What to expect in Pelvic Floor Therapy sessions

Maybe you found your way to pelvic floor therapy on your own or were being referred by your doctor. Either way it is always a bit scary to navigate intimate problems like bathroom issues. Maybe you come equipped with social media knowledge of “what to expect” or perhaps a friend briefed you on what goes down in pelvic floor therapy sessions. (no-pun intended) Even then it can seem daunting to start something without fully understanding what to expect. So in this blog I want to talk to you about just that! 

Darshana holding a pelvic anatomy model explaining something using the anatomy model during a pelvic floor therapy session

What to expect in Pelvic Floor Therapy

It all starts with getting to know you. During the Initial Evaluation in pelvic floor therapy, we want to understand your story. You will spend one-on-one time with your pelvic floor therapist discussing your medical history, your problems and your goals. Tell us all the pertinent information! Trust me everything is relevant… from your broken tailbone 10 years ago to your IUD insertion last week!

Understanding your health history provides us with the clinical context of your problems. Giving us all the information about your past surgeries, birth history, current medicines, allergies and illnesses helps get a full picture of your healing journey. Depending on your unique situation this can go in several directions to gather pertinent information. We review your exercise habits, your previous injuries, your hobbies and your support system.The more we know the more personalized solutions we can create for you!

                   No Such Thing As TMI For Pelvic Floor Therapy sessions!

Pelvic floor therapists help people address issues related to pee, poo, sex, pain, pregnancy, birthing and menopause. Given the nature of this niche there are certain nuances to the information gathering that may feel particularly intimate. In other words there is a lot of potty talk in Pelvic floor therapy! I will ask questions about your bladder habits, digestion, poop schedule…..So yeahhh in pelvic floor therapy be ready for questions like

“ Is your stool soft like a banana or is it more like pellets ?”

The muscles that help us pee, poo and hold our organs inside also help us during sexy time! Muscle issues in the pelvic floor often present as problems in the bedroom. It might be relevant in Pelvic floor therapy to review sexual history particularly any issues like undesired pain with sex. Sex and sexuality have unique definitions for every individual and your pelvic health therapist will follow your lead for identifying and addressing things that are important for you! 

Big Picture stuff

Before looking at the pelvis we first like to look at the PERSON and their unique circumstances. Your big picture assessment consists of all of that! It might include;

  • Looking at your general mobility as well specifically the lower back and hips as they directly influence pelvic floor issues.
  • How is your body moving during things you do most such as lifting kiddos or cleaning etc? 
  • Postures that you often use and its effects on your symptoms. Mostly during activities relevant to your lifestyle. It might be your work desk or breastfeeding posture or your stance for powerlifting or the saddle of your bike.
  • Your exercises and your form during movements that cause your symptoms.
  • Assess all the muscles in and around your midsection such as abdominal wall, hips and lower back. Checking any and all scars around the belly and hips.
  • Breathing patterns at rest or during the things that make you experience symptoms. For example if someone leaks urine during running then a lot of stuff will be assessed during things that happen in running. On the other hand if someone is leaking urine while lifting groceries or a toddler then they might be assessed while lifting a similar weight from the ground.
  • Bladder intake including water, alcohol and all your other favorite drinks.
  • Food logs to see if you get enough fiber.

Getting “down” to Business

a hand holding a anatomy bladder model demonstrating abdominal pressure, bladder muscle and pelvic muscles used during pelvic floor therapy sessions

Pelvic muscles are like muscular underwear inside our body. For a person born with a uterus these undies have three holes- pee hole, vagina hole and butt hole. The most accurate and direct way to check the pelvic floor muscles is via palpation. This involves using a gloved and lubricated finger through the vaginal opening to assess pelvic muscle tone, strength, tenderness and tension. Most pelvic floor muscles and issues are best accessed through the front requiring a vaginal exam. However, there are pelvic floor muscles best reached through the back door requiring a rectal exam. Your pelvic floor therapist will explain the pelvic exam to you in detail. We proceed only after you consent. 

Internal exam gives us the opportunity to check the following things;

  • Are you able to currently identify your pelvic floor muscles?
  • Is your muscle able to squeeze properly?
  • Is your pelvic floor strong?
  • Does your pelvic floor relax properly?
  • Is your pelvic floor tolerating pressure such as coughing or bear down?
  • Is your pelvic floor supporting you well when you are upright?
  • Is your pelvic muscle a source of your pain?

If you are not ready for the internal exam yet..no worries there is always next session. If you are not ready for the pelvic exam ever..no worries.. There are other ways to help you 🙂

pelvic muscle anatomy poster with a finger pointing at the back of the pelvic muscles towards the anus.

Either way here is what you need to know about Pelvic Floor Therapy-

  • Invasive pelvic exams ( vaginal or rectal ) might be indicated to help you solve pelvic floor problems.
  • Certified Pelvic floor therapists go through rigorous training in addition to their doctor of physical therapy school training.They are qualified to perform pelvic floor muscle assessments safely and effectively. 
  • Pelvic floor issues respond well to direct intervention making these awkward exams worthwhile in most cases. 

Your Pelvic floor therapist and you together discuss if the internal pelvic exam is right for you. If you want to avoid any kind of internal exam IT IS OKAY! There is always more than one way to help you achieve your pelvic floor therapy goals. If the fear of pelvic exams is keeping you from seeing a pelvic floor physio please know that there are plenty of times we avoid pelvic exams like with young kids or trauma survivors and yet we are able to help these folks. Just like that you can get pelvic physical therapy without an internal exam.

Is it like the exam I get at the Gynecologist every year?

NO. It is NOT the same.It is different for the following reasons

  • Pelvic floor Therapists are assessing muscles not organs such as uterus or cervix or ovaries.
  • It is a muscular exam not a medical screen for diseases like an annual well-woman check.
  • There is mostly no speculum involved which makes pelvic floor therapy a lot more comfortable than a speculum check at the doctor’s office
  • In some cases pelvic floor therapy might involve muscle assessment through the anus.

Putting it all together

First pelvic floor therapy session often feels overwhelming. We are dealing with some of the most private and sensitive information. It is awkward and emotional for most of us. I get it!! But the hard part is over! 

Between listening to your story and getting the facts from your muscles now it’s time to come up with a plan. A plan that is unique for your situation and a plan that works for YOU!! A pelvic floor therapy plan varies widely and that is a topic for another day. But for now hope this provides you enough information to feel prepared going into your first pelvic floor therapy session!



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