity and tensile strength of the abdominal connective tissues for something called diastasis recti. Oftentimes you may have scar tissue from a previous surgery which I will also assess to observe the quality of movement and to see if there is any pain present.
Depending what your symptoms are, an external and internal pelvic floor assessment is an option. This is the point in the appointment where some clients start to look nervous. With pelvic floor physical therapy, we never use a speculum or stirrups like are used during a gynecologic exam. Just a gloved finger and lubricant.
The external assessment usually involves visually looking at the the integrity of the skin over the external genitalia (scrotum, vulva, perineal body, anal opening) for any lesions or skin conditions, gently pressing over the skin with a gloved finger to feel the most superficial layer of the pelvic floor muscles below the skin to check for any restrictions or discomfort, having you cough, do a voluntary pelvic floor muscle contraction, and then having you lengthen your pelvic floor muscles as though having a bowel movement or passing gas.
The internal assessment is basically a repeat of the external assessment, except internally through one of your pelvic openings (vaginal or anal opening). I usually like to tell people, “Same house, different door.” Again this is all dependent on your preference and what your symptoms are. Usually for people with two pelvic openings (vaginal and anal) sometimes there may be discomfort in one area and so we opt for doing the pelvic exam through the other opening. For people with only one pelvic opening (anal), that is the mode of doing the internal assessment if you decide this is something you want to move forward with. Similar to the external assessment, I am gently pressing through each of the two deeper layers of the pelvic floor musculature and connective tissue to assess for any areas of restriction or pain. With the internal pelvic floor exam we are also able to manually assess the strength of your pelvic floor muscle contraction as you perform a voluntary contraction, your length of time holding a longer pelvic floor muscle contraction, how many times in a row you can complete longer pelvic floor muscle contractions, and then your ability to release immediately following the contraction.
Completing a thorough evaluation during our first appointment helps us figure out where your symptoms are originating from and objective measurements that may be contributing to your symptoms. This helps to guide all future physical therapy appointments and interventions that are provided during subsequent sessions.
With that being said, we only do a pelvic floor exam if it is medically appropriate and something that you are 100% comfortable with and consent to. It is not something you ever have to do. There have been so many times where a client has come in tearful during their first pelvic floor physical therapy appointment thinking that we are going to do a pelvic examination. This does not have to happen if you are not on-board or are feeling unsure or uncomfortable. And in all transparency, I frequently don’t complete a pelvic floor assessment on the first day for the sole reason that the client and I are meeting each other for the first time. I also totally realize that a pelvic floor examination can feel nerve-wracking for you based on your medical and personal history. Again, you are always in the drivers seat.
Thinking that you may benefit from pelvic floor physical therapy treatment? Or know someone else that you think may need pelvic floor care? Reach out to schedule a pelvic floor physical therapy appointment with me today. At Flora Physical Therapy we are passionate about providing 1:1 accessible treatment options including in-home, in-clinic, and virtual appointment options to help meet you where you are.
Dr. Brook Orvis is a Board-Certified Women’s Health and Pelvic Floor Physical Therapist, Duke Residency-Trained in Women’s Health, and the owner of Flora Physical Therapy. As a momma to a spirited toddler, she understands the difficulty of being a parent while prioritizing self-care, including caring for your body and pelvic floor. She believes that pelvic floor therapy is for everyone and is passionate about providing accessible treatment options for birthing people, men, women, kids, and the LGBTQIA+ community so that they can take better care of themselves and receive equitable care. She loves educating and empowering clients to take charge of their body and health and to not accept leaking of urine, prolapse, pelvic pain, pain during sex, and core weakness as a normal part of being a human.
