Hello friends! Have you ever been to a doctor’s appointment and left with more questions than you went in with? There can be lots of information in appointments and sometimes it can be difficult to understand. Pelvic floor therapy is no exception to this. Below is a list of ten questions to ask your therapist.
#1 What Is Your Status?
After your therapist finishes your evaluation, you should have an idea about what they found. Some therapists will discuss this with you throughout their evaluation and others prefer to talk to you about this at the end of the appointment. If for some reason you’ve reached the end of your appointment and you don’t feel like you have a good understanding, make sure to ask what they found.
#2 What Are Your Goals?
Even with the same symptoms or diagnosis, your goals may be different from someone else’s. You may want to get back to running without having any urinary leakage while another person’s goal may be to pick up their grandchildren without leakage. Everyone’s goals will be different. You want to let your therapist know what your goals are. You also want to talk with your therapist about whether your goals are realistic and much time would be necessary to achieve those goals.
#3 What Was My Mechanism of Injury?
Ask your therapist why you might be experiencing symptoms. Sometimes your therapist can tell you immediately what the cause is; however, the cause is not always clear but they should be able to give you an idea of what they think the source may be. Knowing what caused your symptoms is a very important piece to recovery and can be empowering, not only for recovery, but to help you prevent your symptoms from returning in the future.
#4 How Are My Pelvic Floor Muscles?
The most complete way for your therapist to assess the pelvic floor is by doing an internal vaginal, or sometimes anal, exam. This does not mean you have to have an internal assessment, but it is the most accurate way to determine the status of your muscles. If you are not comfortable with an internal assessment for any reason, let your therapist know and they can check it in other ways. Regardless of how they check your muscles, you’ll want to ask what they found. Do they think your muscles are overactive or underactive? Which muscles are involved? How is the muscle strength and endurance? How many repetitions could you perform? The answer to these and other questions about the state of the pelvic floor will help drive your treatment plan to improve your symptoms.
#5 What Is My Timeline?
A big question for your therapist is: how long do you think I’m going to need to be in pelvic floor therapy? There are several factors that go into this decision. First, your symptoms and their cause play a role. Typically, the longer and more severe the symptoms, the longer it takes for symptoms to resolve. Other factors like time and finances may play a role. Insurance may decide how many appointments you can have, but you may also be limited by a high copay or a high deductible. If childcare, time off from work, or the distance to your appointment are difficult for you, this may affect how often you can attend therapy. Ask your therapist how long they think it will take to achieve your goals and how often they would like to see you. Look introspectively at whether what they are recommending is going to fit into your life. If you don’t think it will, have an open conversation with your therapist and try to develop a plan that will work best.
#6 What Will My Pelvic Therapy Interventions Be?
Interventions are essentially the treatments that are done during therapy sessions. The list of possibilities is almost endless, but depending on your symptoms certain treatments would be beneficial while others won’t. That’s where the skill of your therapist is important. They can help to guide you through what will work best for you. Some examples of interventions are: pelvic floor muscle training, hands on stretching, scar mobilization, and exercises. There are so many tools we can use to help like surface EMG biofeedback, ultrasound, dilators, pelvic wands, weights, etc. Have a conversation with your therapist about what interventions to expect during your appointments.
#7 Who Will Be On My Therapy Team?
If you are going to a bigger clinic or hospital setting, it may not be the therapist you see on your first visit that works with you every time you come. Ask them if they will be with you every visit, or if there will be other therapists or therapy assistants that co-treat with them. While we don't recommend seeing different therapists every week if we can help it, communication between treating providers is important. Who is your therapy team going to consist of? If your team consists of multiple people, how will they communicate about your treatment plan and progress?
#8 What Is My Home Program?
Successful therapy often includes a home exercise program. Being consistent with a home program means you need to know what is expected of you. Ask your therapist what you should be doing at home. Should you practice Kegels or work on relaxing the pelvic floor muscles? Should you be performing perineal massage? Stretching? There are so many things you can do at home to help your recovery. You should also leave with an understanding of how often they want you to do it. Most physical therapists recognize that people are busy. Giving you a list of 25 exercises (which may all be great exercises) might be overwhelming and hard to get done. Have a conversation with your therapist about what you can realistically get done in a day, especially if it seems like what they are recommended isn’t going to fit into your lifestyle.
#9 Do I Need Any Equipment?
Equipment at home may be helpful in your recovery. This can range from inexpensive items like resistance bands or an exercise ball to expensive items like biofeedback. In most cases, your health insurance will not cover the cost of equipment, but your therapist may have some relationships to get you equipment at a discount. They may be able to give you alternatives as well, like water bottles instead of small hand weights. Other equipment at home may include tools like electrical stimulation, pelvic wands, and dilators. Not everyone would benefit from all equipment, so ask your therapist what they would recommend before making any purchases.
#10 Who Should Be On My Healthcare Team?
Pelvic floor therapists often work with other healthcare providers like urologists, obstetricians and gynecologists, mental health providers, and so many more. After their assessment, they may recommend you follow up with other providers to get any additional care you need that is not within the therapy scope of practice. Ask them if they suggest any other providers be a part of your healthcare team so that you can work on getting appointments with the necessary providers.
This is by no means an all inclusive list of questions that you need to ask, but it is a great start. If you have any other questions, ask your therapist!
To learn more about your pelvic floor muscles, check out these great resources:
Find a pelvic therapist near you at www.mypfm.com/find-a-pt
Watch our YouTube video on Pelvic Floor Muscle Training
Watch Netflix for Your Pelvic Floor at Pelvic Flicks
Learn more about your pelvic floor on our Instagram
Visit our Amazon store for our favorite pelvic health products
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For providers, check out our online courses to help your clients. Consider joining our Ambassador Program and most of our courses are included with your membership!
Pelvic PT Evaluation of the Pelvic Floor Muscles with Dr. Samantha Richter, PT, DPT, WCS
Written by Emily Reul, PT, DPT