I’m one of those people who tends to want all the details about any new undertaking. Where, when, why… I want to know. Not knowing what to expect leads to more anxiety and fear and this is never truer than if the undertaking in question is related to my health. I’m guessing I’m far from alone in this and I’m also guessing that a first visit to Pelvic Floor Physical Therapy would fall into this category of anxiety producing. To combat these nerves, let’s talk about what to expect and how to prepare.
First and foremost, let’s talk about what Pelvic Floor Physical Therapy is. Pelvic Floor Physical Therapy is a growing field which focuses on the pelvic floor muscles and the neighboring systems that affect how the pelvic floor functions. Pelvic Floor Physical Therapists (PTs) are specially trained to assess your pelvic floor and guide you on the path to reaching your own pelvic floor goals, including goals related to continence (not having urinary or bowel leaks), constipation, reducing pain with daily activities, helping you through pregnancy and the postpartum period, addressing pain or dysfunction with sexual activity, and getting you back to dynamic activities without fear of injury.
To prepare for your first visit, make sure you show up with all paperwork completed or allot enough time to do so at their office. They typically have a set time scheduled for each evaluation and you want to allow as much time as possible to tell the history of your symptoms, assess what is going on with your body, and ask questions. Wear clothing you feel comfortable moving in and make a list of your questions and concerns to go over during your first visit. Do not feel like you have to “spruce up” first (i.e., no need to shave or wax or do anything you would not do on any other day) and do not worry if you are on your menstrual cycle. Being on your menstrual cycle changes very little for us as providers. However, if you wish to delay any internal assessment for another visit, that is completely fine! There are plenty of things we can do and check and talk about that do not require a vaginal or rectal exam.
The main goal of your first visit is to establish a plan to tackle your pelvic floor goals. To do that, we need to do some detective work and find out what exactly is going on. The first step is to hear your story. You will tell your PT your medical history and your symptom progression and they will likely ask questions about your bowel, bladder and sexual function. Make sure you let them know exactly what is going on. Some people find it embarrassing or stressful to talk about these topics, but doing so will help your PT figure out what is causing your symptoms and how best to move forward in treatment. Let your PT know if you need a break, are simply not ready to discuss a topic yet, or have questions yourself at any point. If there is any element of care which causes you fear or anxiety, let them know.
Every Pelvic Floor PT I’ve ever met (which is quite a few at this point in my own Pelvic Floor career!) is in this line of work because they care deeply. We do not judge and what we talk about in our treatment room stays between us. We document what is needed to make future decisions related to your care and to remember important details, but we take privacy of your information extremely seriously and have the option of setting your note to private if there are elements of your story you do not wish other healthcare providers to see. Long story short, we’ve got your back.
So now back to the nitty gritty of going over every step of the process (because like I said before, I like details!). Depending on how much time you have in your first appointment, your therapist will likely do a quick screen of your hip joints and muscles, your abdomen, and your low back. Ideally during the evaluation they will also perform an internal vaginal or rectal exam to assess your muscles directly. You are welcome to have a chaperone present during any portion of the exam, particularly any internal component, but this is not required. You can bring someone with you or can request a chaperone at their office. Once you are ready, the therapist will step out of the room while you get undressed from the waist down. They will provide a gown or cover for you to use. When they return, they will direct you to lie on the table either in a hooklying or side-lying position. They will ask your permission to look at and touch your body so as to evaluate your pelvic floor.
I always tell my own patients that any internal assessment or treatment is not a “no pain, no gain” situation. If you’re coming to Pelvic Floor PT for a non-pain condition, I want to keep everything pain free. If you’re seeing me for a condition where part of the problem is pelvic pain, I want to keep any increase in pain as minimal as possible and ideally aim to keep any discomfort below 2-3/10 on our pain scale. This is partly because I want to make everything as comfortable as possible, but also because causing too much of an increase in pain is counterproductive. Let your PT know when pain starts to increase. The more information you can give us the better. Last point here, we do not have to check everything on the first visit. The goal is to make a plan and get things started. We will be assessing more and more components of your pelvic floor as time goes on. Let us know if you want to stop at any point for any reason (this holds true for any future visits too!).
At the end, after you get dressed and ready, we work together on a plan. We’ll talk about what is working and what isn’t in your pelvic floor, how we hope to improve things, what treatment will entail, how often we’d like you to come in, and what things you should be doing at home. Give your therapist an honest assessment of how much time you can devote to your home program so we can prioritize your homework appropriately.
If you have any other questions about what to expect or how to find a Pelvic Floor PT, reach out to us directly and we’ll gladly help.