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What to expect at a pelvic floor physical therapy evaluation

If you’re experiencing pelvic pain, relentless hip issues, bowel or bladder dysfunction or coccyx pain, a pelvic floor physical therapy evaluation could be your next step towards finding a solution.

These evaluations help not only assess the pelvic floor, but they also look at whole posture and movement as well.

A pelvic floor physical therapy evaluation is often recommended for new moms, but we see male and female patients of all different ages, including patients from five to 95 years old.

But if you’ve never had a pelvic floor physical therapy evaluation before, you might not know what to expect.

Here, we describe what a pelvic floor physical therapy evaluation actually includes, and what you can expect during them.

What Is the Pelvic Floor?

Before I talk about what happens during a pelvic floor physical therapy evaluation, let’s get a quick understanding of what makes up the pelvic floor.

The pelvic floor is made of muscles, tendons, ligaments and connective tissue that form a “floor” at the base of your pelvis. The pelvic floor has four main functions we like to call the ‘four “S’s”.

  1. Supportive: The pelvic organs in our bladder and bowels, and in females, the uterus and vaginal canal rely on the pelvic floor for support and proper function.
  2. Sphincteric: The sphincters of the pelvic floor are muscles that help us control our bladder and bowel. They flex to keep waste inside, and relax to allow for urination, defecation and flatulence.
  3. Sexual: The superficial muscles of the pelvic floor help with clitoral and penile erection and arousal.
  4. Stabilization: The pelvic floor muscles play a significant role in stabilizing your hips, pelvis and lower back.
  5. Sump Pump: The muscles work to help pump out blood, lymphatic fluid, cellular waste, etc.

Putting It All Together

Each of the functions are essential to your pelvic health. If the pelvic floor were to become weak or injured, those organs could be pulled downwards. This can lead to rectal, bladder or uterine prolapse, or urinary or fecal incontinence.

On the flip side, imagine tight pelvic floor muscles. This could prevent the rectum from expanding, causing constipation and preventing normal urine flow through the urethra. It could also cause the vaginal canal to tighten, resulting in dyspareunia (painful sex) or pelvic pain.

In males, tight pelvic muscles could also result in painful sex and urinary symptoms.

Now that we understand the pelvic floor, let’s walk through what happens during a pelvic floor physical therapy evaluation.

Step 1: History Intake

A thorough physical therapy evaluation will begin with the therapist taking an extensive history.

In other words, this is not just a reading of your medical chart. I prefer a more personable and thorough approach, sitting down with each of our patients so we can have an open conversation.

Because pelvic floor dysfunction is multifactorial — which means that it could be caused by more than one thing — we need to be extremely thorough. We will discuss your pain, symptoms, bowel and bladder habits, diet, fluid intake, lifestyle choices, career, stress levels, pregnancy history, trauma, medications and more.

This is a time for you to be heard and for us to begin exploring a physical therapy diagnosis. No two patients are the same, so it’s important we take the time to understand your case.

Step 2: Postural Examination

You might not realize it, but posture is closely linked to pelvic health. When your skeletal alignment changes, so do the length and tension of the pelvic floor muscles.

During a pelvic floor physical therapy evaluation, I will check your posture while sitting and standing, starting from the head and ending up all the way down at your feet.

Many people have poor posture, as it’s caused by bad habits including sitting hunched over a desk for long periods of time and weak or imbalanced muscles. In some cases, scoliosis and differences in leg length could contribute to bad posture.

Step 3: Movement Analysis

During the history intake, we’ll work to figure out which of your activities, exercises, postures or movements contribute to or worsen your symptoms.

Expect to demonstrate these movements. For example, if you’re a mother suffering from stress incontinence when picking up your child’s toys off the floor, we’re going to ask you to mimic that exact task.

Watching you perform this sequence of events helps us assess if you exhibit a movement pattern impairment. I can show you proper squatting or lifting techniques tailored to what your body needs.

Step 4: Orthopedic Assessment

Because pelvic floor physical therapists have orthopedic physical therapy expertise, I am also able to evaluate and provide follow-up orthopedic treatments.

During the orthopedic assessment, we evaluate your spine, sacroiliac joints, hip joints, rib cage and breathing patterns.

If I find any problem areas, such as a tight hip, stiff lower back or faulty breathing, I typically tackle those first.

Step 5: Pelvic Floor Assessment

The pelvic floor assessment consists of two parts: an external and an internal examination of the vagina and/or rectum.

Internal pelvic floor assessment: During this part, we are able to evaluate the strength, length, symmetry and quality of your pelvic floor muscles. It’s different than the exam your doctor administers.

External pelvic assessment: This involves an examination of the contraction and relaxation of the pelvis. We’ll look for trigger points, muscle spasms, weaknesses and organ prolapse.

If you have too many symptoms or feel uncomfortable with an internal examination, let us know that you prefer an external examination.

It’s a common misconception that all women should be performing kegel exercises (pelvic floor contractions). However, if a you have a tight or painful pelvic floor, kegel exercises can potentially make the muscles tighter — sometimes resulting in more pain.

There is no way to tell if kegel exercises are right for you without a medical history examination and an internal pelvic floor assessment.

Step 6: Patient Education

This is a favorite step for all of us physical therapists. Often, if you’re seeing us for your pelvic pain, you’ve already been through the ringer.

We know that it can be exhausting, but we love sharing our knowledge to help you live healthfully and pain-free.

We’ll arm you with a wealth of tips and advice on things you can do to help yourself on your own, discussing your home exercise plan as it relates.

Step 7: Treatment

(Oh my goodness how many more steps are there?) This step is the reason you came to us in the first place, the final step is your treatment.

Depending on your needs, we might explore:

  • Muscle trigger point release to the pelvic floor musculature
  • Trigger point dry needling
  • Mobilization of tight joints like the hips, coccyx, lumbar and thoracic spine
  • Muscle energy techniques to free restricted motion
  • Pelvic floor muscle education with manual feedback or electrical stimulation
  • Biofeedback to assist in downregulation or relaxation of the pelvic floor musculature or upregulation to increase the pelvic floor contraction
  • Movement retraining and education

Your job’s not over, though. Most treatment plans require some work on your end; we cannot make the pain go away instantly with a magic pill, injection, chiropractic adjustment or massage.

Instead, pelvic floor physical therapists help you on your long-term health. We want to set you up for years to come, so you’re not faced with the same recurring problems.

Pelvic PT’s can alleviate your pain permanently, not temporarily.

-Dr. Betsey Stec PT, DPT

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