But Really, What does a Pelvic Physical Therapy Session Look Like?

This is a continuation of the initial blog series I have written to answer some of the most common questions I get about being a pelvic physical therapist and what our treatment involves. I hope you enjoy reading these posts, and if you have any questions after reading them, please feel free to contact me by leaving a comment below the post, filling out the contact form on the website, or by calling the office at (928)350-8270.
 
A pelvic floor physical therapy session is really quite similar to any other physical therapy session, except we also talk about and treat problems with muscle function “below the belt.” As you may have read in last week's post, problems with pelvic muscle function can create a lot of barriers with engaging in the activities we enjoy doing. 

I think one of the big questions people really want to know the answer to is, “does pelvic floor physical therapy involve an internal examination, when does it happen, and what is it like?”
 
Here are some facts about that internal pelvic muscle assessment that we pelvic floor physical therapists are specifically trained to provide: 
 

• Only with your informed consent and when clinically appropriate, an internal pelvic muscle exam can be performed by a physical therapist with specialized training to assess your pelvic floor muscle function.
• The internal pelvic muscle exam involves a gloved and lubricated finger to assess for pain in the pelvic floor muscles and surrounding structures, as well as strength, endurance, and coordination of a muscle contraction. I can also assess pelvic organ prolapse during an internal pelvic floor muscle assessment.
• The pelvic floor muscle examination can help us understand if your pelvic floor muscles need strengthening exercise, relaxation training, or a combination of both interventions. 
• Not everyone coming to pelvic floor physical therapy needs an internal muscle examination.
• The pelvic floor muscle exam does not always occur during the first appointment (or the second, third or fourth). It occurs when it is clinically important, and you have provided your full, informed consent.
• This exam is not really like a pap smear for those who are used to that procedure.
• There is no speculum involved in the internal muscle exam.
• You have the right and are encouraged as needed, to have a support person with you during a pelvic floor muscle exam. 
• You do not have to agree to participate in the internal muscle exam, even when it is clinically indicated. People have many different reasons for not wanting to participate in an internal pelvic floor muscle assessment, and as a compassionate and trauma-informed care provider, I fully respect this. There are many other methods for assessing your pelvic floor muscle function. 

 
On your first visit you should expect that we will talk (a lot) and for me to ask (a lot) of questions, and hopefully you will feel comfortable asking (a lot) of questions too! We will figure out your physical therapy goals together and then do an examination (which may or may not involve that pelvic floor muscle assessment), and you will go home with some homework.
 
Follow up sessions will look similar, but with less examination or assessment time and more treatment time. We will check in with how your homework went, discuss progressing your exercises when appropriate, and changing some of your homework if you had difficulty with it. Honesty is important during physical therapy sessions, because if an exercise really increases your pain, I can very likely modify it. If you are not doing your home program because life is busy, we’ll talk about that and figure out some solutions together.
 
As always, I look forward to helping you achieve your goals with pelvic floor physical therapy, or perinatal physical therapy (for those during and after birth). Please contact me if you have any questions about this post, by sending me an email at [email protected], or calling the office at (928)350-8270.