What Exactly Does A Pelvic Floor Physical Therapy Examination Look Like?

I always joke and say that pelvic floor physical therapy is simply “orthopedics in a cave”, but really, it’s so much more than that. Unfortunately, many people with pelvic floor issues have had less than desirable experiences at a urology or OB/GYN office. The fear and unknown surrounding pelvic floor physical therapy then prohibits these individuals (who really need care!) from getting to the provider that they need. I wanted to do a brief write up to hopefully remove the mystery and taboo surrounding pelvic floor physical therapy.

First and foremost, your pelvic floor pt needs to know a lot about you.

I usually spend the better part of a patient’s first visit in my office chatting with them. Of course, there are the basic medical and social questions: What kind of medical conditions do you have? What’s your surgical history? Do you take any medications or supplements? What kind of work do you do? Do you exercise? What kind of orthopedic injuries have you had?

This is where we start, but we are just getting warmed up.

After getting an idea of your general health status, we start getting into the questions that usually make people squirm in their seats a little bit: Do you leak pee? How often do you pee? Is there pain when you pee? Are you constipated? Do you have hemorrhoids or fissures? Do you feel completely empty after you pee or poo? Are you sexually active, and if so, what does that mean to you? Is sex painful? And so much more.

Rest assured, your pelvic floor physical therapist has heard it all. There’s no such thing as TMI in pelvic floor physical therapy. The more information you’re able to give us about your symptoms, the clearer our understanding is of what you’re dealing with and what kind of treatment plan you’re going to need!

orthopedic assessment

Most often, pelvic floor issues are rooted outside of the pelvis. Therefore, the first part of the physical examination should include a thorough assessment of your posture, rib cage, lower back, hips, abdominal wall, and the rest of your lower kinetic chain. In these areas, we like to look at your range of motion, flexibility, strength, coordination, and movement patterns. This portion of the assessment should also include some degree of assessment of your breathing, any scar tissue that you might have, and screening for hypermobility. We look at how you transfer loads between your upper and lower body, and how you manage pressures that might impact your pelvic floor.

pelvic floor assessment

I want to start this section off by stating that no portion of any medical assessment should ever be performed without your consent. While I do think that the gold standard assessment for those experiencing pelvic floor issues should include internal assessment of the pelvic floor, I also recognize and respect that there are many reasons why a person might not wish to pursue this portion of the assessment—And that is ok. It’s ok to defer it to a later appointment, it’s ok to defer it indefinitely. As I go over what’s involved in assessment of the pelvic floor in the following sections, I am assuming ongoing consent is being given by the patient.

observation

First and foremost, we observe what’s happening in the perineum. Does the skin look healthy? Are there any cysts? Any scar tissue? Any asymmetries from right to left? Are there signs of infections, inflammation, or hormonal imbalances? After checking the external skin and connective tissue, we observe the coordination of the pelvic floor by asking the patient to contract the pelvic floor muscles as if they’re trying to hold back urine. Then, we ask the patient to bear down. Do they coordinate the correct way? Are things backward? Are things symmetric from side to side? We can get so, so much information about what’s going on without even touching the tissues.

external palpation

The most superficial muscles of the pelvic floor can be palpated externally with gentle pressure. As we palpate these muscles, we are looking for tension, tenderness, and asymmetries from side to side. We are also looking to see if palpation of these muscles reproduces familiar symptoms. Along with this portion of the assessment, I will often do a Q-Tip test, assessing for hypersensitivity and pain in the vestibule.

internal assessment

During the internal portion of the pelvic floor assessment, we gather a ton of information about the supportive fascia of your pelvic floor, along with the muscle function of your deepest pelvic floor layers. I generally perform a detailed assessment on BOTH sides of the pelvic floor, because often there are imbalances from side to side. During the internal assessment, I palpate over all of the muscles deep in the pelvic floor, checking for tenderness, tightness, and reproduction of familiar symptoms. I also assess for strength, endurance, and coordination of these muscles. I do an assessment of pelvic organ prolapse, including anterior wall, uterine, and posterior wall prolapse. If a patient is coming in specifically for prolapse symptoms and my supine examination is unremarkable, I’ll often repeat the assessment in standing to get an idea of how much gravity and posture are playing a role in symptoms.

Then, we take all of the information gathered from the history, ortho exam, and pelvic floor exam, and develop a treatment plan specific to your very needs.

there you have it….you’ve made it through your pelvic floor assessment and you’re on your way to feeling well.

At Paradigm Pelvic Health & Wellness, we understand that this stuff is hard to talk about, let alone seek help for. Just know that you are brave, your body is capable of healing, and you deserve to feel well.

If you’re ready to start your journey to feeling well, give us a call at (240)-267-2924 to book an appointment.