What Should I Expect During A Pelvic Floor Evaluation?
Scheduling an appointment with a pelvic floor therapist can feel a bit daunting, especially when dealing with personal concerns like bladder leakage or urgency, bowel leakage or urgency, painful intercourse, or prolapse symptoms. Many people don’t know what to expect during their initial evaluation so here is an idea of how an evaluation at Pelvic Balance Physical Therapy is conducted.
Prior to the first appointment, you will receive an intake form via email. This will ask about your past medical history, current concerns, previous treatments, goal for therapy, and consent for treatment. We ask for this to be completed prior to your appointment to allow for the therapist to gain a comprehensive understanding of your concerns to better utilize the 90-minute appointment.
Upon your arrival, your therapist will greet you, show you where to locate the restroom if needed, and offer for you to make yourself comfortable whether that be sitting or standing. The first part of the evaluation allows for you to share your story and reason for seeking care. It is your body and your story after all, and no one should be making assumptions based on paperwork alone. From there, the therapist will ask more in-depth follow-up questions to determine what is functioning normally and what is functioning outside of normal. This would include questions about bladder, bowel, sexual functioning, and any other concerns including a previous or current history of back or hip pain.
After screening the functions in these areas, an external assessment is performed. This is always tailored to each patient but may include assessment of spine range of motion, hip flexibility, leg and core strength, breathing mechanics, and balance. This is used to better determine how the body is functioning as a system since we do not use our pelvis, bladder, bowel, and sexual systems in isolation. For example, about 80% of people will have repeated episodes of back pain and 10-40% will develop chronic or persistent low back pain that occurs for 12 or more weeks.1 Studies have shown that about half of women who suffer from chronic low back pain experience nerve pain, which has a high association with pelvic floor dysfunction.1 Uncontrollable urinary urgency, increased sensitivity of the nervous system, and lumbopelvic pain (pain in the low back, hip, pelvis and glutes) are predictive of pelvic floor discomfort with internal examination.2 Some women with urinary urgency and frequency have significantly less hip external rotation and hip abduction strength than those without symptoms.3 Hip strengthening can be important for both stress urinary incontinence and urinary urgency and frequency, which is why it is important to assess the body as a whole.3
Once the external assessment is complete, the therapist will likely recommend an internal pelvic floor examination. This is always at the discretion of the patient who is more than welcome to decline this part of the evaluation; however, it can provide important information about any contributing factors to your pelvic health concerns. A pelvic floor examination with a therapist is much different than with a medical doctor. At Pelvic Balance, we don’t use stirrups or a speculum. We also don’t use those dreadful paper sheets to cover yourself. I don’t know about you, but I always rip those to shreds before the doctor comes in the room anyway and it leaves me feeling cold and exposed. During the pelvic examination, your therapist will walk through the process step by step ensuring that you are comfortable with proceeding and also asking for feedback along the way. The therapist will be assessing the pelvic floor from the muscles closer to the surface to the deeper muscles, including their strength, coordination, endurance, flexibility. Basically, we are looking to see if the muscles are able to move well (just like any other muscle group in the body) and to ensure the nerves are not overly sensitive or lack sensation (just like if you put gentle pressure on your thigh or arm it should just feel like gentle pressure).
Once this portion of the assessment is complete, you will be able to take your time getting dressed before the therapist will rejoin you and discuss the findings from the evaluation. The therapist will explain what was found during the evaluation and how this is contributing to your symptoms. They will also use this information to recommend a treatment plan of care which will include a number of sessions, frequency of sessions and overall timeline. A brief overview of the types of treatment will be discussed. You are able to ask any follow-up questions as well to clarify and ensure that you feel this is an appropriate plan for you.
While scheduling and attending an initial evaluation, especially for pelvic health concerns, can feel daunting and scary, please know that you don’t have to share anything or do any portion of the examination or treatment that you aren’t comfortable with. Your therapist is a teammate to help you figure out why your symptoms are happening and develop a treatment plan to address your concerns. You don’t have to deal with symptoms on your own!
Written by Jordan Schmidt, PT, DPT
References
- Algudairi, G., Aleisa, E., & Al-Badr, A. (2019). Prevalence of neuropathic pain and pelvic floor disorders among females seeking physical therapy for chronic low back pain. Urology annals, 11(1), 20–26. https://doi.org/10.4103/UA.UA_123_18
- Keizer, A., Vandyken, B., Vandyken, C., Yardley, D., Macedo, L., Kuspinar, A., Fagahani, N., Forget, M. J., & Dufour, S. (2019). Predictors of Pelvic Floor Muscle Dysfunction Among Women With Lumbopelvic Pain. Physical therapy, 99(12), 1703–1711. https://doi.org/10.1093/ptj/pzz124
- Foster, S., Spitznagle, T., Tuttle, L., Sutcliffe, S., Steger-May, K., Lowder, J., Meister, M., Ghetti, C., Wang, J., Mueller, M., & Harris-Hayes, M. (2021). Hip and Pelvic Floor Muscle Strength in Women With and Without Urgency and Frequency-Predominant Lower Urinary Tract Symptoms. "Journal of Women's Health Physical Therapy", 45(3), 126-134.
