What to Expect at Your First Visit of Pelvic Floor Physical Therapy

Your first day of pelvic floor physical therapy isn't as scary as you think. We're not like gynecologists where we use stirrups, a speculum and get in and out before you even know what happened.

Instead, we take it SLOW and at your own pace.

Here's what you can generally expect on your first visit:

When you arrive at the clinic, we'll sit down and I'll take a very thorough history that might go back to some things that happened in childhood. I'll ask questions like...

• Have you ever fallen on your tailbone?
• What's your history with things like constipation?
• How have you experienced menstrual cycles throughout your life?

We're going to dig deep and look at the full picture of what's been going on over the course of your history that may have led to some of your pelvic floor dysfunction that you're having now.

Then we'll do a full body examination. We look at the full body because the full body interacts with the pelvic floor... it's all connected from head to toe. That'll involve things like...

• A standing movement screen
• Watching your form as you do functional movements like squats, lunges, and balance exercises
• A range of motion and strength assessment on your hips, spine and abdominals
• Palpation to different areas of the body externally

Then, we may or may not do an internal pelvic floor exam, depending on your comfort level and with your consent. You are always allowed to bring a second person with you to your appointments if it helps you to feel more comfortable. It tells me a lot to be able to assess the pelvic floor muscles internally.

There are three openings in the pelvic bowl:

• The urethra where we urinate
• The vaginal opening where we have babies and intercourse
• The anal sphincter where we have bowel movements (and for some intercourse)

We can assess your pelvic floor muscles through one of two openings: the vaginal opening (transvaginal assessment) or anal sphincter (transrectal assessment). 

When we assess the pelvic floor transvaginally, it helps us the access the front of the pelvic bowl easier and when we assess transrectally, we have better access to the tailbone and some of the muscles on the backside of the pelvic bowl like the piriformis which runs next to the sciatic nerve. So depending on your history and your symptom presentation, we might do one, the other or even both. But usually not in the same visit.

The internal assessment is done on the treatment table where you are comfortably positioned on top of a sheet and chuck pad to help you feel confident if you're worried about leaking or discharge.

When you're ready, I'll use a gloved finger and a little bit of water-based lubricant to SLOWLY assess the strength, tension, tenderness, coordination, and endurance in your pelvic floor muscles.

Depending on how you are tolerating the exam, we may just assess one layer. We don't have to assess everything in the first visit. It just gives us some information to get started and helps us to start connecting some dots.

Once I've done the examination and have an idea of what's going on, I'll usually start by educating you on your diagnosis and prognosis. Then, together we'll set some goals for you, like...

• What do you want to achieve with pelvic floor physical therapy?
• Where do you see yourself down the road?
• What activities do you want to be able to do?

Finally, we'll get to some treatment!

I often do some manual therapy on day one, like massage, trigger point release or myofascial release with cupping. We usually do some exercises to start training the core and pelvic floor. Sometimes we use different modalities like kinesio taping for symptom relief.

I promise you, pelvic floor physical therapy is actually quite fun and informative! Don't let it be intimidating. No one ever teaches us this stuff about our bodies, so you'll definitely walk away learning something new after your first session and feel ready to walk down the road to recovery from your pelvic floor condition.

Remember... Everyone has a pelvic floor and so many of us are struggling with pelvic floor issues (often silently). So know that you are not alone. I look forward to working with you!