What to Expect During Your Pelvic Floor Evaluation

If you’ve been referred to physical therapy for pelvic floor rehabilitation, you’re probably dealing with pelvic pain, urinary leakage, prolapse, or a number of other conditions that impact your quality of life. While it is perfectly normal to be nervous about your pelvic floor exam, rest assured that we are here to support you and guide you through every step of the way. In this article, we will discuss what to expect during your first visit and follow-up sessions so you can be as prepared as possible.

During your first visit, you will start by filling out some questionnaires about your current symptoms, birth history, bowel and bladder habits, sexual health, and other medical history. Your physical therapist will use this information to guide the exam and find the best treatment options for you. After you have completed the paperwork, your physical therapist will take you to a private room to discuss your symptoms and review your concerns. They will assess your mobility, strength, and flexibility of your hips and low back as these areas tend to be closely related to your pelvic floor. They will educate you on the different muscles and tissues that make up your pelvic floor and how they may be impacting your pelvic function. They will likely give you some exercises to do at home, as well as potentially having you fill out a bladder diary in which you track your bathroom trips, leakage, and fluid intake over the course of a day or two. 

At your follow up visit, your physical therapist may suggest doing a more thorough pelvic exam in which you will undress from the waist down with a sheet for coverage. During this exam, your physical therapist may visually assess your pelvic floor while you perform a series of movements. Your physical therapist will watch to ensure that your muscles activate and move the way they are supposed to. They may have you contract or perform a Kegel, cough, and take a few deep breaths to assess your movement. Then they may perform an external exam in which they will palpate, or feel, the outside of your pelvic floor and perineal region. They will assess for tenderness in the muscles and make sure that your skin looks and feels healthy. Lastly, they may perform an internal examination of your pelvic floor muscles. This exam involves inserting a gloved, lubricated finger into the vaginal canal at three different depths to assess your muscle tightness and activation. During this exam, your physical therapist will apply gentle pressure to your muscles and may have you repeat pelvic floor contractions or coughing to assess your movement and control. Lastly, your physical therapist may look at the internal walls of your vaginal canal to look for signs of prolapse. During the entirety of the exam, your physical therapist will be asking for consent to proceed. If at any point you are uncomfortable, the therapist will end the exam immediately. You are allowed to decline any or all portions of this exam at any time for any reason.

After the examination, your physical therapist will use the information to make a plan specifically designed for your condition. This plan will likely include breathing exercises, stretches, and strengthening exercises for your pelvic floor, hips, and back. They will also give you a home exercise program that includes a few activities to perform at home. It is very important to complete these activities at home to make sure that you build strength and mobility.

Your physical therapist is there for you every step of the way on your pelvic rehabilitation journey. If you have any questions or concerns about the examination or treatment, please contact our office to discuss with one of our pelvic floor physical therapists at any of our three locations.