What to expect at your pelvic floor physical therapy assessment

Miral Patel, PT


Though Pelvic Floor PT is becoming more and more recognized, most patients still come to our clinic slightly embarrassed, uncomfortable, nervous and unsure of what to expect. With this post I hope to ease any fears associated with your appointment and also to answer any questions about what to expect in a pelvic PT appointment. Let’s start with clarifying any misconceptions about what we do; we work on correcting alignment, addressing soft tissue restrictions, and strengthening the muscles to improve overall function. Pelvic Floor physical therapy follows the same principles as any other type of physical therapy… the only difference being that the pelvic floor muscles are best accessed vaginally and/or rectally, thus many of your treatments may involve internal vaginal/rectal palpation.

So here’s what a visit to our clinic would look like:

You arrive for your appointment, and Yup! You guessed it, your appointment starts with some paper work. You'll be asked to complete a few basic forms including a personal information form, consent forms, and a general health questionnaire that asks a little about why you are here.

From there your therapist will escort you to a private treatment room and give you a questionnaire more specific to your issues. These questionnaires are well researched functional surveys that help us track your progress with physical therapy.

Your actual physical therapy assessment starts with lots of chatting. Your therapist will ask you questions about why you are here. She will go into specific details about bowel and bladder habits, sex life, birthing history (if appropriate) and more. This is where some of the blushing begins. Some patients come in and feel embarrassed or awkward sharing details that really do contribute to their issue. Let me make it clear, we've heard it all! It doesn't strike us as strange if you tell us the texture of your poop, or various sex positions that may be uncomfortable. In fact, it provides us with a lot more detail, and helps guide our assessment and treatment.

Once all the chatting is over, we get to the actual exam. Your physical exam will start with an external assessment where we look at general movements of the pelvis and spine. We will check your pelvic alignment, breathing mechanics and deep core activation, as well as any appropriate sensation screens, reflexes and/or other strength screens.

Next is the internal assessment. You will be given some privacy while you undress waist down. You will have a sheet or a gown to use for draping. Your therapist will be performing an internal vaginal and/or rectal exam depending on what your concerns are. The internal exam is not meant to be a painful or uncomfortable experience. Your therapist will explain to you step by step what she is doing and why.

Your therapist will be wearing non-latex gloves and start with palpating the tissues externally, checking for swelling, tenderness, and sensation. From there she will insert one finger vaginally. We may ask you to kegel or squeeze your pelvic floor muscles, cough, push or bear down like you are having a bowel movement and a few other things. When the vaginal exam is completed we may or may not do a rectal exam depending on what your complaints are. With the internal exam we are checking for general muscle tone, scarring, trigger points, hypertonic (tight) muscles, pelvic floor muscle strength and pelvic organ prolapse. Let me emphasize that we do not push through pain. Many of our clientele are patients that come in to be treated for pain with intercourse or pain with any type of penetration. In these cases an internal exam on the very first visit may not be possible or warranted. Your therapist will work with you to slowly progress to being able to do an internal exam.

Once the physical assessment is complete your therapist will explain their findings, and proceed to put in place a plan of care for you. You will determine your goals for physical therapy together and come up with a treatment plan to help you get there. Last, but not least you will be given an opportunity to have any questions or concerns answered or addressed.

Day one usually begins with mostly an assessment, loads of patient education and occasionally some form of treatment to get you started. Follow up treatments will include some manual therapy, as well as exercises that you are able to do independently at home. If you’ve been wondering if pelvic floor physical therapy is right for you, hopefully this post will have answered some of your questions and put your mind at ease with what to expect! If you’re still feeling hesitant about booking an appointment feel free to call us and speak to a therapist directly about your specific concerns!

We accept most major insurances in the Louisville area including Medicare and Passport.