What To Expect From a Pelvic Floor PT Examination

In my previous post I touched briefly on what you may be able to expect from your first physical therapy appointment, but I wanted to dive in a bit further. Often times patients are very apprehensive when they walk through our doors for the first time. I see a lot of that concern wash away once they know what we’ll be doing that day. I thought I could ease some worried minds by shedding light on exactly what you can expect from your initial evaluation. Keep in mind that I am describing an initial examination at Sullivan Physical Therapy, and mileage may vary from clinic to clinic.

Before you even come in for an appointment, you will be asked to fill out some paperwork. Some of that will be insurance related and will help our wonderful front office staff get you the most out of your benefits. Some of it will be to give your therapist a little information about what you’re experiencing and what you’ve already done about it. We’ll also need a referral from your physician, but you can just have him or her fax it to us or bring it with you to your first appointment.

Now, to the good stuff. When you show up for your first appointment, your therapist will come get you from the waiting room and bring you to our private treatment room. The walls will likely be lined in hand drawn pictures of Napa to help put your mind at rest. Also because that’s where our Kimbelee Sullivan hails from. They’re very nice. You’ll like them.

Once we get back to the treatment room, you and your therapist will talk. This is a great time to ask any questions you have about pelvic floor PT and voice any concerns. This first part of your evaluation is called the subjective portion, or the talking portion. You’ll have a chance to tell us your story from beginning to end. Afterwards we’ll ask more questions about your bladder, bowels, sexual activity and pain in the pelvis to help us get the clearest idea of what’s happening with your pelvic floor and determine if there are any other affected areas that you hadn’t thought were connected. This can last anywhere from ten to fourty-five minutes depending on what you need and how much there is to cover.

After the subjective portion, we’ll be able to tell you what your physical examination will entail. The physical exam will be tailored to you and will differ based on what you’re experiencing and what your goals are. We may want to look at your lumbar spine to see if we think any of the symptoms are stemming from your back. We may want to strength test your hips and legs to see if we think weakness in your lower extremities is a contributing factor. We’ll look at pelvic alignment and abdomen if it seems necessary based on your symptoms and we may want to watch you squat, walk and pat your head and rub your belly at the same time. Kidding. Sort of.

Lastly, your physical examination may include an internal and external examination of your pelvic floor. An internal exam can be done vaginally or rectally for women and rectally for men. This part of our physical exam gives us a ton of information. It helps us determine whether your pelvic floor muscles are tight or weak and if you know how to use them correctly. It also helps us decide if they are a likely contributor to the pain or symptoms you’re experiencing. Our exams may be uncomfortable, but they should never hurt you and we want you to know that. If gynecological examinations have been painful in the past, know that we do not use a speculum or stirrups. We use a gloved, lubricated finger and we will not push through any intense pain or discomfort.

Like I said in my previous post, if you are uncomfortable with an internal exam, there are ways around it. I have seen patients and they have gotten better all without an internal exam. Don’t let fear of an exam stop you from getting PT care, because we can do our best to help even without this testing.

The physical exam will take up the majority of the remaining time of your first PT visit, but before you leave we will arm you with at least a few tips, tricks or exercises to start implementing over the following week or until your next appointment. This will be considered your home exercise program (HEP) and it’s a HUGE part of PT. We may see you once a week, maybe twice a week at absolute most. Our goal is to teach you little things you can start doing at home to make sure that you and your body are moving in the right direction between PT appointments.

And that is an initial evaluation with a pelvic floor PT at Sullivan Physical Therapy, folks. Thanks for reading! If you have any questions or comments, feel free to leave them below or email me at becky@sullivanphysicaltherapy.com.

Also, a couple of my amazing colleagues have an informative podcast called PT Below The Waist. If you want to hear a more about a pelvic floor evaluation, you can hear Jessica Chastka, PT, DPT and Jamille Niewiara, PT, DPT talk about it on episode 3! Or follow this link: https://soundcloud.com/ptbelowthewaist/episode-1

-Rebecca Maidansky, PT, DPT

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