What to Expect at Your First Pelvic Floor Physical Therapy Appointment

Considering contacting a pelvic floor physical therapist, but unsure of what to expect?

First, pelvic floor physical therapy isn’t just for pregnant and postpartum women! It addresses countless conditions such as:

• Pelvic pain
  
• Incontinence
  
• Pelvic organ prolapse
  
• Hip or back pain
  
• Endometriosis
  
• Amenorrhea (painful menses)
  
• Dyspareunia (painful intercourse)
  
• Interstitial Cystitis (painful bladder)
  

That isn’t even all of it! Although extremely important for childbirth, many of these conditions have nothing to do with it! Aging, acute or chronic injury, and dysfunction can all lead to the pelvic floor. I’ve decided to do my work due to personal experience with infertility and pelvic dysfunction that had nothing to do with the act of bearing a child! I’m passionate about sharing this knowledge and helping other women who may also feel shame, confusion, or frustration towards the standard medical system.

If you’re considering it or have already scheduled your first pelvic floor physical therapy appointment, it’s natural to have questions and perhaps a bit of apprehension. This post will walk you through what to expect on that first visit.

Subjective: the talking part

This is probably the most important part of the exam! Prior to talking to the physical therapist you will be asked to fill out a few forms, where you will answer questions including your current complaint, medical history, physical activity, past surgeries, medications, etc.

Then, most pelvic floor PT’s really will want to hear from you and let you speak, probably more than any other MD office you’ve been to. They want to know your goals, history with your current and other conditions, health journey, and more. Be prepared for questions relating to:

• Pain/discomfort
• Previous births
  
• Menstrual Cycle
  
• Surgical History
  
• History of other injuries
  
• Current and past levels of activity
  
• Past experiences with physical therapy or other providers
  

The primary goal during this portion of the exam is to get to know you! Everyone is different, with different goals and experiences. We strive to hear you and put together the entire picture to approach your care with a holistic model.

Objective: the physical part

Once we’ve gotten to know you as an individual, we will approach our physical exam with your goals in mind. The physical portion will include a general scan of the body to look at any alignment issues that can clue us into any specific areas we want to dive deeper into. The deeper dive may include:

• Specific muscular strength
  
• Specific mobility testing
  
• Specific nerve testing
  
• An internal exam
  

The Internal Exam:

This is the part of the exam that may cause the most anxiety ahead of time. It is important to note that prior to any internal exams, written consent will be taken. If you are uncomfortable in any way, an internal exam does not need to be performed at that time. Our internal exams are different from a gynecological exam. The goal of an internal exam is to assess strength, mobility, coordination, and any points of tension:

• Your physical therapist will explain everything before it happens and as it happens. There should be no surprises!
  
• They will perform a pelvic floor muscle test with one gloved and lubricated finger.
• They will palpate the pelvic floor muscles looking for any points of tension.
  
• They will assess pelvic floor coordination and strength, through directed exercises such as kegels, bearing down, and diaphragmatic breathing.
  

Again, an internal exam will never be performed without your consent. If you are uncomfortable, we don’t have to do it. It is, however, a helpful tool that can guide us to the right diagnosis and treatment approach.

Finally, it is also important to note that it is rare that an initial exam will give the physical therapist all the information that they need. We are continuously assessing and reassessing to best adjust the treatment approach for your body! This may involve internal exams in subsequent visits.

Assessment: the putting it all together part

This portion of the exam brings together all the information from your subjective and objective portions of the exam. This is the time when a physical therapist will determine what might be going on to cause your symptoms. If you are visiting for preventative care prior to or during pregnancy, this is the time the physical therapist will determine any imbalances in the body that you can address NOW to assist with a successful pregnancy, and labor, and delivery.

This is the time when we will come up with a plan. We will talk about the best visit frequency and schedule for your follow up visits. We will talk about any exercises that you may start doing at home. Homework is always customized, taking your goals and symptoms into account. This is also the time when the physical therapist should be educating you on what they found and how to approach treatment! Ask as many questions as you need. We want to help you feel empowered and supported!

Hope this was helpful! Feel free to email me at: blumehauspt@gmail.com with any questions you may have!

Ready to book an appointment? Text or call: (208) 996-3421

~ Dr. Alina Wright, PT, DPT