What can I expect from a pelvic floor physiotherapy appointment?
We ask that you show up 15 minutes early to your first appointment since there is some paper work to be completed. Your initial appointment always takes place in a private office space and lasts approximately one hour. Once you are in the office with the physiotherapist you will be asked about your issue and how it affects your daily life. We need to know about any previous and current medical conditions, past or up-coming surgeries and any medications that you are taking. Urination and bowel habits, as well as sexual function are discussed.
For women, they are asked questions about gynecological health, and also about any pregnancies or deliveries. The physiotherapist will explain the pelvic floor or core muscle anatomy and describe each of the assessment options. Together the physiotherapist and the client decided which type of assessment and treatment course are best for the individual.
Internal Exam
For women this can be either vaginal or rectal, depending on the issue and the patient’s decision. For men this is a rectal exam. The assessment starts with examining the muscles, tissues and skin of the thighs, buttocks, abdomen and pelvic floor externally. Providing that there are no reasons not to proceed with an internal exam, one will be performed. No speculum or other instruments are used during the exam. The physiotherapist checks for muscular strength, endurance, coordination, proper ability to contract and relax the muscles and for tender spots, “knots” or trigger points. The initial internal exam usually takes 5-10 minutes or less. Sometimes a small amount of treatment may be done. This would include teaching someone how to squeeze or relax the muscles, or perhaps internal massage techniques to help with pain.
Clients always have the right to refuse an internal exam at any point during the assessment or during any follow-up treatments. Even without an internal exam, other assessment or treatment options might be available to you. See below for a brief description
External Exam
For some people, an internal exam may not be needed or desired. An external assessment can be performed as the pelvic floor, tailbone and core muscles can still be accessed from outside the pelvic cavity to a certain degree. This involves investigating posture, the manner in which you move, bend or lift, the flexibility of the spine, pelvis, hips and knees, and the strength of the surrounding muscles. The muscles that contribute to the core, abdomen, hips and buttocks are examined. The physiotherapist can gently press into muscles, tendons or ligaments to determine if they are tender to the touch. Even the way that you breathe can be a clue as to how your pelvic floor and core muscles function.
Biofeedback Exam
EMG biofeedback is a useful tool for those who are not good candidates or unwilling to undergo an internal exam. With EMG biofeedback, small external electrodes are placed on the skin of the pelvic floor muscles – near the groin and close to the vaginal or rectal opening. An internal vaginal or rectal electrode probe can also be used if needed. These electrodes work in a very similar way to an ECG heart monitor, though instead of picking up heart muscle activity, they collect information about pelvic floor muscle activity. This muscle activity is captured on a computer screen so you and the physiotherapist can visualize how the muscles might be working. EMG biofeedback can also be used as a treatment tool, teaching people how to properly use or relax their pelvic floor muscles.
Treatment
Once the physiotherapist has your assessment results, a comprehensive and personal treatment plan is developed. There is almost always an education component, manual therapy (the use of the therapists’ hands to help painful, weak or inflexible tissues) performed, exercises to do and behaviors or poor habits to change. Patients are always sent home with some sort of homework. Occasionally, things like ice or heat packs, therapeutic ultrasound, EMG biofeedback, TENS units, pelvic brace or medical tape techniques are recommended.
Treatments last between 30 and 45 minutes.
Appointments are usually scheduled 2 – 6 weeks apart, depending on the condition being treated.