Pelvic Floor Evaluation: What to expect

What will happen on the first appointment?

After filling out your initial paperwork, a physical therapist with special training in the muscles of the pelvic floor will talk with you and discuss your concerns in private. Your medical history and the history of your problem will be discussed. Since the muscles of the pelvic floor relate to a person’s bladder function, bowel function, pelvic and low back pain, and sexual function, you will be asked about these topics. You are free to discuss whatever you are comfortable sharing, and the therapist will listen and guide you in order to understand your problem and the goals you want to achieve. Common goals include sitting through lunch without having any leaking, pain free and enjoyable intercourse, comfortable and controlled bowel movements, improved strength to reduce a pelvic organ prolapse, reducing pelvic pain in order to enjoy a hobby, urinating less frequently in order to sleep through the night, or returning to increased physical activity with better bladder control.

Internal exams

At this point the PT will have a good idea of what your problem might be. She may want to do an external evaluation of your posture, back and hips. The PT will then explain to you how physical therapy can help and why an internal examination is important for assessment and treatment. Because of the location of the pelvic floor muscles, the best way to assess and treat them is to work internally. This can be through the vagina in the female or the rectum in the male. You will be given a sheet to cover up and the therapist will be out of the room while you dress or undress, much like a regular physical exam at the doctor’s office. It is a good idea to empty your bladder before the exam and wear comfortable clothing.

Do I have to have an internal exam?

If you are not comfortable with having an internal exam on your first visit, or at all, there are still some things that the PT can do and advise you to do that will help your condition improve. Sometimes people need a little longer to establish a rapport with the therapist or even to reduce their general pelvic pain to be able to tolerate an internal examination or treatment. The physical therapist will do everything to reduce any pain or embarrassment that you might have. An internal exam is still possible while a woman is having her period, and is determined by the comfort level of the patient. A therapist does not, however, perform internal exams during an active local infection or during pregnancy.

Physical therapists do this?

Most people are totally unaware that physical therapists do any internal work. It is within our legal scope of practice and the pelvis is just like any other area of the body with muscles inside. Physical therapists are licensed to treat this area of the body, just as they are licensed to treat your neck or your knee. The best way to access the muscles inside the pelvis are to do so with an internal exam, and our therapists have had specific continuing education courses in order to do this safely and with expertise. The therapist will make every effort to make sure that you are comfortable with an internal examination before proceeding.

How do physical therapy internal exams differ from what a doctor does?

Physical Therapy internal exams are different from the pelvic or gynecological exams performed by your medical health practitioner. We do not use a speculum and we are not evaluating the reproductive, urinary or intestinal systems. We evaluate the pelvic floor muscles, joints, ligaments and fascia for strength, quality, endurance, and motor control. We have 45 minutes to do your complete evaluation and can take our time to move slowly and discuss what we are doing as we go. We will be very sensitive to any pain or other issues you may have. PTs are looking for what areas are painful, how much muscle spasm you have, what strength you have in your pelvic floor, whether you can do a good pelvic floor contraction and also whether you can release it.

What happens after the evaluation?

After the examination, you will get dressed and discuss your treatment plan with your therapist. She will tell you the outcome of the evaluation, discuss your goals, and let you know how and if further physical therapy can help. You will likely be given homework and advice on how to start helping to improve your situation. Typically the visits are 45 min long, coming 1‐2 times a week, and can range in length from 4‐20 weeks of ongoing therapy