Pelvic Floor Evaluation: What to Expect

So You have been Referred for Pelvic Floor Physical Therapy:

…And you find yourself asking, “What is Pelvic floor Physical Therapy?”  You are not alone! So, let us clear the air on what to expect when you arrive!

Your very first visit: The Evaluation

Walking into the Clinic:

• You will come in and check in with the front desk! Usually some paperwork needs to be filled out so being a few minutes early is never a bad thing!
• Your therapist will come introduce themselves and bring you back into the private room.

In the Examination Room:

• Initially there will be a short chat to get a history and learn all the information we need to know regarding to your reason for visiting.
  • This can include, depending on reason for attending; your drinking and eating habits, your pain levels during different activities such as using a tampon or intercourse, or even counting how many times you go to the bathroom in a day.
  • Try to be as detailed in your history as possible!
• Then moving onto the evaluation. This involves moving around and doing our testing or measurements to determine if your back, hips, or core are playing a role.
  • In a study by Dufour et all. 85 women were tested with low back pain with 95.3% having pelvic floor muscle dysfunction. There is a correlation!

Prior to doing an Internal Examination:

• Your therapist will explain a little bit about pelvic floor physical therapy and what they are about to do.
• Consent Form: There will be a form provided from the clinic explaining your options for the internal visit.
  • You will provide the second person: saying that you would bring another person to sit in the room during the internal examination to supervise.
  • The clinic will provide the second person: The clinic would find another provider or worker at the clinic to sit in an supervise.
  • You declining to have a second person present: It would be just you and your therapist in the room.
  • Declining the internal all together: This does not mean that we would not treat you, it just means we would discuss tips and tricks to get you towards your goals without an internal examination.
• The therapist will set up the table with sheets and step out of the room for you to change. You would be undressed from the waist down and cover yourself with the sheets.

The Internal Examination:

• The therapist might start with an observation of a kegel, a cough, and bearing down.
  • Kegel: Squeezing your vaginal muscles as if you were to stop the flow of urine.
  • Bearing down: Pushing out like you were going to pass gas
• Then the they might palpate (feel) externally to see if there are any tight spots, like a knot in a muscle.
• Then if agreed by the patient, the therapist using a glove and lubricant will use their finger to internally assess the muscles and ask you to kegel again to determine your strength and endurance.
• Some therapists might expand upon this short examination due to your history and your findings at the discretion of you and your therapist.
• The therapist will step out and have you get ready for the rest of the examination. Some therapists might do the orthopedic first and some might do pelvic first.

Why do we do an Internal Examination?:

• What most women don’t know is that you have 3 layers of your pelvic floor!
  • Layer 1:
    • Bulbocavernosus, Ischiocavernosus, Superficial transverse perineal, and external anal sphincter
  • Layer 2:
    • Urethral sphincter, Compressor urethrae, sphincter urethral vaginalis, deep transverse perineal
  • Layer 3:
    • Levator Ani (Pubococcygeus and Iliococcygeus), Coccygeus, piriformis, and Obturator internus.
  • Doing the internal examination provides details into if one muscle is tight or weaker causing specific issues related to your problem. This would let us know if we need to potentially give you exercises that strengthen layer 2 instead of layer 3 helping to provide you with more complete care.
  • If you have previously chosen to decline the pelvic internal examination, make sure you are very detailed with your therapist as to your symptoms. We can still provide you with excellent care with our Orthopedic exam.

The Rest of the Examination/ Orthopedic Exam:

• The therapist will run through the muscles and joints in your hips and back which can tell the therapist a lot about your body and what brought you into the clinic.
• Typically, this involves going into seeing how you move with range of motion, flexibility testing, and looking into your strength with manual muscle testing.

Your Plan of Care:

• After your therapist examines everything, they will go into detail about what they found during the evaluation to make sure you are aware and fully informed as to your findings and what the therapist would like to help in treating.
• Your specific frequency of visits in how many times a week and for how long depends upon your therapist and the findings. Sometimes there only needs to be a few visits spread out to teach techniques and sometimes it can be a little more involved and hands on requiring more frequent visits.
• Your therapist will send you home with some exercises to help you progress towards the goals that you will set together in the clinic.
• Depending on your evaluation, you might be doing stretches for your hips, strengthening for your core and hips, hands on manual stretching, kegels or reverse kegels, or all of the above.

Think you might need Pelvic PT?:

• There are several diagnoses or issues that might require or benefit from the assistance of pelvic physical therapy. Some include but are not restricted to:
  • Dyspareunia, vulvodynia, vaginismus, pelvic inflammatory disease, lichens sclerosus, pudendal neuralgia, vulvar vestibulitis, stress incontinence, urge incontinence, mixed incontinence, interstitial cystitis, irritable bowel syndrome, constipation, coccydynia, Postpartum, Pain during pregnancy, and more.
• Not sure exactly if you would benefit from pelvic PT? Give us a call. We can always answer your questions.

Now every therapist and every patient is different. The things listed above are just some of the things you might expect.

Any questions? Give a call to your local clinic and our front desk can answer the question or have one of your local pelvic therapists give you a call back!

Written by Dr. Sidney Hagge, PT, DPT

Information Derived for this Blog:

1. Dufour, Sinéad & Vandyken, Brittany & Forget, Marie-Josée & Vandyken, Carolyn. (2017). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice. 34. 10.1016/j.msksp.2017.12.001.
2. Drake, R. L., Vogl, W., Mitchell, A. W. M., & Gray, H. (2005). Gray’s anatomy for students. Philadelphia: Elsevier/Churchill Livingstone.
3. Petrou, S. P. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. International Braz j Urol, 36(1), 116–116. doi: 10.1590/s1677-55382010000100032