Your first physiotherapy appointment.

What can I expect from a pelvic floor physiotherapy consultation?

Many women will tell me on their second or third visit just how nervous they felt before their first pelvic floor physiotherapy consultation.

It is not exactly something that is talked about regularly in social groups, is it?

My hope is that one day pelvic floor becomes a conversation topic that women are comfortable to have with their friends. Until that day, I want to makes sure I can share as much information as possible – especially relating to what you can expect from pelvic floor physiotherapy.

Here are some of the most common questions that I have been asked before a pelvic floor physiotherapy consultation/ initial assessment and information women wish that had have known.

What should I expect when I arrive for my appointment?

You should allow yourself an hour for the initial appointment, and between 30 and 45 minutes for follow up sessions. This is sometimes handy to know if you are scheduling around sleep or feeding times for a baby or if someone is driving you to the appointment.

Usually, the majority of that first hour is spent chatting. There’s a lot I need to learn about your story and there’s a lot I like to teach you.

Prepare to be asked questions relating to your bladder, bowel and sexual function.

This is because all three systems are impacted by the pelvic floor and can affect each other in different ways and it is important to screen all three systems to get the best idea of what might be driving your problem.

Most importantly, I will ask you about your goals. What you would like to achieve by coming to physiotherapy can be different for everyone e.g. ‘to participate in a gym class without leaking’ or ‘to be able to have sex without pain’ or ‘to be able to lift my 2 year old son or grandson without prolapse symptoms’.

Pelvic health assessment can involve both external and internal examination

What are you looking at?

That will depend on what you are coming to see me for. After I have asked you some questions about your symptoms, I will get some ideas on what might be going on. Often the best way to get the information is by doing an internal vaginal or anal examination which does surprise some women. To put it into perspective, if you went to a physio for a shoulder injury, you would be pretty disappointed if they didn’t even look at the shoulder.

However, please do know that if you are not comfortable with an internal exam, that is ok. I can also offer a real time ultrasound of the lower abdomen to see if your pelvic floor muscles are turning on, or a visual assessment of the vulva.

Common examples of what I assess include pelvic floor contraction, signs of pelvic organ prolapse or if there is any muscle tightness or sensitivity contributing to pain.

Please do know that if you are not comfortable with an internal exam, that is ok. There are alternative options for examination.

How to set up for a pelvic floor examination

Erin will step out of the room to allow you to derobe and place a towel over you before knocking on the door and returning to the room.

What do I wear?

Absolutely anything that you feel comfortable wearing. Dresses and skirts are popular choices because they can stay on during the assessment, but pants are also completely fine. Sometimes pant suits and leotards are tricky, but as I say to my patients, ‘we can make it work!’

Before I perform an internal pelvic floor assessment, I leave the room and allow you to derobe. If you are wearing a dress or a skirt, you can take just your undies off and if you are wearing pants you can take the pants and undies off. After that you lay on the bed and pop a towel over top so you are covered. I will knock on the door to check if you are ready and come in when you say ‘yes.’

I will say that generally when I am doing a pessary fit consultation, a dress or a long top is very handy because I do need to get you standing up and moving around once the pessary is in to check if it is a good fit.

Will the examination hurt?

The majority of the time, my answer is no and I make sure you know to tell me if there is pain so I know to stop.

There are times, however, where there might be some pain brought on by the examination. This is usually when a person is coming in for a pain related problem. Like any other part of the body, sometimes reproducing the pain during the assessment helps to understand what could be causing it. I always make sure you are ok with the level of discomfort that occurs and I stop the moment you tell me that you are not.

What type of treatment is involved?

Based on the outcome of the assessment, I will work with you to decide the best course of action. Often this will comprise of a pelvic floor exercise program tailored to you. For some women just practicing a Kegel alone with or without body weight is the right place to start. For others a vaginal weight may be required to challenge the pelvic floor enough to make a change (literally lifting weights for your vagina!).

For women who struggle to achieve a pelvic floor contraction, or if the contraction is not very strong, I will talk about using an electrical stimulation (e-stim) unit which provides an electrical impulse to the muscles to switch them on or ‘wake them up’. We might also discuss the use of a feedback unit such as the perifit which provides a visual aid.

Your treatment plan might also involve ‘down-training ‘ overactive pelvic floor muscles using cues or using e-stim,  soft tissue release or progressive stretching with dilators.

Other treatments might include advice and education to help manage symptoms or a discussion about trialling a vaginal pessary for pelvic organ prolapse of incontinence.

We will sit down at the end of the session and work out a short and long term management plan to achieve your goals and I will answer any questions you may have.