You have been referred to Pelvic Floor Physical Therapy by your doctor, a friend, Instagram, TikTok, etc. but you’re unsure about what to expect or even why you are being referred to pelvic floor physical therapy.  Let’s break it down. 

What is Pelvic Floor Physical Therapy? 

In essence, Pelvic Floor Physical Therapy (PFPT) is a speciality within the physical therapy field. PFPTs undergo additional training beyond the doctorate degree provided today to treat specific conditions related to pelvic floor muscles and nerves, such as incontinence, pelvic pain or prolapse. For a more detailed explanation of the conditions PFPT can treat, you can check out an earlier blog on what is pelvic floor physical therapy?

Okay…but really what happens in a Pelvic Floor Physical Therapy session? 

If you’ve ever been to physical therapy before, the initial evaluation is a “get to know you” session where we start peeling back the layers of what brings you into physical therapy. If you have been specifically referred to PFPT, treatment sessions should occur in a private room. A private room allows you to speak freely about some pretty intimate issues that are bringing you in. If you are in a space you cannot speak freely, that may not be the best fit as the therapist won’t be able to provide you with the best care. 

The History!

The therapist is going to ask you questions, and nothing is too much information. In fact, we typically encourage you to share as much detail as possible. This helps us build a better picture of what is bringing you into the session. If you are nervous to share, most likely you are not alone and we have heard it! Typically, questions will revolve around your bowel, bladder, urogynecological, sexually, orthopedic or surgical history. The goal is to understand why you are seeking treatment, and if a question feels uncomfortable, you have the right to say you don’t want to answer at that time or ask the therapist why they are asking.  

Education! Education! Education! 

Personally, this is my favorite part. As a side note, I am the daughter of two teachers. While I didn’t pursue a career within the school system, providing education comes naturally to me, and it’s deeply ingrained in pelvic floor physical therapy. During this time, information is provided on pelvic floor muscle anatomy, the connection between the pelvic floor and the body, and how the muscles affect the bowel, bladder, and reproductive system. Education can be tailored to you based on your specific complaints. For example, if you are seeking treatment for pelvic pain, the education will likely focus heavily on how the muscles affect your pain rather than explaining pelvic organ prolapse. A skilled therapist can and will tailor this information to your individual needs. 

Now that you have been informed, let’s move on to the exam, which can be the most overwhelming part. However, when you walk into a pelvic health physical therapist's room, you are always in control!

The Exam!

A part of the exam process may involve an internal muscle exam, but that is not the only aspect that can occur if you are not comfortable with that process. Some may be reading this with widened eyes and in disbelief that physical therapy can perform internal exams. Let’s delve into this to gain a better understanding.

The internal muscle exam is distinct from an OBGYN exam. While we access the same opening, our focus is on different structures of the body. Your medical team focuses on the organs of the reproductive system, whereas we focus on the muscles. If you want to have a better understanding of the pelvic floor muscles, check out information on the female anatomy and pelvic floor muscles.

Another crucial point with a skilled pelvic health therapist is that they will explain what they are doing to gain consent before and during the exam. You should feel informed throughout the process, and if you feel uncomfortable at any time, tell the therapist, and they will stop the exam.

Another aspect of the exam process is a general orthopedic or "external" examination. First, if you are uncomfortable with the internal examination, many therapists can and should begin by assessing external muscles and nerves that may contribute to your complaints. As mentioned, your consent is paramount in this setting. No consent, no internal exam! So, if you do consent to the internal exam, an external exam is still warranted to assess the interrelationship between the external and internal muscles.

Common Questions about the Exam?

Many individuals are unsure about what to wear to the exam and how the exam will proceed. First, it's best to wear comfortable clothes, as if you were heading to the gym. During an internal exam, you’ll be asked to undress. Either a gown or a sheet will be provided to cover you from the waist down depending on the therapist set up. The therapist will specify how this will work for you.

One common concern is whether the exam can still be performed if you are on your period. The short answer is yes. Ultimately, it is up to you if you would like to be examined while on your period. We have appropriate medical wear to perform the exam whether you are menstruating or not.

The Assessment!

Between your story (history) and the examination, a clearer picture begins to emerge. At this point, a diagnosis or working diagnosis is formed. An explanation of this assessment will be provided, possibly with the use of images and/or models to help solidify the findings. This assessment guides the treatment and plan of care.  The plan of care could include additional internal muscle treatments or it could require internal “check-ins” every few weeks.  

Homework (yes, you have to do homework again!)

At the end of the session, you will receive an individualized plan of care along with exercises. Remember, PFPT is not just about kegels (or pelvic floor exercises); there is a plethora of exercises, stretches, and home treatments that go beyond kegels. During the initial session, you will be given information, treatment, and/or exercises to start at home. Success in PFPT requires teamwork between you and your therapist. We are here to coach, guide, educate, listen, and adjust the plan of care, but it only works if you fulfill your end of the deal and execute the information provided to you. Your therapist is not there to fix you but to become a member of your team, leading you in the right direction to address your complaints.

The process described above may take place in one session, but it may also occur over 2-3 sessions, depending on the clinic and if you choose to use insurance with an in-network provider and seek a cash pay provider. Whether it happens in one session or three, the most important aspect of the pelvic floor physical therapy exam is informed consent. If at any point you do not feel comfortable with the therapist you have found or have been referred to, seek out another therapist who fits your needs.

Is this process a little weird and awkward? Yes! 

But is it worth it? Also, yes!

Dr. Susan Miller PT, DPT, is a licensed pelvic floor physical therapist and the owner of Lotus Core Physical Therapy in Colorado. I welcome both in-person and telehealth appointments for Colorado residents, as well as coaching calls for clients residing out of state.  

Book at www.lotuscorept.com