What Actually Happens At A Pelvic Floor Physical Therapy Session

I get asked this question all the time, “what actually happens at a pelvic floor physical therapy session.” Many of us are familiar with a gynecological exam, so the idea of another medical practitioner all up in our most personal space isn't the craziest thought. But, most people have no idea what they are walking into unless they’ve gotten a low down from their friend, sister, mom, or a random thread online. So, I’m here to answer what actually happens at a pelvic floor physical therapy session. I’ve been on both sides of the table so trust me when I say I know how anxious you may be and how nerve-wracking it can be to come to one of these appointments. I assure that you will leave feeling reassured, validated and hopefully excited to start healing and getting back to what you love.

Why Doesn’t Anybody Know About Pelvic Health PT?

So many people who come to pelvic health physical therapy have been living with their condition for years and have no idea that physical therapy can help them. There is a huge lack of education and awareness of all the benefits of physical therapy for the pelvic floor. It’s sad, but talking about this area of the body is still pretty taboo. A lot of us grew up with so much shame surrounding our private parts and we’re not comfortable discussing this with others, or even our doctor! Even for those who are comfortable, half the time their doctor dismisses their concerns or doesn’t mention pelvic floor physical therapy so they continue to struggle with these issues for years.

A Specialty Within Physical Therapy

It is important to note that pelvic health physical therapy is a specialty within physical therapy. Most pelvic health physical therapists are also general orthopedic physical therapists, meaning they treat other orthopedic injuries of the body like your hip, knee, shoulder, and back. Physical therapists who specialize in pelvic health receive additional training to develop this specialized skill set and get trained in internal examination and treatment. Internal examination and treatment is a huge part of pelvic health physical therapy that many people will benefit from. Don’t worry though - this is never required. During our session we will discuss this type of examination in great detail and you’ll be able to make an educated decision on whether or not this interests you.

Pro Tip: Before you book an appointment, ask what the training level is of your provider and if they offer internal evaluations. If they do not, seek a different provider. You want someone who is fully trained to be the one treating you.

The Beginning of the Session

First, your physical therapist will ask you questions about the history of your current problem(s), things you are unable to do because of those problems, relevant medical history, childbirth history, your current exercise level and your unique goals. It’s important to tell your physical therapist if you have concerns with any other part of your body to make sure you receive a comprehensive evaluation and treatment plan. 

Next, your physical therapist will evaluate your entire body, mostly focusing on your areas of concern. This evaluation includes your posture, strength, flexibility, balance, functional movements like squatting or exercise mechanics, and anything else related to your movement. We will also check your breathing mechanics, rib movements, abdominal area and assess for Diastsis Recti if you have been pregnant.

The Pelvic Floor Assessment

Your physical therapist will walk you through each and every step of the exam. We are trained to be gentle in our technique, so you will not be leaving the session in pain. During the pelvic floor assessment, the physical therapist will visually examine the genital area. They will check for the quality of the skin and tissues which is especially important if you had any perineal tearing with childbirth. You’ll be asked to complete a few movements with your pelvic floor and your physical therapist will gently press on areas to see if they are tender and causing any pain you may have.

During the internal pelvic floor assessment, your physical therapist will evaluate the pelvic floor via either your vagina or rectum. They will check if any of these muscles are tight or painful. Then you’ll contract and relax the muscles to test the strength, endurance, and coordination of the pelvic floor muscles. They might also assess for prolapse to see if your pelvic organs are being well supported by your muscles.

It is important to remember that the pelvic floor assessment that physical therapists do is not a gynecological exam. As physical therapists, we are concerned with assessing the muscle function of the pelvic floor. There are no stirrups and no speculum– phew! 

Treatment & Plan

Pelvic health physical therapy involves a number of different treatment approaches including:

- Education - We have a lot of information to give you that you might not be receiving from anybody else. Don’t go to Dr. Google for your information - seek information from a qualified healthcare professional who can give YOU a personalized plan.

- Exercises - breathing exercises, specific pelvic floor muscle exercises, and specific movements to strengthen your core. Dr. Mary is a certified Pilates instructor and she loves to utilize this treatment approach into her sessions.

- Manual therapy – Internal and external soft tissue mobilization, joint mobilization, stretching, anything you need to get your body moving smoothly and efficiently

- Bladder retraining – Your bladder is smart and sometimes gets a mind of its own. This can contribute to frequency, urgency and leakage. We will talk about techniques to retrain your bladder and prevent urges and leaks.

- Vaginal dilators & pelvic wands – There are treatment tools that we can teach you how to use at home for self-release. This helps you to do more on your own and quicken the pace of your recovery process.

How do you know if pelvic PT is right for you? 

If you are experiencing pain with sex, urinary leakage, excessive urinary frequency, pelvic organ prolapse, diastasis recti, painful periods, abdominal pain, pelvic pain, constipation, low back pain, sciatica, hip pain, are pregnant or just had a baby - pelvic floor PT is right for you. Talk to your doctor about what you are experiencing OR find yourself a PT right away using this link! In many states, you do not need a doctor’s referral to go see a physical therapist. Many physical therapists, myself included, offer virtual appointments as well.

Go forth & give your pelvic floor the love and attention that it deserves.

- Dr. Mary

Updated 5-18-22