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What to Expect: Your First Visit
Most women experience emotions ranging from inquisitive to down right anxious prior to their first pelvic physical therapy appointment. There is no need to be nervous! The first session of pelvic physical therapy is an initial evaluation. You will be asked to fill out forms to provide your pelvic PT with a complete medical history including current medications, ongoing chronic conditions, surgeries, and other pertinent medical information. A good pelvic physical therapist will perform visits in a private room, and you are welcome to bring a partner, friend, or other chaperone for comfort if you choose to. The pelvic PT will discuss your medical history and ask specific follow up questions pertaining to how your bladder, bowels and sexual organs have been behaving. This helps the therapist better understand what the driving factors of your condition are. A good pelvic PT will seek to help you solve the underlying issue, not just treat the symptoms.
Next, a physical examination will be performed. This includes an assessment of your posture, coordination, and an orthopedic screen of the spine, hips, and often knees and feet as they can be associated with issues in the pelvis - the body is a connected, dynamic structure, and it’s important to be thorough!
Finally, an external and most often, internal assessment of the pelvic floor muscles can be performed on the first visit, and sometimes is deferred to later sessions depending on the timeframe, needs, and desires of the individual patient. The external examination allows the pelvic PT to visualize the tone, integrity, and vascularization of the vulva and superficial pelvic floor muscles. This assessment gives important information to the pelvic PT as to the overall health of the vulva and pelvic floor muscles. Many women are self conscious during this examination, but rest assured, the examination is relatively short, and provides vital information to the pelvic PT.
The internal assessment of the pelvic floor muscles consists of the therapist using a gloved hand (usually just 1-2 fingers) to assess the strength, endurance, and coordination of the pelvic floor muscles. The physical therapist will ask you to perform various types of pelvic floor muscle contractions (also called Kegels), as well as asking you to elongate or “drop” the pelvic floor by bearing down. This gives information on how the pelvic floor muscles are behaving throughout your day. Additionally, the therapist will assess areas of pain or tenderness inside the pelvic floor via the vagina. In some cases, particularly in the case of tailbone pain, a therapist might recommend a rectal assessment of the muscles and joints.
The first session will allow the pelvic PT to create an overall plan of care unique to your needs. The length of treatment may span from a few weeks to a few months depending on what your issue is, and how long your symptoms have been present.
Treatments consist of many different modalities of care. Manual therapy involves soft tissue mobilization, relief of trigger points, joint mobilizations, and scar tissue massage to restore health length and function of the muscles of the pelvis and abdomen. Biofeedback is a tool that allows the therapist to help you to “retrain” your muscles for better coordination. A sensor may be placed on the outside or inside of the body that is connected to a device that gives real-time feedback as to how your muscles are performing. Ultrasound imaging may also be utilized to show you your organs and pelvic floor for training purposes and to give the therapist added information. Exercises are tailored to help restore muscle functioning and are also an integral part of pelvic floor rehabilitation. These exercises may consist of specific forms of stretching, stability exercises, pelvic floor exercises, and overall wellness exercises.
Additionally, lifestyle changes might be part of the rehabilitation process. Certain foods, beverages, and habits can contribute to bowel and bladder dysfunction. Bladder irritants are often recommended to be limited to allow the bladder to heal and reset. Smoking cessation is recommended as it affects the bladder, vasculature, and nerves in the pelvis. Certain dietary changes might be recommended to allow for improved digestion and better bowel functioning as well.
How do I find a pelvic physical therapist?
Pelvic physical therapists are in all fifty states in the United States and most countries around the world. It is important to remember that as in all professions, not all pelvic physical therapists are created equally, and there are various levels of training and skill levels. Your healthcare provider may already have a trusted relationship with a pelvic physical therapist, it is helpful to ask them for a referral to a pelvic physical therapist as most insurances cover pelvic PT, but require a referral from an MD, DO, nurse practitioner, or certified nurse midwife.
There are a few trusted databases that allow you to search for pelvic PT by your location. These include:
- The American Physical Therapy Association’s Academy of Pelvic Health PT locator: https://ptl.womenshealthapta.org/
- Herman and Wallace Pelvic Rehab Locator: https://pelvicrehab.com/
Written by Amanda Olson, DPT, PRPC, Certified Pelvic Floor Physical Therapist
President and Chief Clinical Officer at Intimate Rose: www.IntimateRose.com