What Happens During a Pelvic Physical Therapy Evaluation?

What happens at my first pelvic PT appointment? It is normal if you are experiencing some anxiety regarding your first appointment! The purpose of this article is to help you know what to expect on your first day so you can feel at ease. You will be scheduled with a Pelvic Floor Physical Therapist – a Physical Therapist that has sought additional training beyond their Doctorate in Physical Therapy to specifically learn more about the anatomy and function of the pelvic floor muscles and how to treat pelvic issues such as incontinence (leakage), pelvic organ prolapse, vulvodynia, vaginismus, interstitial cystitis, and pelvic pain.

A big difference between an examination by a Pelvic Physical Therapist and an examination performed by your OB or Gynecologist is that we focus primarily on evaluating the condition of the pelvic floor muscles instead of the pelvic organs. 

Your first appointment is a comprehensive evaluation and is scheduled for an hour of one-on-one time with a Pelvic Floor Doctor of Physical Therapy in a private treatment room. You have an option to bring a family member or friend along to your appointments if you feel more comfortable having another person in the room with you. The first thing that we do is discuss your specific issue of what has been going on and how it is impacting your daily activities or your life. We discuss your medical history and also ask questions regarding urinary and bowel function, sexual history, and OB/GYN history. 

Typically, during the examination on the first day we will look at the big picture of how you are moving and how you transfer load during everyday activities such as walking, sit to stand, bending, lifting, and standing on one leg. We evaluate your posture and how your spine, hips, pelvis are aligned. We test the strength of back, abdominal, core and hip muscles and look at the motion in your back, hips and sacroiliac joints as well as the flexibility in the muscles of your legs. We may look at the condition of any scars from abdominal or pelvic surgeries or C-sections. We feel for any areas of tension or trigger points in the muscles in the abdomen, hips, buttocks and lower back. 

Next, if warranted and you consent, we have you change into a gown and will move into the pelvic floor part of the examination. This is a vital part of our evaluation and helps us determine the best course of treatment for you. We observe how you are able to coordinate the pelvic floor muscles to lift or “close the holes”, relax, and bear down or “open the holes”. We may feel for areas of tender points or restriction along the inner thighs and externally around the perineum as well as the condition of any episiotomy scars.

Then, if warranted and you consent once again, we will move into the internal (vaginal) portion of the evaluation – no stirrups or speculums are needed for the internal portion of this evaluation. Your therapist will palpate for any areas of tightness or restriction in the superficial, middle and deep layers of the pelvic floor and may also test strength, endurance and coordination of the pelvic floor muscles. 

Depending on our findings on the first day, we may start some treatment addressing any areas of tightness or restriction in the muscles of the pelvic floor, abdomen, back or hips or we may start teaching you exercises to help relax, strengthen or better coordinate your pelvic floor muscles. If you are reporting any urinary or bowel issues, we will likely give you a 24 hour bladder diary to track how often you are voiding and when any episodes of leakage are happening.   

If you are currently menstruating during any of your appointments, it is okay! Just let us know and depending on your comfort level and your flow, we can either go ahead with the internal evaluation/treatment or work on external treatment and defer internal work to another session. 

Hopefully, reading through this article has helped you better understand what to expect on your first day in PT. If you have any additional questions, keep reading the articles listed below. 

If you would like discuss a specific issue and learn if pelvic floor physical therapy could help, please give our office a call at 315-635-5000 to schedule a free 15 minute consultation, which can be scheduled either in one of our offices or over the phone.

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