Pelvic Rehabilitation: Visit #1 for Women

Pain and other disorders of the pelvis can be embarrassing and socially isolating for women, men, and children. When referred to physical therapy for “pelvic rehabilitation” often times women (and men) are scared, surprised, and confused as to what a physical therapist can do to assist in improving their overall condition. The purpose of this blog post today is to give you some general information on Pelvic Physical Therapy as well as tell you what the first Pelvic PT visit will be like! This post is specifically geared toward women. (Stay tuned for my post geared toward men.)

Let me first start off by telling you that Pelvic Physical Therapy is much different than out-patient PT such as what you may experience if you sprained your ankle. Women’s and Men’s Health Physical Therapy can address a wide variety of diagnoses (see pelvic rehabilitation section of website for specific conditions we can treat). Much like specific “sects” of PT (sports, pediatrics, etc.), Pelvic PT requires advanced training, vast anatomical knowledge of the pelvic girdle, and manual techniques that are not always covered in Physical Therapy school. Fortunately, we offer compassionate and highly specialized treatment by a highly trained physical therapist in quiet and private rooms.

What to Expect During Your First Visit

First you will sit down with the Physical Therapist and talk about what brought you to Pelvic Physical Therapy. This is a great opportunity to tell “your story” about your complaint or condition. The Physical Therapist will then ask questions about your symptoms and medical history. The purpose of this questioning is to obtain as much pertinent information about your condition so she is best able to determine the appropriate treatment approach and interventions to get you better.

Next, the Physical Therapist will then examine your sitting and standing posture, how you move, and how you walk. The way you hold your body and move your body may affect your symptoms in the pelvic floor region. She will assess your hips, low back, abdominals and pelvic girdle---paying special attention to alignment, range of motion, strength, and mechanics. Dysfunction at the hips, pelvis, low back, and abdominal region can contribute to pelvic floor dysfunction.

Next, depending on your chief complaint, an internal pelvic evaluation may be indicated. Let me preface this by saying---not everyone needs or gets an internal evaluation on the first visit! There are some diagnoses that do not require an internal evaluation or are contraindicated (i.e.-pregnancy, immediately post-surgery, shoulder pain, etc.). There are even instances when patients who are referred for significant pain may be unable to tolerate an internal assessment on the first visit. Thus, the internal pelvic floor evaluation will only be performed with your informed consent and will be dictated individually by patient’s discomfort/pain level and tolerance.

What to Expect During an Internal Evaluation

Let me start off by stating that an internal evaluation of the pelvic floor is MUCH different than a gynecology examination. You are NOT placed in stirrups and we do NOT use a speculum for the internal assessment. These can be scary and uncomfortable to women specifically if you are seeking treatment for pain. The internal assessment will take place in a private room on a high-low mat--much like those that are used if you were getting a massage. The Physical Therapist will show you a model of the pelvis and pelvic floor muscles and describe first how the internal assessment will take place. She will then get your consent to proceed and give you an opportunity to ask questions before starting.

The Physical Therapist will then step out of the room and have you remove your clothing from the waist below, cover yourself up with a sheet, and sit on the treatment mat. You will have the choice of using a hand-held mirror or looking at a pelvic model so that you can follow along with the examination if you prefer. Your Physical Therapist will explain the “pelvic clock” so that you can have a reference of which area she will be assessing during the internal and external examination. The Physical Therapist will first start with an external observation of the pelvic and vulvar region. She will palpate externally for bony landmarks and pelvic floor muscles to feel for tightness as well as map out your area of pain/discomfort. She will visually observe the perineum region and have you contract your pelvic floor muscles, relax, and bulge or push out to assess your coordination.

The internal component of the evaluation will then proceed depending on tolerance to external assessment. The Physical Therapist will palpate the pelvic floor muscle layers internally using her finger and assess length, tension, ability to contract/relax, as well as map out pain internally. Again, the Physical Therapist will make reference to the “pelvic clock” to guide you through the internal assessment. If indicated, the Physical Therapist may also assess for a prolapse as well as grade the strength of your pelvic floor muscles. The Physical Therapist will then step out of the room and allow you to get dressed and use the restroom if desired.

When you are ready, the physical therapist will discuss what she found through her assessment as well as how physical therapy may or may not help you. You will discuss your goals for physical therapy and the therapist will give you information on typical interventions used, length of sessions, as well as answer any questions you have. The Physical Therapist may then give you “homework” for you first visit that will be tailored to your assessment findings, chief complaint, and learning style.

The most important thing to understand is that you run the evaluation. You have the choice to proceed or terminate at any time. The Physical Therapist can get a lot of information from an external exam and she does not have to do an internal exam if you choose to not undergo this part of the evaluation on the first day. You are always free to ask your therapist if you have any questions before, during, or after your Pelvic Physical Therapy examination.

Check out part 2 of Pelvic Rehabilitation: Visit #1 for Men and stay tuned for part 3, Visit #1 for Children.