So you’ve been hearing all about these pelvic floor muscles that you apparently have and have started to think that maybe some of the symptoms that you’ve been experiencing could be related. You’ve sought out a physical therapist in your area that specializes in treatment of the pelvic floor. Now what? What is this appointment going to look like?
Not every practice set-up is exactly the same, but I can give you insight into what to expect if you were to come to our office, which is a pelvic floor specialty clinic. When you arrive, you’ll bring with you your prescription (as in the state of Texas a prescription is required - this can come from nearly any of your providers) and you will meet with a patient care coordinator at the front desk. You’ll fill out paperwork that discusses the basics of what symptoms you’re experiencing, and then will be called out of the waiting room by your physical therapist. You’ll have the chance to sit down (as long as you don’t have sitting pain) in a comfortable private room, where your therapist will ask questions about you: what your lifestyle is like, activities you’re participating in, medical history, how your symptoms started, and what they look like now. The physical therapist will ask questions about pain, bladder symptoms, bowel symptoms, and sexual symptoms, as all of these areas are very interrelated and can provide us with clues to the root of the problem. You’ll have the opportunity to talk about your goals and any of your concerns.
The physical therapist will determine what facets of an exam need to be performed, based on the nature of your symptoms. Many exams start out looking at standing posture, how your spine, pelvic bones and hips are aligned and move. Oftentimes, we examine abdominal tissues to assess for diastasis recti (a separation of the abdominal musculature), tension, or tenderness through the abdomen and visceral mobility (movement of organs within the abdominal and pelvic cavities). Other tissues , such as muscles through your legs, gluteals, and back may also be examined for strength, flexibility, and tenderness as well as restriction of connective tissue. If symptoms suggest that your problem may be contributed to by the pelvic floor directly, superficial muscles (those right underneath the skin of the vulva or perineum) may be examined for tenderness or tension. Your physical therapist will also look at the skin to assure there are no signs of irritation or hormonal deprivation through the vulvar tissues. Internal exams are performed only when and if a patient feels ready, but can provide very important information, providing insight into the problem. If you’ve had unpleasant exams in the past, we can first work on skills such as breathing patterns to make the exam much more comfortable. The physical therapist uses a gloved finger to gently press on internal muscles to assess for pain or tension while also assessing the muscles’ ability to contract as well as relax. Rectal exams, when deemed relevant to symptoms, can be performed as well to learn more about pelvic floor function.
The information found on exam will lead the physical therapist to design a program that is right for your body specifically. You will likely leave the appointment with lots of information on what is going on in your body, things you can try at home to lessen symptoms, and a home exercise program to strengthen or stretch muscles.
Going to a new medical provider is always a bit nerve-racking, especially when it involves topics as sensitive as those dealing with the pelvic floor. The good news is that your pelvic floor physical therapist has dedicated their career to knowing about these issues specifically and is excited to get you feeling better as soon as possible. As we say over and over, these issues are common, not normal. You can get help and get back to feeling like yourself.
Christina McGee PT, DPT
Christina McGee is a physical therapist at Sullivan Physical Therapy, a pelvic floor specialty clinic in Austin, Texas. She received a bachelor of science in Athletic Training from University of Iowa and a Doctorate of Physical Therapy from University of Delaware. Christina treats men and women with bladder, bowel, and sexual dysfunction, as well as abdominal and pelvic pain. She has specific interests in pregnancy and postpartum care and is additionally the head of Sullivan Physical Therapy's pediatric bladder and bowel program and the Center Coordinator of Clinical Education. Christina also partners with Austin Area Birthing Center to provide pregnancy and postpartum physical therapy care and provide education to AABC clients on site. She is on the medical advisory board of ReCore Fitness.