What Happens During a Pelvic Floor Physical Therapy Evaluation?

I think there are multiple things that hold people back from scheduling a pelvic floor therapy evaluation.

1. They don’t know what pelvic floor therapy is/how it can help them. If that’s you, check out these blogs: Pelvic Floor 101 or Do I Need Physical Therapy?

2. They’re apprehensive/unsure/nervous about what happens during a pelvic floor therapy appointment. If that’s you, keep reading. I will go over what an evaluation at Mid-Missouri Pelvic Health looks like. Hopefully this puts some of those fears/concerns at ease.

Scheduling

Prospective patients reach out via online form or phone or their provider faxes us a referral (866-404-5398) to let us know that they’re interested. Once we receive your contact information, I (aka Jen) gives you a call to get an idea of what’s going on. Then I walk through what happens during the eval, answer any specific questions you might have, and lastly schedule the evaluation.

Before the Appointment

After scheduling, you’ll get two emails. The first is a “welcome” email with instructions on setting up an online account and frequently asked questions (where to park, where to go inside the building, etc). The second email contains the online intake paperwork. There is where you will fill out details about your symptoms, medical history, surgical history, pregnancy and delivery histories, and more. If you think it might be related, put it on the intake form. I review all of your information before your appointment, so we can hit the ground running.

Beginning of the Appointment

The beginning of your evaluation is known as the “subjective” portion. The first 15ish minutes is spent just talking. This is where we go over your intake form and you get to tell your story. We talk about your symptoms, your medical history, and any other pertinent information. Sometimes this section is short and straightforward. Sometimes your story is complicated, it needs to be longer to allow you time to talk. And that’s okay! This is also where I’ll ask more specific follow up questions to really get an understanding of what I want to focus on during the physical assessment.

Education

Next, we go over a little pelvic floor anatomy. I use a pelvic floor model to show how everything is connected, and exactly what we’ll do during the hands-on portion of your assessment.

Assessment

We are a solid 20-25 minutes into the evaluation before we do anything hands-on. There is some variability during this part of the assessment, because I like to focus on why you’re coming. My assessment looks different for someone who’s 6 weeks post-partum compared to someone coming for a 10 year history of pelvic pain. Your evaluation is tailored to your specific symptoms/history and we spend more or less time on each section as needed. In general, I look at these things:

• Posture

• Spine and rib movement

• Hip and ankle strength/stability and range of motion

• Abdominal strength and/or separation

• Abdominal visceral mobility (I push around on your belly to see how your organs move - primarily your intestines and your bladder)

• External pelvic floor assessment (I look skin health, see if there is any pelvic organ prolapse, and palpate/apply pressure to your pelvic floor muscles via the perineum from the outside)

• Internal pelvic floor muscle assessment (This is done with a single gloved examining digit either vaginally or rectally to assess your pelvic floor directly. Here is where I check out any pelvic floor muscle tenderness, muscle strength and coordination.) This should not be painful. If you have any discomfort, let your therapist know.

  *NOTE: You are 100% allowed to decline the internal (or any) portion of the evaluation. Please discuss any concerns or hesitations you have with Jen (or your therapist) and together we will decide what you feel comfortable participating in.

Wrap Up/Action Plan

In the final 10 minutes, we will do a wrap up and go over your “Action Plan”. We will discuss the following:

1. Your goals

2. Evaluation findings/contributing factors

3. Home Exercise Program

4. What the game plan moving forward is (how often to come back, scheduling appointments, etc)

5. As always, answer ANY questions that you might have

As You’re Leaving

I want all of my patients to leave their evaluation with 3 key feelings:

• Respected - You got to tell your story, your concerns were validated, etc.

• Informed - You have a better understanding of what’s going on, how your body works, etc.

• Hopeful - You know what our plan moving forward is and that there is light at the end of the tunnel. You. Will. Get. Better.

Hopefully, this helped alleviate some apprehension you might have had. As always, please feel free to reach out if you have any questions. Decided you’re ready to give pelvic floor physical therapy a try??