What to Expect From a Pelvic Floor Physical Therapy Evaluation

Okay so it’s happened – you’ve gone to the doctor and told them. It was hard. But this pelvic pain, discomfort, urinary leakage, urinary urgency, chronic constipation - whatever it is - has gone on for far too long. You sit down in the sterile room with your medical provider of choice and you let loose (all in the time span of 3-5 minutes) and rattle off all of the crazy, painful, sleep depriving symptoms you’ve been having. They listen and they tell you it seems like you could benefit from a pelvic floor physical therapist. You thank them for their time, take your script out to the car and sitting in the car you think what the actual f**k is a pelvic floor physical therapist? Or maybe you’ve told your girlfriend that you too leak after having babies and she told you that it doesn’t happen anymore since she’s been seeing this “amazing new pelvic floor PT”. Or maybe you’ve had a night out with the guys and after a beer or two you couldn’t sit on the bench anymore so you just had to tell them that every time you drink beer it makes you feel like you’re sitting on a golf ball and you friend turns to you and says “man that sucks, my friend told me once that he goes to this chick who helped him with some pelvic pain”.  No matter how it happened, you’ve decided, it’s time to open up. But seriously, what the actual f**k is “pelvic floor”? Do I get on the floor to do my exercises? Is this even a real thing? What the heck has gotten me to this point?

Now, before you take out your phone and ask your second favorite medical provider, Dr. Google, I’m here to give you a little break down about what to expect when it comes to visiting your pelvic floor physical therapist for the first time. The initial evaluation/initial meeting with your physical therapist may vary based in time on the location they are offering services in. To start if you see someone who works for a hospital/medical system their first session may be shorter in time then if you see someone privately so the amount of time it takes to get through the entire assessment will vary (meaning that for some providers it may take up to two sessions just to get all the information in place).

Before the appointment even starts, be ready to fill out some paperwork. We’re going to want to know all about what’s been going on for you and how your body has been working. There’s going to be your basic medical history, we’ll ask about any past surgeries and a list of medications. From there also be prepared to answer in detail about what is going on for you. This isn’t your typical evaluation with a medical provider, we want ALL of the details – leave nothing out (that’s right I’m talking about that time when you were younger when you couldn’t figure out how to put a tampon in and it burned OR that time you and your partner were thinking about anal and she/he/they really hurt you so NOTHING can come near that area again). For many people venturing in to the pelvic health world, this is the first time that someone may have actually cared to ask you about further details when it comes to your pelvic floor and pelvic health. It’s going to seem like it would be awkward but trust me, there isn’t anything you could tell me I haven’t heard already so lay it out there. After we’ve gathered all of the information about your current situation there are a few questions we go through about bladder and bowel health. Your therapist is going to maneuver these questions to be able to reflect what we’ve gone through already and make sure we get all of the details ironed out. 

The next step in your initial session with a pelvic floor therapist is the almighty education session. Personally, this is my favorite step because you don’t know what you don’t know until you know (ha!). The therapist will take the information you’ve given us and educate you on pelvic floor, where it is, what is happening and how to change it. This part of the evaluation goes in to detail about the anatomy, the muscles and the function of each component of the pelvic floor. It’s so important to learn from someone and in person because it gives you the tools and power to be in charge of your health. Your physical therapist’s main goal is to empower YOU to take charge of your health and learning about your body and why/how it works is the best first step.

Now, depending on how much time you have in session with someone these next parts may take place during the second session. It’s so important that you get to tell your story first and learn about your body a bit before we dive in to the rest overall so dedicating a portion of your therapy to tell your story is vital. Once that is complete, your therapist will look at the muscles of your low back, hips, abdominals and (externally) at the entire pelvis. This is important because the muscles of posture and the ability to assess the hips externally can play a large role in some of the symptoms of pelvic floor. Depending on your current diagnosis and what you’ve disclosed to the physical therapist you’ve been working with they may decide to work on anything from you inner hips, the low back or even (surprise surprise) your abdominal wall and the organs themselves! Although it is highly recommended to have an internal assessment done to map out the pelvic floor muscles themselves when having symptomatic pelvic health issues, it’s entirely not necessary. There is a ton that we can and will do externally that will help the symptoms that you’re reporting, but if the external work is not 100% and we can’t get a good understanding of the pelvic floor muscles from externally it may be beneficial to do an internal assessment and potentially use manual therapies (such as massage, scar work and muscle reeducation) internally. But again, this is an entirely OPTIONAL step and when you meet with your pelvic therapist they will be able to give you more information as to whether or not you are a candidate for internal work.

And now you’ve done it. You’ve gone through all the steps for the physical therapist to be able to gather information on you, your situation and what is going on “down there”.  The final steps are going to be working with your physical therapist to make a game plan on what’s next for you. The game plan typically encompasses goals that you would like to reach, how often you can/should be seen for follow up appointments, homework assignments to complete before next treatment session and a way to contact the therapist if any emergencies or issues arise. 

So, now that we’ve gone through all of that, let’s take a nice deep breathe. Know that it’s totally in YOUR control how little or how much we do together in every session. And trust that if and when you meet with a pelvic health specialist they’re there *for you* and to guide, create and establish a plan of action to get you on your way to healing and feeling better.