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  • Yee Yeoman

What to expect at your pelvic floor physiotherapy appointment

It can be confusing to know what the difference is between your common physios who treat your ankle sprains and low back pain compared to pelvic health physiotherapists. In this blog, we will address common questions you may be wondering when booking your appointment with a pelvic health physiotherapist.

Your first appointment will usually take an hour, and a large portion of that time will be spent asking about your history and concerns. We will complete a comprehensive pelvic health assessment which includes your current concerns, what activities/hobbies you enjoy, current lifestyle, past medical, obstetric and gynaecological history, bladder and bowel habits, sexual function, exercise, and general health. Additionally, we will ask you what types of treatments you have already tried for your symptoms. Many of these questions can be quite personal and sensitive in nature and you do not have to discuss anything you don’t feel comfortable with. However, discussing your history will provide a good indication of what assessment and treatment techniques may be helpful. It may also be necessary to take a look at your movement patterns and assess if you have any muscle imbalances or connective tissue defects related to your pelvis from the outside.

Questions we will ask you include:

  • How long you’ve had the problem, and whether it’s improving or becoming worse

  • What you’ve tried to do to improve things so far, and whether that’s helped

  • Whether you have problems with your bladder, bowel, prolapse, sexual problems or maybe a combination of these issues

  • Any past medical problems, including childbirth history and any previous surgeries

  • What is the problem that is bothering you the most?

  • Bladder habits including how often you go to the toilet during the day and night, if you leak urine (and if so, how much and how often), if you feel you have to rush to get to the toilet on time, and the kinds of symptoms you have when urinating, including pain or feelings of incomplete emptying.

  • Bowel habits, including how often you empty the bowel, whether you find this difficult or painful, the consistency of your bowel motions, any loss of control from the bowel or any sense of having to rush to get to the toilet on time.

  • Pregnancy and childbirth history including how many pregnancies and children you’ve had, the types of deliveries and the weight of your babies.

  • Any symptoms of prolapse, including a feeling of something dropping internally or a heaviness, lump or bulging inside the vagina or rectum.

  • Questions related to sexual intercourse or penetration, including whether you find this painful or if you have any difficulties or concerns.

  • Your medical history including current medical problems, medications you’re taking and any past surgeries.

  • What you do for work and in your leisure time, so we can understand how your problem may be impacting on your daily activities.

  • Your knowledge on connecting with your pelvic floor muscles and their function. ·

Following this, an internal exam may be recommended to further investigate the symptoms you are describing. However, internal pelvic floor exams are not mandatory but it is the gold standard method of assessing the pelvic floor muscles and connective tissues within the pelvis. This will commonly occur at the first appointment, but not always. Before an internal exam, we will first discuss and show you where your pelvic floor muscles are, how these muscles are assessed as well as the clinical reasoning and risks with carrying out an internal exam. You will always be asked to provide consent before any assessment or treatment and you are welcome to remove your consent at any time during the entire assessment.

For the internal assessment, we will leave the room for you to undress from the waist down and have you lie on the treatment table (similar to your doctor's clinic) and drape/cover yourself with a sheet provided. We will use a clean technique, using non-latex gloves and water-based lubricant for the internal exam. We will first observe your pelvic floor externally. The internal portion involves your physiotherapist inserting one or two gloved fingers into the vaginal canal, or one finger is inserted into the rectum in order to access the front and back portions of the pelvic floor muscles. We are assessing your pelvic floor strength, tone, laxity, coordination and connective tissue integrity. We will talk you through the entire physical exam with you providing feedback during the assessment.

If you are not comfortable with an internal exam, there are other external treatment options that can be used to successfully treat your symptoms or we can leave it until another session. Please let us know and we can work around it. However, this may mean we cannot diagnose and treat your problem to the best of our ability, and we can discuss that with you. It is always up to you to determine what you feel comfortable with during your consultation.

After the exam, we will then explain the findings and come up with a management plan going forward to work towards your goals. This will include timeframes, expectations, and what the treatment will involve. Use this time to ask us all the questions you may have regarding treatment expectations and goals.

If you have your period, it is still possible for us to do an internal assessment if you are comfortable doing so. If you have your period and would prefer not to have an internal assessment, there are other aspects of your treatment we can address during your session.

We are passionate about working with you to help you achieve confidence and control over your pelvic health. We look forward to meeting you for your first appointment. If you have any further questions or would like to book your initial appointment, please contact us here.

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