While pelvic floor physical therapy has been around for centuries, it’s largely unknown to the average person, keeping people from addressing issues that are all too common, yet often considered too “taboo” to talk about.

I’m talking about issues involving peeing, pooping, and sex.

(If you’re interested in learning more about what the pelvic floor is and does, check out my post here. Otherwise, today we’re going over what to expect in a pelvic floor physical therapy session.)

For many first time patients, the initial visit can be intimidating.

So, for the individuals who are still working on mustering up the courage to call and set up their first appointment with a pelvic health professional, I’m going to take you through what to expect on your first visit with a pelvic floor physical therapist.

“So, tell me why you’re here.”

During your first session, your therapist will spend a lot of time getting to know you, gathering information about your current symptoms, concerns, and even your past medical history.

Forewarning… there will be a lot of talk about peeing, pooping, sex, diet, exercise, and other day-to-day activities. 

External Assessment

The therapist will then dive into an observation and assessment of posture, including spinal and pelvic alignment, postural deviations or compensations, quality of movement, as well as breathing patterns.

Next, the therapist will palpate (or examine by touch) structures in the spine, abdomen, and hips to assess for tone, trigger points, or tender points.

The therapist will also assess the patient’s mobility and strength, looking to see if anything can reproduce the patients symptoms.

The therapist will also assess the abdomen for scars, as well as tone and tenderness near specific visceral tissue (or internal organs), such as the bladder, uterus, rectum, kidneys, and other tissues found in the abdomen.

These “other” tissues may include ligaments attaching to the bladder and other structures found in the pelvic floor.

Internal Assessment (always with consent)

This is typically done through the vagina, but can also be performed through the rectum (depending on the patient’s presentation and symptoms.)

Why an internal assessment you may ask?

Most of the muscles, nerves, and tissues existing within the pelvic floor are only accessible vaginally or rectally.

Unfortunately, we can’t palpate them as easy as we can palpate your glutes or your biceps.

However, the internal assessment is brief, and will never be performed without consent from the patient or if there is pain.

The internal assessment allows us to identify the muscles and tissues that may be the source of your symptoms.

Common findings include muscles or tissues that are too tight, too weak, uncoordinated, etc.

If you’d rather wait to have the internal examination performed on a subsequent visit, we are completely okay with that as well.

An internal assessment is important for a pelvic floor physical therapist, as it allows us to gain extremely important information regarding your condition, and helps us to determine how to most effectively treat the problem at hand. 

Education and Exercise

After the assessment, the patient will be provided with education and exercises, tailored specifically to their needs, so they can immediately start working towards relief of symptoms at home.

Education and exercise differs from patient too patient, but can include exercises to enhance relaxation, lengthen muscles, strengthen muscles, breath work, habit adjustments, helpful tips, etc.

So, the initial visit is over– now what?

Your pelvic floor physical therapist will use the information obtained during the initial evaluation to plan future treatment sessions to ensure both yours and their goals are met.

Subsequent visits with your pelvic floor physical therapist typically include a combination of external work, internal work, exercises, and patient education, depending on the patient, how they present each week, and what they’re trying to achieve.

While each patient case is different, whether you’re being seen 1x a week or 3x a week, it’s important to stay consistent at home and do your part to expedite the healing process.

As a patient, you should feel comfortable, respected, and heard by your pelvic floor physical therapist.

The goal of pelvic floor physical therapy is to address pain, discomfort, or dysfunction, alleviate symptoms, improve function, and improve a patient’s overall quality of life.

Have any questions? Feel free to reach out!

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