This month we are highlighting women’s health – specifically pelvic floor health.  We are talking about pelvic floor integrity, core strength and how truly vital healthy, strong, supported women are to our entire society. 

Now since we’ve been discussing pelvic floor integrity and how physical therapy can assist with issues from incontinence to prolapse to postpartum care (did you know you’re considered postpartum FOR YOUR ENTIRE LIFE after pregnancy)?  We thought today would be an excellent day to share a little bit more about what you can expect during a pelvic floor assessment with one of our specialists.

What is a Pelvic Floor Assessment?

Any pelvic floor assessment with one of our therapists is going to be focused on YOUR needs, YOUR comfort, and YOUR journey that got you to this point. The therapist will ask tons of questions (we’ll cover what kind of questions in a minute) and will really take the time to listen to you, get a clear idea of the “big picture” in your situation, and examine you from a holistic perspective, not just looking at the problem you’re experiencing.

What Happens In A Pelvic Floor Assessment?

The first thing that will happen something we’ve already mentioned – questions! You can expect a *ton* of questions from your PT, and come ready to share about some potentially tender topics, like “the 5 P’s”. What are those, you ask? I’ll tell you.

1. Peeing

Are you able to empty your bladder fully when you pee? Do you have trouble with incontinence or leakage? Do you find you are frequently needing to make trips to the bathroom “just to be safe”?

2. Pooping

How are your bowel movements? Do you have to strain to get them out? Perhaps you experience diarrhea. Maybe constipation?

3. Pregnancy

Are you pregnant now? Have you ever been pregnant? If yes, what were those pregnancies like? When did they occur, and how were you supported in the time after birth?

4. Penetration

How’s your sex life? Do you find intercourse painful? Are you able to enjoy intimate experiences? Are pelvic exams OK for you? Do tampons cause any problems or are they uncomfortable?

5. Periods

What are your periods like? How long do they last? Are they regular? Do you experience cramping or PMS?

These are just a few examples of some of the questions your PT might ask you to help them create a clearer picture of your health. We know there can sometimes be some hesitation around sharing these types of details, so we always promise you these three things:

1. We are never judging you!

It’s important that you share honestly and openly with your therapist so they can most effectively customize your unique plan of care.

2. What’s shared in a session stays in a session.

We will NEVER share your health information of any kind with others outside the clinic, and we deeply value your vulnerability and trust in sharing with us. We will treat you and your information with the utmost respect.

3. You are absolutely safe.

Our clinic is a safe, protected space, our doors are locked during any kind of pelvic floor work, and YOU are always in control of your session and can step or shift gears at any point in time. We can also promise you that whatever you’re about to tell us, we’ve probably heard it before. More than 50% of women have problems with their pelvic floor at some point in their life (meaning that they might be having symptoms when they’re reporting on the questions above). We help women with these things all the time without surgery or medications and would be honored to help you too.

Ok, So Some Tender Questions – Then What?

After you and your PT go through any questions she has about your unique situation and she has a clear understanding of your history as it relates to the pelvic floor and your particular challenges, she will perform a full body assessment including postural analysis and strength exploration as you would expect in a traditional PT session.

Once that’s done, that’s usually all that’s completed assessment-wise in your first session. Your PT may offer treatment on some of the other challenge areas found in your whole body assessment, and will undoubtedly share some information or exercises to help you in your integration process between your first appointment and your next follow-up. It’s at that second (or maybe even third!) appointment when your PT may suggest actually moving forward with a pelvic floor assessment. It’s important this step feel supportive and safe for you, and for that reason it is almost never done on the first visit. We want you to feel like you can take all the time you need to get comfortable with your PT before moving into addressing the pelvic floor.

We’re Two Sessions Into A Plan Of Care Now – What Happens Next?

After you’ve and your pelvic PT have built a good rapport and you’re ready to move into an internal assessment, your PT will help you get set up for the experience. (And don’t worry, this is NOTHING like going to your OB/Gyn and sitting in the stirrups. WAY less invasive, WAY more supportive of your innate body wisdom and inherent autonomy!)

The pelvic floor assessment itself is pretty simple. Your therapist will wear gloves, and with a gloved hand and gentle touch begin by checking in with the tissues of the vulva and anus. She is checking to see, is there redness, tightness, irritation, or even pain? Those are important clues for your PT and will help provide context for your situation! While her attention is there at the opening, she’ll ask you to do a “Kegel”, otherwise known as a pelvic floor contraction, just to check in with the muscles and their activation at this sacred gate.

After that, it’s time for the internal assessment. With utmost care and attention, your PT will gently insert one gloved finger into the vagina and assess each of the three layers of the muscles of the pelvic floor. Each one is about a knuckle deep (so by the end of it, your therapist will briefly have one entire finger inside your vagina), and as she moves through the layers she will be continually checking to assess if there is any tightness, tenderness, or pain. There absolutely shouldn’t be pain at this point! If there is for any reason, it is of utmost importance you use your voice and share that with your PT so they can help you address that expediently.

Another thing that your PT will be checking for as she feels through the layers of your pelvic floor musculature is whether you can contract and release those muscles, and what the general tone of the muscles is like. Believe it or not, this can be one of the most empowering parts of the whole experience, because you will have a licensed expert actually checking those deep muscles in real time telling you if you’re engaging correctly or not and offering tiny adjustments that can make a world of difference. If you saw our last video about Kegels, you may already know just how tricky they can be for some people, and how a little bit of “live” feedback can make a huge difference in proper engagement of the muscles of your pelvic floor.

All in all, the whole assessment will take between 5-10 minutes. Even with that brief time, it provides so much valuable information for you and your therapist. Afterwards, you will both have a clearer picture of what’s going on with your incontinence, pelvic pain, or any other pelvic problem you’ve been navigating, and your therapist will be able to even further customize your plan of care to meet your unique needs and provide you with the best support possible.

Side note: If you prefer not to do an internal assessment or not take your clothes off, that’s totally OK! Some women don’t feel comfortable with this and we’re still able to accomplish 80-90% or more of what is needed while keeping their clothes on. If this is of concern for you, it is still very much worth scheduling a visit or picking our brains as there is still so much we can do.

Dr. Megan Shares Why A Pelvic Floor Assessment Is Such A Great Tool