What to Expect at A Pelvic Health PT Evaluation
Welcome back, Bestie! Today, let’s talk about what it’s like to go to your very first pelvic health physical therapy appointment. In my experience, a pelvic health visit seems a lot more daunting than it actually is. A lot of the time, folks will feel intimidated by the thought of going to see a pelvic health professional, and that is completely valid! It can be super scary to talk with someone you’ve never met about some of the most intimate parts of yourself. It is never easy to openly discuss things that bring us shame or embarrassment.
Take urinary incontinence, for example. If you’re suffering from urinary incontinence, you may feel embarrassed about it and you might try to cover it up by using pads, taking more frequent showers, or bringing a few extra pairs of underwear with you when you leave the house. These are all examples real clients have mentioned to me. If you are willing to go to these lengths to mask the urinary incontinence, then talking about it with a stranger could be a little uncomfy. However, I want you to rest assured that nothing you say to your pelvic health provider is something they haven’t heard before. They are there to listen intently, make you feel less alone, and support you so that you can get back to the activities you enjoy symptom-free. At the end of an initial visit, patients commonly remark “Wow, I was really worried about this visit today, but it was a lot better than I expected!” Your pelvic health provider is likely extremely adept at putting you right at ease, so take the leap and book your first visit today.
So, what does an initial visit look like? Let’s talk about it! When you first arrive at your appointment, you’ll meet your therapist. The initial visit is all about figuring out where your symptoms are coming from. Depending on the type of clinic you are visiting, your therapist might already have some of your medical history in their system, giving them insight into what is ailing you. Your therapist will start off the visit by running through what is called a subjective exam. This is where they ask a bunch of questions about you and your symptoms. Some common questions include the following:
What do you do for work?
Who do you live with at home?
What symptoms are you experiencing?
When did your symptoms begin?
What types of activities make your symptoms worse? Better?
What are your goals for physical therapy?
Since you are being seen for a pelvic health-related condition, your therapist will likely also ask some pelvic health-specific questions such as:
How many times per day do you urinate?
How many times per day do you defecate?
Do you experience pain with urination/defecation/sexual intercourse?
Do you need to strain to urinate/defecate?
Do you have a history of pregnancy or childbirth?
After this portion of the initial visit, the therapist might provide you with some education about your condition. It is important to understand the anatomy and function of the pelvic floor in order to have the best chance of success in physical therapy. After this, your therapist may want to perform some objective tests. They will want to look at your strength and mobility. To test for these things, the therapist will have you go through a few different motions such as a forward or backward bend and they’ll assess your upper body, lower body, and core strength. The therapist might also test your nerves at this point and will likely do so by assessing the skin sensation on your legs. As you go through these tests and measures, your therapist should be explaining what they’re testing and why. If you ever have a question about what is being tested, feel free to ask!
Once general strength, mobility, and nerve testing is completed, it is time for a pelvic exam. A pelvic exam is not always performed at a first visit, but it can be useful in providing the therapist with information about your condition. Prior to the pelvic exam, the therapist might ask if you’d like to use the bathroom and the therapist will leave the room while you change for the exam. You will be provided instructions on how to sit/lay on the table to prepare for the therapist’s return.
The pelvic exam is only performed when the client consents to the exam. If the pelvic exam is not performed at the first visit, it may be performed in a subsequent visit, but only if the patient consents. A vaginal pelvic examination is performed by the therapist in order to assess the muscles, nerves, and other tissues of the pelvis. It allows the therapist to determine the strength of the pelvic floor muscles and localize any points of pain you are experiencing. Unlike a pelvic exam performed at the gynecologist’s office, the pelvic exam in a physical therapy setting does not utilize a speculum. The therapist inserts a single, gloved finger and uses this to assess the pelvic floor. The whole thing only takes a couple of minutes!
Sometimes, a chaperone will be present during the pelvic exam. A chaperone is a person who acts as a witness for the patient and health professional during the medical exam. Chaperones have been trained as such and their role is to ensure patient and provider comfort, safety, and security during exams. In some settings, a chaperone may not be available due to the limitations of the clinic. In other settings, the patient can request a chaperone or request that a chaperone not be present. In some cases, clinic policy requires chaperones to be present during all pelvic exams, regardless of whether the patient wants the chaperone there. Each clinical setting has its own policies and this may result in differing experiences if you’ve received pelvic health physical therapy across multiple locations. Last year (2023), the Academy of Pelvic Health released a statement supporting the right of patients to request and receive a chaperone, if preferred (1).
After the pelvic exam, the therapist will leave the room so that you can change back into your regular clothing. Once the therapist returns, you’ll discuss the findings of the exam and your condition. Your therapist should provide you with some exercises or activities that you can complete at home before your next visit. Then, you’re all done! The time really flies by and the appointment is over before you know it.
As I mentioned, I think you’ll find that your pelvic health appointment is a lot less scary than it seems. You will probably leave the visit excited about the information you received and the concrete steps you can take toward improving your pelvic health. Remember, your therapist is there to work with you and will happily accommodate your preferences. If you’ve been worried about scheduling your first pelvic health physical therapy visit, this is your sign to do it! You’ve got this!
XOXO,
Your Pelvic Bestie
References:
1. Use of Chaperones Position Statement [REVISED] - APTA Pelvic Health. https://www.aptapelvichealth.org/info/use-of-chaperones-position-statement-revised-
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
