What to expect at your first pelvic floor physical therapy session

Your pelvic floor physical therapy evaluation starts with a lot of talking. I want to know you're history. I want to know how long symptoms have been present, how they affect your life, and how you describe your symptoms. If you are in pain, I want to know where the pain is located, how intense the pain is, how long it has been present, what brings it on, what makes it better, and what words you use to describe the pain. If you are constipated, I want to know how frequently you use the bathroom, what your poop looks like, how much effort it takes to have a bowel movement, and whether it hurts you. If you are having urinary frequency, urgency, or incontinence, then I want to know what fluids you drink and how much, how often you go to the bathroom, what circumstances lead to leakage, and how often you have symptoms.

After we have a nice long chat about all of your symptoms, then I start evaluating your body including your strength, muscle function, and movements. As we start the physical portion of the evaluation it is important for you to know, I will only continue if you are comfortable with each step.

I first evaluate your back and hips. I want to know how you move in general, and whether other body parts nearby are affected by your pelvic floor symptoms. I want to know how strong your hip muscle are, how strong your core is, and how your hips and spine move.

Finally, I can start looking at your pelvic floor. I wear gloves when I am examining the pelvic floor. I start by looking to check your skin for irritation, infection, scars, and wounds. I observe your contraction, relaxation, bearing down, and what happens when you cough. Then I touch all around the outside to check for tenderness. The spots I touch can give me a sense of what muscles may be tender once I examine you inside.

For the internal portion of the evaluation, I lubricate my glove and insert one finger vaginally. I gently touch each of the 6 muscles in the outermost layer, 7 muscles in the middle layer, and 8 muscles in the deepest layer of tissue. That is 21 muscles in all! I want to know which muscles are tender, I assess the tone of each muscle, and I will ask you to contract and relax a lot to asses your strength and endurance. Then I will assess for prolapse while you bear down.

Now did that sound so bad? It is really pretty quick and I do my best to avoid pain as much as possible. That means that if I find pain then I get off of that spot as quickly as possible.