What Happens in a Pelvic Floor PT Examination?

What Happens in a Pelvic Floor Examination?

By Becky Parr, PT, DPT, OCS

Physical therapy pelvic floor assessments are NOT gynecological exams. Do not expect a speculum! Rather, this type of assessment is focused on assessing the muscles and connective tissue for strength, endurance, motor control, and pain. It is performed by a licensed physical therapist who has taken advanced coursework in pelvic rehabilitation. This type of specialty therapy has been shown to cure or improve symptoms of urinary incontinence, bowel disorders, post-partum dysfunction, pelvic organ prolapse, and pelvic pain disorders, sometimes preventing surgery¹. Physical therapy is direct access in Ohio so you do not need a physician referral to seek this type of care.

So what happens in pelvic floor physical therapy? Each woman is unique with their own individual background as to why they are seeking care, so each visit will be individualized. However, there are some common elements.  

• History
  • During your evaluation, your physical therapist will take a detailed history about all of your symptoms. 
  • Your PT will want to know where and when you have pain, information about previous pregnancies/deliveries if applicable, prior surgeries, and bladder and bowel symptoms such as leakage, frequency, and urgency, straining, or constipation. Questions about sexual function may also be asked such as painful intercourse, fear of penetration, or difficulty with orgasm. Your PT may discuss diet, exercise, and medication use with you as well.
• Examination
  • Functional Assessment
    • First, your PT will assess your posture, movement patterns, and breathing. This is important to determine the root cause of your dysfunction.
  • Pelvic Floor Assessment
    •  If the PT feels a more specific examination of the pelvic floor is necessary, you will be comfortably positioned and draped on the treatment table in a private room. Then your PT will assess the area externally to look for any signs of inflammation or irritation.
    • Next your PT will ask your consent to do an internal evaluation. This is only if you feel comfortable with this part! Your PT will insert a gloved finger into the vagina or rectum to feel for the pelvic muscles. This will determine muscle tightness, symmetry and feel for trigger points/pain. Your PT will also measure how strong your pelvic floor muscles are and may assess for pelvic organ prolapse as well.
• Treatment and Education
  • Your PT will design a specific treatment plan individualized to your needs. This may include:
  • Manual therapy externally or internally
  • Strengthening exercises
  • Relaxation exercises
  • Behavioral strategies
  • Diet/fluid/fiber recommendations
  • Sport or activity-specific strategies
  • And more!

Reference

1. Wallace, S. L., Miller, L. D., & Mishra, K. (2019). Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women. Current Opinion in Obstetrics and Gynecology, 31(6), 485-493.