What Does A Pelvic Floor Evaluation Look Like?
Going to a therapist for pelvic floor therapy can be really scary. Like really, really scary.
I have had people tell me things like they have delayed going for YEARS. I have known people to spend thousands of dollars on incontinence pads -those things are NOT cheap- instead of coming in to see a pelvic floor specialist. I hear stories over and over about people avoiding certain activities like laughing, exercising, or playing with their children to avoid leaking urine.
I have had patients come in after not being intimate with their partners for years. The sex was just too painful, but the thought of doing anything about it was even worse. I have had patients who literally wake up 6 – 8 times a night due to a cranky bladder, and finally come in because they are on the verge of being suicidal due to lack of sleep. I could go on, but I am thinking you get the point.
As a pelvic floor therapist, I get all sorts of fun questions.
“Are we going to do exercises on the floor?” (NOPE)
“Do you HAVE to look at my vagina?” (NOPE!)
“How on earth are you going to fix my problem?” (IT’S COMPLICATED)
“Who would choose to do this job?” (See this blog!)
Like Elsa says, let’s dive “into the unknown!”
Yes, pelvic health therapy can be intimidating and intimate. However, everyone I know who works in pelvic health has a personality made to put their patients at ease. I honestly can count on my hand the number of times a patient has been unhappy coming in for pelvic floor therapy, and usually that is because of a personal reason on their part, not anything to do with the services they are provided.
So what to expect when you arrive for your appointment?
ALL THE PAPERWORK: I want to know ALL about you. This includes your medical history, any injuries and any/all symptoms related to the issue bringing you in. Did you bust your butt ice skating when you were 10? Tell me. Did you have a traumatic delivery 25 years ago? Let me know! Did a cousin get a little handsy with you back when you were a preteen? Let’s acknowledge that that may affect your pelvic floor’s function. We do not have to get into your deepest, darkest secrets on a first visit, but the more information I have, the better (and faster) we will be able to address your problems. I also want your understanding and consent about this evaluation and treatment. So be prepared to sign your life away (just kidding), but be ready because the paperwork is coming.
LOTS OF TALKING: After you fill all of that paperwork out, I am going to want to review it with you to make sure I have a full picture of what you and your body have been through. I want to hear, in your words, the “story” of what has brought you to pelvic health therapy. It is OK if you are angry telling me about it. It is OK if you cry– I invest in really bougie tissues. I promise I want to hear your story and will not be judging you in any part of it.
LOTS OF LEARNING: The best gift I can give you as a therapist is my knowledge. The first time this happens will be when I review what I affectionately refer to as Pelvic Health 101. (A little side bar…I believe so strongly in going over this mini class that in 2021, I hired an illustrator to draw beautiful, inclusive, not terrifying images of pelvic health topics). We are going to talk about your body’s anatomy, physiology, and function, in reference to the areas you want addressed. The goal of this is to give YOU the power to understand how to help improve your issues, and for you to “buy in” to the treatment and advice I recommend as being helpful to you. It is really easy for me to say something like, “Let’s drink less coffee,” but if you see how coffee makes your bladder more cranky and leaky, you may be more willing to give it a try.
SCREENING OF OUTSIDE AREAS: Many people think I am going to jump right to the private parts. Honestly, sometimes we do not even get to those areas on the first day. I refer you to point #2 – sometimes we do A LOT of talking. But screening wise, first, I want to look at things more globally. These are things like posture, breathing, range of motion of the back and hips, the core muscles, and strength of the body overall. Some people will never want me in their nether regions, and there are tons of things we can do on the “outside” that can still improve pelvic symptoms and a client’s quality of life greatly. So first, we will assess your back, your belly, your hips, and your pelvis, all fully dressed!
DIVING DEEPER: This part is always optional. This part is always optional. This part is ALWAYS optional. Please do not let your fear of an internal examination stop you from getting pelvic floor therapy. The patient is always the boss of what happens to their body. If someone says something to me like, “if you must” or “my doctor says I have to,” I consider this a red flag, and I will often wait a few visits until we have a better trusting relationship.
If the patient is alright with allowing me to take a look at the pelvic floor, then that is what we do. We start with me stepping out of the room so the patient can undress from the waist down and get settled laying down covered with a sheet. I bought super soft, mermaid colored sheets (teal/gray) because when you have your own clinic, you can enjoy those little details. With permission, I will uncover the perineum to look at the outside areas first to see what is happening from a functional standpoint. I will ask you to do things like “show me your kegel,” fake cough, fake sneeze and fake laugh. Each step of the way, I ask new permission after explaining what I would like to do. I will palpate the outside landmarks, bony, nerves, and muscular areas and see if anything needs attention there. I switch gloves at this point because NOTHING FROM THE OUTSIDE SHOULD EVER GO INSIDE. With permission, using one newly-gloved and lubricated finger (NO SPECULUM OR STIRRUPS HERE) we will check out the pelvic floor muscles. I will narrate every step of the way, and do everything to make you comfortable and avoid any pain. There are layers of the pelvic floor, and we will slowly check these areas out. This part of the exam typically takes 5 minutes or less, but gives a wealth of information.
PUTTING OURSELVES BACK TOGETHER: Once we assess the pelvic floor, which is usually pretty quick and painless, I will give my client time to wipe up with water wipes and get dressed. We will sit down together and create a plan of care. I will explain what I found and how I think it is contributing to the symptoms that brought you in.
DO THE WORK: I am very into handouts and repetition with teaching my clients about pelvic floor therapy home programs. Why? Because it is HARD to remember anything I say after I ask to look at their pelvic floor. So as we wrap up a session, I will give you lots of evidence-based but easy-to-understand handouts to address areas specific to YOUR issue. We will talk about any exercises, retraining, or lifestyle changes that may help improve your quality of life. I will keep it simple and be reasonable about what I can ask of you on a daily and weekly basis, because adulting is already hard.
SCHEDULE: We will work on a schedule. I typically see clients 1 x per week starting out, and we can space them out as you get more comfortable with your homework and notice improvement in symptoms. Every visit will be planned to build on and progress from the previous visit. I am not looking to waste your time, and my goal is for you to be “practically perfect” in a reasonable time, which generally is about 8 – 12 weeks time, but can definitely be sooner!
Still not so sure about this? Here are some frequently asked questions and their answers.
What is a pelvic floor therapist/pelvic floor therapy? Dr. Mora Pluchino is a licensed physical therapist who has gone through specialized training to be able to evaluate, assess, and treat the pelvic floor and associated problems. The pelvic floor is the muscular base of the abdominal canister attached to the pelvis. It is composed of muscles, ligaments, and fascia that gives support to the abdominal organs. Pelvic floor therapy addresses issues that may occur in the back, abdomen, or pelvis.
What if I have a hard time making it to appointments? Practically Perfect PT provides flexible scheduling, kid-friendly treatment spaces for little stowaways, resources to supplement sessions, and a convenient, accessible location. PPPT offers weekly evening hours and monthly Saturday visits. Virtual visits are also available for clients who cannot physically come in, and can be attended via smartphone, tablet, or laptop.
What if I have my period? NO BIG DEAL. If you are comfortable, I am comfortable. If you are in a lot of pain or bleeding EXTREMELY heavily, we can focus on other areas on the outside, but a period is not a reason to cancel. If you would be more comfortable rescheduling, that can be arranged as well, but typically, therapy helps your menstrual symptoms!
Can my partner come? OF COURSE. Our goal at Practically Perfect is for you to feel comfortable and safe. If bringing your partner along does that for you, then by all means, bring whoever you need with you. It does not even have to be a romantic partner. It can be your mom, aunt, bestie, dad, grandma, favorite neighbor, emotional support kitten, etc. Feeling safe can help you absorb all the information of a session more easily. Having an extra set of eyes and ears can be great for the learning process too.
What if BLANK leaks out of me? Can I just take a moment to say that 50% of the people walking through my clinic’s door will be coming because some unwanted something is leaking out of them at some point or other in life. This could be pee, poop, toots, blood, discharge, medication, all of the above. I promise, we will do things in such a way that IF things leak out of your body, we will still be good afterwards. That is what gloves, pads, linen sanitization, and hand hygiene are for.
When can I come during pregnancy? Anytime! Unless your doctor has put you on bedrest, a pregnant person can always do pelvic floor therapy. There are certain times we may not do certain interventions like internal work or abdominal massage, but we can make those decisions as a team. I typically recommend a first trimester check up to make sure you have some safe exercises to help your core, pelvic floor, and back get ready for the next months of growing. The second trimester can address any growing aches and pains, and progress any stretching and exercising plans. In the third trimester, it is valuable to start preparing the pelvic floor to relax for childbirth and discuss some birthing strategies. This could look like anything from 3 visits to 12 + visits depending on what the expectant parent feels is needed.
When can I come after having my baby? A medical provider will typically not sign off on an official exercise routine or internal pelvic floor work prior to being 4 weeks postpartum. However, a client who is experiencing pain, movement limitations, or extreme pelvic floor dysfunction like terrible hemorrhoids, constipation, or full urinary incontinence may benefit from really early, gentle, functionally based pelvic health treatment. We would let a knee replacement start therapy the day of surgery, why can’t a grade 4 perineal tear or c-section patient have the same early intervention?
When can I come after surgery? Typically, a medical provider will again not sign off on pelvic floor services with the intent of exercise or internal work until 6 weeks after a surgery such as prolapse repair, prostate removal, or hysterectomy. However, they may be willing to send you for functional movements, breathing, and bowel/ bladder management if you ask. <<wink, wink>> The earlier we start to work on a healed scar, the better and faster it remodels.
This probably went over and above your questions about what can happen during a pelvic floor therapy evaluation, but knowledge is power, and after this blog, you should be a superhero in understanding, and even possibly advocating for yourself!!!
To register for your evaluation, click here.
Perfectly Yours,
Dr. Mo
