What can I expect on a Pelvic Floor Examination?
History
As with any physical therapy examination, the evaluation will begin with talking to the physical therapist about your current problem/concern. Information your physical therapist will want to know include where you have pain, what causes your pain, information about previous pregnancies and deliveries, surgical history, and medication history. If you have had any previous bladder testing or imaging, this will be discussed as well. If you are not having pelvic pain, but instead are concerned about bladder retention or leakage, you and your physical therapist will discuss how frequently you are voiding (urinating), diet, activity level, and information regarding pads you have been using along with any surgical history, testing/imaging, and history of previous pregnancies/deliveries.
Orthopedic Assessment
The way your hips and back are aligned can often tell us a lot of information about your pelvic pain. We will begin by watching how you move and walk as well as checking alignment and typical muscle testing. We will also check for diastasis recti, or a separating of the abdominal wall that is common post-partum.
Pelvic Floor Muscle Exam
The pelvic floor muscle examination is very different from the typical pelvic exam you are used to having performed at a gynecologist’s office. The pelvic floor muscle examination will be completed in a private treatment room with your physical therapist. Another person may act as a chaperone to be present in the room if you request, otherwise it is a one-on-one treatment session. The pelvic floor muscle examination requires the patient to undress from the waist down but draping will performed for privacy. The physical therapist completes the exam using a gloved hand as the testing instrument. No speculums are utilized. For this examination, the physical therapist will examine the perineal area (vaginal area) externally to look for any asymmetries, scarring, or tissue abnormalities that help us identify areas of inflammation or irritation. Following this external examination, an internal examination will be performed with the patient’s permission. The internal examination utilizes a gloved hand as the physical therapists tool to assess the muscles of the pelvic floor. Through palpation of the vaginal wall, the physical therapist can assess muscle tightness, areas of tenderness or pain, and muscle strength. The pelvic floor muscles will be assessed for strength to better help understand areas of weakness and dysfunction.
Plan of Care
Through this examination, the physical therapist will find any muscle weakness, tightness, and areas of dysfunction. Combined with the history, this helps the physical therapist create a treatment plan for your pelvic pain or bladder dysfunction. Treatment often involves manual treatment both internally and externally, strengthening, relaxation training, and behavioral interventions that all work together to solve your problem!
