Pelvic Health at Precision: What to expect on my first visit

There are never any “cookie-cutter” appointments here at Precision Performance and Physical Therapy, but many people wonder what they might expect their evaluation to look like if they’re coming in for pelvic floor physical therapy. In my last blog post, I explained how the pelvic floor plays a role in your deep core, how it could be a component in your running injury, and when you should consider getting your pelvic floor assessed. Today I’ll dive into what that assessment entails so you can feel prepared for your session!

Review: What is the pelvic floor?

The pelvic floor is a group of muscles that sits like a hammock within your pelvis. It plays a critical role in stability, bowel and bladder control, sexual function, and helps support your pelvic organs. Everyone has a pelvic floor, but the organization of the muscles within the pelvis vary between males and females. To learn more about the structure and function of the pelvic floor, along with how the pelvic floor works with the other deep core muscles, check out my previous blog post here.

What would we do in a pelvic floor physical therapy evaluation?

Like any evaluation in physical therapy, I’ll start by listening to your story. In medical terms, I take your “subjective exam.” Getting a thorough understanding of what brings you into physical therapy is a key step in determining how we will prioritize the rest of the session. Sometimes pelvic floor symptoms are one’s primary concern, and other times folks tell me that something else is more bothersome, but pelvic symptoms may also be present. As an example, two different people with both back pain and urinary leakage may have very different experiences on how those symptoms impact their lives. Patient 1 may find that their back pain prohibits them from moving around easily and impacts most activities they want to do, but the urinary leakage can be managed with the use of protective pads. Patient 2 may explain that the urinary leakage stops them from engaging in exercise in a meaningful way, but that they can deal with the back pain. The same two symptoms that these individuals are experiencing are impacting their lives in entirely different ways, so although these symptoms are likely related in both cases, what we focus on in our first session will vary. Your subjective exam will also help me determine if there are any other factors that could alter the course of the physical assessment such as recent surgery, recent infection, or personal preference, among many others.

It’s not possible to assess ALL the contributing factors that could be related to one’s symptoms over just one session, so I always ensure that I understand each individual's priorities before beginning a physical assessment. If pelvic floor symptoms are the primary complaint, we may perform a pelvic exam (which I will explain more coming up). Even if we spend most of the session addressing the pelvic floor, we will start with a brief screen of your core function, lumbar spine and hips, as well as functional movements such as squatting, hopping, and balancing on one leg to gather more information about what we may find in the pelvic exam.

What is a pelvic floor exam?

In pelvic floor physical therapy, we can learn a lot about the way the pelvic floor is functioning through an external and/or internal pelvic exam. An external exam can be performed over clothes (if that is your preference) and we can check the superficial pelvic floor muscles for pain and coordination of activation (i.e. can you contract and relax your pelvic floor on command and does the pelvic floor move upwards when doing so?). An internal pelvic exam can give us information about muscle tension and/or pain in both the superficial and deep layers of the pelvic floor, as well as a more detailed assessment of muscle activation and coordination. Unlike at the gynecologist’s office, we don’t need to use a speculum for this internal assessment because we don’t need to observe the pelvic organs that are higher up in the pelvis. Instead, we use a gloved finger in the vagina or rectum to feel for tension or assess pain and grade the quality of muscle activation and relaxation. If you are comfortable with either an external and/or internal pelvic exam, it can provide a lot of useful information about why your pelvic floor symptoms are occurring; however, a lumbar spine, hip, core, and functional movement screen can often give us plenty of great information to use to make your plan of care if you would rather defer or decline a pelvic exam.

Is there anything I need to do to prepare for the pelvic exam?

It is best to wear clothes that you feel comfortable moving around or being active in and it’s always good to come with questions if you have any! I want you to be comfortable during your pelvic exam, but there is nothing specific that you need to do to prepare your body for it. I am trained to perform these exams on all bodies in all phases of the menstrual cycle, and we will only move forward with a pelvic exam if you consent to one on the day. Keep in mind that if you feel uncomfortable at any point during the exam, we will stop the exam immediately. You are in charge!

What will rehab look like for my pelvic floor?

Again, there is no “one-size-fits-all” approach to pelvic floor rehabilitation, but based on what we saw in the physical exam, we may be working on pelvic floor strength, endurance, or tolerance to high impact; we may be finding strategies to reduce pelvic floor tension or pain; we may be increasing your pelvic floor range of motion; we may be improving your pelvic floor coordination with movement and exercise; or any combination of these! The key here is that pelvic floor rehab (similar to any other physical therapy you do) will require consistent effort outside of the PT clinic to really see results. I work with patients to ensure that the home program they are leaving with is feasible and will fit into their daily routine.

I am currently practicing pelvic floor physical therapy in both our Atlanta and Serenbe offices, so please come see me if you want to learn more about your pelvic floor function! Don’t hesitate to email me at perrin@precisionpt.org if you have any questions!

Your pelvic health nerd,

Dr. Perrin Clavijo, PT, DPT

Precision Performance & Physical Therapy in Atlanta and Serenbe