Many people don’t know that physical therapists can treat the pelvic floor, let alone what a session looks like! And once one does find out what a pelvic floor assessment entails, many are intimidated or too embarrassed to see a pelvic health specialist. Remember, you are not alone – whatever your condition, your pelvic health physical therapist has seen it and treated it before. You are not at fault for your condition and the more details you give your PT, the more she can help you.
So, what is the pelvic floor? The pelvic floor is simply the group of muscles that attach to the pelvis. It consists of the deep, internal muscles but also the external tissue called the perineum. Both women and men have this anatomy, so this is not purely a “women’s issue,” so we treat both men and women.
The evaluation begins like any other physical therapy evaluation. You’ve probably been asked to fill out copious amounts of paperwork detailing your condition, past medical history, medications and surgeries you have had, etc. You meet your PT and are brought into a private treatment room where you then talk about your symptoms and function level – this is very important for your PT! The more details you can give about when your symptoms started, what increases and decreases your symptoms and what you have done to try to alleviate your symptoms, the better! Personally, I am a firm believer that the patient has all the answers, and through detective work, together we can figure out possible causes to the condition and better yet, where to begin with treatment.
Once the history has been taken and talking has been completed, we move on to a postural and functional assessment. Pelvic floor conditions rarely occur in isolation – usually there is another component that is perpetuating your symptoms. We need to address both the pelvic floor and the whole body – everything is connected and works together so a dysfunction in one place means there is dysfunction elsewhere. Throughout the evaluation, your PT should be talking to you about what they are finding and how it relates to your condition. We look at range of motion of the spine, pelvis, and hips as well as strength, especially the core.
Now, the part where many people get anxious – the internal exam. As one of my teachers said, “a vagina is like a face, every one is different.” So, whatever yours (or if you are male, your perineum) looks like, is fine! This is a judgement free zone. We are interested in getting you back to your life, not if you’ve groomed, if you are sweaty, or if you are finishing your period. First, we look at the skin to make sure it looks “normal,” no redness, swelling, rash etc. We gently push on the outside, perineal area, targeting the more superficial muscles to see if anything is tender. If it hurts, tell your PT! You will be asked to contract and relax your pelvic floor, so the PT can see how well you can coordinate this movement. The actual internal assessment should not be painful – if is too painful for your PT to insert a finger, tell her and the assessment will stop. If you can tolerate a finger, the PT will gently push on various muscles of the pelvic floor to see if they are tender. You may be asked to perform pelvic tilts, hip motion or breathing while the PT palpates different structures. This gives us an understanding of what is happening to the muscles as you use them during the day. Again, you will be asked to contract and relax the pelvic floor so the PT can truly assess your strength.
It is important to remember that the evaluation and treatment are ultimately for you, the patient. If you are nervous about something, tell your PT; if you are uncomfortable doing an internal exam on the first or any visit, say it. This is not supposed to be a painful or traumatizing experience, it is supposed to be therapeutic and beneficial for you!
The findings of the evaluation turn into the treatment for your future sessions. For example, if your pelvic floor is too tight, we will work to reduce the tone to a normal level. If the pelvic floor is too weak, we will do things to strengthen it and so on. Each person’s treatment is individualized since no one is exactly the same. And that’s it, you’ve made it through your first pelvic floor assessment!