So, you are going to start pelvic floor physical therapy. It’s possible that you either had no idea that pelvic floor physical therapy was a thing or that you even had a pelvic floor (or both!). You may feel unprepared or nervous. If so, this blog is for you!
First, I want to tell you that not knowing about pelvic floor physical therapy or not knowing you have a pelvic floor are more common than you’d think. Most patients that I treat really don’t know much about the pelvic floor, let alone the different things that can go wrong with it. Surprisingly, even those in the healthcare field learn about the pelvic floor. Second, the thought of pelvic floor physical therapy may make you feel uncomfortable or embarrassed…these are very valid feelings (and normal)! For the most part, it isn’t every day that you have a conversation with anyone about leakage, constipation, or pain with penetration (all of which are common, but not normal), so let’s talk about what you can expect when you start this journey.
Like going to any new provider, there will be some new patient paperwork and an evaluation. This is so that the physical therapist can get to know you and what you have experienced, along with what kinds of symptoms you are having. While it can feel like we are asking you to share all of your private life, it really is best if you share as much as you can so that your physical therapist can tailor the plan of care to fit your needs. During the initial evaluation, you will be asked about your bowel and bladder habits, any pain that you may be experiencing, and any pregnancies and birthing experiences you may have had. You will also learn a lot about the anatomy of the pelvic floor and what kinds of things could be affected if the pelvic floor isn’t working correctly. Don’t be afraid to ask questions or request further explanation! This is your time to really start to understand how your body works.
During your initial evaluation, your physical therapist will also look to see how you move as a whole, as your pelvic floor plays many roles in how your body moves. We will look at things like how your rib cage expands with breathing, how you contract your abdominal muscles, and what it looks like when you squat.
One thing that many folks don’t know is that there may be an internal pelvic floor muscle assessment. This could be done vaginally or rectally, depending on your symptoms and your anatomy. Don’t be alarmed! Your physical therapist has special training to be able to complete this. It gives us an idea of whether or not you have a lot of tension in the pelvic floor muscles. It can also allow us to see how strong these muscles are and how they coordinate with other muscle groups, like your abdominals and glutes. This can be done on the first visit, but is often done at the second or third visit depending on your needs. Toward the end of your first visit, we will develop a plan that works best for you. In general, you will work on understanding and connecting with your pelvic floor, strengthening your core, and learning how your pelvic floor interacts with other parts of your body.
Whether or not you know all the ins and outs of your pelvic floor, you will learn so much during your pelvic floor journey. Many folks see progress within a few visits, but know that it can take several sessions for complete resolution. Your physical therapist will work with you and your health care team to help achieve your goals.