Congratulations! You advocated for yourself and either got a prescription from your doctor or you are going directly to a pelvic floor PT on your own. Great job!
Now you’re wondering, what’s next? What is pelvic floor PT? What have I gotten myself into?!?!
It’s normal to feel a lot of emotions. You may be nervous discussing an intimate problem with a total stranger, skeptical that this will help at all, and/or excited to finally find out what is going on. This guide will help you get the most out of that first day!
Step 1: Prepare for the appointment
Many patients have had pelvic floor issues for months or years and have seen multiple specialists before seeking out PT care. No one knows your body better than you and evaluation day is all about hearing your story. We want to know your whole journey, even things that may seem unrelated (they’re almost always related)!
It might be helpful to organize your thoughts and write them down.
- When did this start? What does it feel like to you?
- Have you seen any other doctors for this? When?
- Have you had any tests or surgeries done? Do you have the records?
- What are you having trouble doing because of this issue?
- What do you want to get back to doing?
- Do you have any other issues in your body that seem unrelated? Back/hip/knee pain? Smokers cough? Depression/anxiety? IBS? History of abuse?
- Are you on any medications?
- Are there any patterns associated with this issue? Time of day? Activities? Foods? Stress?
If you are a person with a vagina and you have pelvic pain or pain with sex, the Pain Perception Project is a great resource (from the makers of Ohnut). It will ask you a lot of the questions I just listed and send you a printable PDF that you can take to your appointment. It is HIPAA compliant so no need to worry about your information getting exposed. They also have some helpful facts within the assessment and a great page of patient resources for people who love to research.
Step 2: Going to the appointment
Pro Tip! We all hate sitting in the waiting room and filling out a mountain of paperwork. Call the office and ask if they can send you the paperwork so you can fill it out before the appointment. You will still want to arrive about 15-20 minutes early so you can finish any last-minute forms. But, that will make things run more smoothly for you and the therapist.
The PT is going to want to watch you move around so wear something comfortable. Sneakers and workout clothes are usually a good choice.
Step 3: Telling your story
No need to be shy, you will be in a private area so no one will hear except the therapist. The PT will have reviewed your intake paperwork and know the basics but the details of your story are like clues to a detective! Every little bit of information helps us narrow down the long list of things that might be going on. Here’s where all those notes come in handy! The PT may ask some follow-up questions to clarify some points.
By the end of this conversation, they will have a pretty good idea of what is going on. The rest of the physical examination will be confirming or ruling out our thoughts.
Step 4: Big Picture Physical Screen
You are more than your pelvis so we need to look at more than your pelvis! We will evaluate your posture, walking, strength, and range of motion for a variety of joints and muscles – usually low back, abdominals, and hips. We may touch and push on your belly – we call this palpation – to see if there are any tender spots or separations (Diastasis Recti). Depending on your other conditions, we may also want to check blood pressure, reflexes, look at scars, and functional activities like getting out of a chair or lifting mechanics.
Step 5: The Star of the Show! (The Pelvic Exam)
IMPORTANT! You are in the Drivers Seat! This examination only goes as far as you are comfortable and want it to go.
It’s true! You have muscles and bones in your pelvis and PT’s are muscle and bone experts. Pelvic floor PT’s have pursued specialized continuing education above and beyond our degree because we are so passionate about treating this part of the body. If you are coming to us with a pelvic floor problem, it is likely that the pelvic floor examination will be uniquely helpful in identifying specifically what is the issue.
All that being said, I strongly believe it is not essential to do an internal exam on the first day and, in some cases, at all! Like I mentioned earlier, after hearing your story we have a pretty good idea of what is going on, and after doing our physical screen we’ve probably identified some other issues to address. It is OK to stop there for the day!
If and when you’re ready to move forward with a pelvic examination, you will get undressed from the belly button down and get settled under a sheet. This is a good time to tell your PT if you have any trouble laying on a table such as needing extra pillows or discomfort with a particular position. We want you to be comfortable and often have props for just this purpose. The PT will gather supplies like gloves and lubricant and sanitize their hands before joining you. They will explain the examination as planned and get your explicit consent before starting and at every step of the examination.
- Visual examination: The PT will look for any skin irritation, cuts, or signs of infection
- Pelvic floor mobility: The PT will ask you to squeeze your pelvic floor, cough, and bear down like you are having a bowel movement and observe how much the perineum (area between the genitals and the anus) moves. This gives us an idea of strength and support.
- Surface palpation: The PT may want to palpate the outermost muscles of the pelvic floor which form a triangle around your genitals. This lets us know if they are weak or tight or tender and if they reproduce your symptoms. We can also test sensation and make sure you have appropriate feeling in that area
- Internal examination: This can be vaginal or rectal. This allows us to evaluate the internal pelvic floor muscles for strength, endurance, and tender spots. We may ask you to cough, bear down, or squeeze up again to evaluate these internal muscles
Don’t worry too much about grooming “down there” more than you’re usual routine. We’re medical professionals and we’ve pretty much seen it all. If you are menstruating, this should not interfere with the internal evaluation but if you are uncomfortable you can always wait until the next appointment for any internal work.
Step 6: Homework!
Yeah, you survived your PT evaluation! Now it’s time to start getting better. Depending on what your PT finds this might include stretching, deep breathing, strengthening weak muscles, and learning to consciously relax painful muscles.
They may also give you some writing homework like journaling or handouts to track your eating, bowel, and bladder habits to look for any patterns.
Either way, you are on the path to getting better and I am so proud of you for taking this step.
