What to Expect During a Pelvic Floor PT Exam
So you have been referred to a pelvic floor physical therapist. What exactly does that mean? Well, it means you will be examined, evaluated and treated by a specialist who is trained in traditional physical therapy and then received extra training and education to become a pelvic health specialist. If you have been to traditional physical therapy, you know that they look at lots of things, starting with your movement patterns. How do you walk? How is your posture? They also check range of motion, strength, flexibility and reflexes among other things to help problem-solve and get to the bottom of your pain or dysfunction. They ask lots of questions.
Pelvic floor therapy is no different, except one thing: an internal vaginal or rectal exam if warranted, and of course consented to. These therapists are specially trained to do an internal exam of your pelvic floor. So what does that actually mean? The beginning of the exam may start with a typical assessment as previously described to assess any other issues or areas that may be bothersome or contributing to your pelvic floor issues, such as your lower back, hips and pelvis. They may assess your breathing pattern, check specifically on your abdominal wall, your back and hip muscles for diastasis, muscle tone, tenderness or trigger points.
Examination of the pelvic floor through the vagina is typically done with you lying on your back, head supported by a pillow and either legs supported by pillows or a bolster, or just resting with knees bent and feet flat. We don’t use stirrups! With your consent they will start the exam and explain each step of what they are doing. Talking to you will help calm your nerves. The therapist will first do a visual exam of the external genital area, urethra, clitoris and anus, checking for skin integrity or signs of irritation. They may use a light to have better visibility. They will then usually check the outer layer or superficial layer of pelvic floor muscles, which are in the area of the vulva, labia and perineum. They may use a q-tip or their gloved finger to check for any sensitivity in these areas. They will ask you to contract your pelvic floor and watch to see if movement occurs at the perineum. They may ask you to bear down or push out as if to have a bowel movement (this checks the lengthening of the pelvic floor, or ability to relax voluntarily.) When able, they will use a lubricant if needed and insert one or two gloved fingers in the vagina to check the deeper pelvic floor muscles. They are checking for resting muscle tone, tight bands, general integrity and of course strength. Pelvic floor strength is graded on a scale of 0 (no contraction at all) to 5 (tightening around one inserted finger and a lift felt and held for several seconds). Your therapist will ask you to contract your pelvic floor and will grade your strength. They may ask you to repeat this, holding for longer or doing repeated quick contractions, or ask you to bear down again. They will instruct you on how to properly perform a pelvic floor contraction if you are not able to do that. At this point, the exam is usually complete and likely only took roughly 5 minutes! One other thing to note is that we do not use a speculum like gynecologists, because we are examining muscle and not the uterus or cervix.
After the exam, a treatment plan is designed and discussed with you. Subsequent visits may or may not always entail an internal exam, it depends on your specific plan.
