What To Expect with Pelvic Physical Therapy
Hello friends! We often recommend going to see a pelvic floor physical therapist (PT) for any kind of pelvic floor symptoms. Today we’re going to talk about what you can expect when seeing a pelvic floor PT. A pelvic floor PT can help with a range of symptoms including leaking pee/poop/gas (incontinence), pelvic pain, pain with sex, constipation, and so many others.
So, let’s talk about what you can expect on your first visit. Keep in mind that every therapist is different and will make decisions based on your individual needs so your treatment session may vary.
Most likely, your therapist will start your evaluation by sitting and talking with you. They will ask questions about your symptoms. What makes them better? What makes them worse? How long have you been experiencing them? The list can go on and on. Your answers to these questions will help to guide your therapist’s exam and treatment plan for you. It may be hard or embarrassing to talk about intimate topics such as peeing, pooping, and having sex with a complete stranger, but it is important to be open and honest with your therapist so that they can give you the best treatment possible. Your therapist should be non-judgmental, and chances are your therapist has heard it all!
After asking questions, your therapist will begin a physical assessment. They should be looking at many different things, including your pelvic floor muscles along with other body parts like your hips and back, or even your feet, as these can play a big role in pelvic floor disorders.
Either on the first visit, or on subsequent visits, your therapist will likely want to perform an internal exam. The internal exam will allow your therapist to feel the pelvic floor muscles to check how they are working in real time.
With an internal exam, you will be asked to remove your clothes from the waist down and you should be provided with a sheet to drape over for comfort. (Don’t worry about shaving prior to an exam, a little hair will not bother your therapist, and hair can actually help prevent infections!) The internal exam should be done in private with just you and the therapist, but you have the right to request that a friend or companion be present during the PT session. There are no speculum or stirrups used like you would have at the gynecologist’s office. The therapist should wear gloves and use a lubricant while inserting 1-2 fingers in the vaginal canal. A rectal exam is performed the same way and is often used for males or can be done in females with rectal or tailbone issues. Your therapist should let you know if they will be performing a vaginal exam or a rectal exam beforehand.
While an internal exam provides the most complete and accurate assessment of the pelvic floor muscles, there are many other ways a PT can help you without doing one. An external exam or other interventions can be performed instead of the internal exam. The external exam (exam without going into the vagina) can give the therapist insight into how the pelvic floor muscles are working, but it is not comprehensive. Imagine having a leak in your house, but the plumber has to figure out where the leak is coming from without actually going in the house. You can tell them what’s happening and where you are seeing signs of the leak, but the quickest way for them to fix it would be to go inside.
Remember that it is always your choice whether or not to have an internal exam. In some cases, your therapist may not feel that an internal exam is necessary. On the other hand, it may be possible to provide treatments without an internal exam initially and gradually transition to a full pelvic floor assessment over time. On the other hand, if you are having an internal exam but decided it is not right for you, tell your therapist that you would like to stop immediately. There is no need to wait until the end of the assessment. Your therapist should be understanding and work with you on your needs and your comfort.
If you do decide to participate in an internal pelvic floor exam, keep in mind that this may cause you to feel emotions unexpectedly. It is not abnormal to start crying or feel emotions/memories from the past. Don’t feel the need to hold back these emotions. It is healthy to allow them to happen and can be crucial in the healing process.
So, what exactly is your therapist looking for with an exam? They want to see how strong your pelvic floor muscles are and see if they are coordinated with activities like sneezing or laughing. Your therapist may also check for the endurance of your muscles (can you hold a muscle contraction for longer periods of time—like 10 seconds). The therapist may check for sensation (the ability to feel touch) and reflexes in your pelvic area.
After the assessment is completed, your therapist should review their findings with you and establish a treatment plan. Because a thorough assessment takes a lot of time, there may not be much time left over for treatment during the first session, but your therapist should be able to go over a few things with you to start until your next treatment session. This may include lifestyle changes (like eating or drinking habits), exercises or stretches, breathing techniques, or tricks like performing a pelvic floor muscle squeeze before you do activities like jumping or sneezing.
Having a pelvic floor exam done for the first time can be overwhelming and you may leave with questions. Watch this video from Jeanice on 10 things to ask your pelvic floor therapist to help make sure you get the most out of your visit.
What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.
Here are some great resources to help you find a pelvic floor PT and learn more about your pelvic floor muscles:
Ask your healthcare provider for a referral to a pelvic therapist.
Find a pelvic therapist on your own at myPFM.com. We have links to 4 free searchable databases under Find a PT.
Learn more about the pelvic floor muscles with our book: My Pelvic Floor Muscles The Basics
Sign up for our email newsletter!
Visit our Instagram page for more on pelvic health.
Watch a quick video to learn about your pelvic floor.
Written by Emily Reul, PT, DPT