Questions about Pelvic Health Therapy

What will happen at the first appointment? 

It is common for clients to feel some apprehension about their first pelvic physical therapy session.  Pelvic health challenges are very personal by nature and you may not clearly understand how physical therapy can help your problem.  CorePhysio's Pelvic Health physical therapists understand how challenging that first appointment can be. Our priority is to put you at ease, explain to you what your options are and how physical therapy can help. CorePhysio physical therapists are good listeners and empathetic to what you have been going through. They have heard many similar stories and been asked about all manner of things before, so you should not be worried about telling them any concerns you might have.

Your physical therapist will want to know all the details of your problem, which can take some time, as most people have had quite a journey to even get to a physical therapist.  We realize you have filled out so many intake forms each time you see someone new.  It is really important and helpful when you fill out your Client Self-Assessment beforehand so your PT can get up to speed on your medications, medical history and contributing factors.  Your physical therapist will want to know what you have tried so far, what surgeries or procedures you have had, what medications you are on and what your general health is like. They will also want to know what makes your pain or leaking worse and how it affects your life. The primary difference with having a problem in your pelvis, compared to having a problem in your shoulder or knee for example, is that it affects some of life's most important functions. So the therapist will ask you about how often you go to the bathroom, whether it is painful to urinate or have a bowel movement and how and if it has affected your sexual relationships. After all, the aims or goals of treatment are often things like being able to have intercourse again without pain, being able to sit through a movie without having to get up to go to the bathroom, being able to have a pain-free bowel movement or being able to return to hiking or the gym without the fear of leaking or your pain increasing. 

Because you need a very thorough report, your PT will be taking meticulous notes during each visit.  There are so many important details, your therapist will want to make sure that everything is correct.  At CorePhysio, we focus on the client and please know that even when we are taking notes, your time, attention and trust are important to us. Each physical therapy visit will be 40 minutes and your physical therapist will focus completely on you during that time. It can be hard to get through all the history and the examination within in the time allotted, but your PT will educate you about the drivers of your pain, what steps you can take right away and how physical therapy will help.

Are you just going to teach me Kegels?

This is a very common question, and the answer is No!  Kegels are the common term for the exercise of contracting pelvic floor muscles and the first thing that people think of when it comes to the pelvic floor.  Your CorePhysio Pelvic Health PT is an expert on the entire colorectal, urogynecologic and musculoskeletal function relating to the pelvic floor.  After your evaluation, they will let you know if you need to LENGTHEN or STRENGTHEN your pelvic floor muscles, and best of all, perform specific training to teach you how to control these essential muscles.  Pelvic floor muscles need to do three things:  Contract (strengthen), relax and lengthen.  Muscles that are in spasm will hurt with pelvic floor strengthening.  Also, pelvic muscle contractions are done incorrectly for more than 50% of the time.  Incorrect pelvic muscle contractions can result in back pain, breath holding, altered breathing patterns, visible contractions or spinal movement. We do not want our clients to practice dysfunctional patterns like this. Our pelvic health PT's have multiple techniques and technology to assess and re-educate pelvic floor muscles to enable the right contraction and support at the right time. We use real time ultrasound, surface EMG (biofeedback), direct assessment, manual therapy, motor imagery, visceral mobilization and synergistic movement patterns to precisely re-educate pelvic floor muscles to return to normal function.  

Why assess the pelvic floor?

Your CorePhysio Pelvic Health PT will evaluate your posture, spine, pelvic joints and hips.  Pelvic health is complex and it is important to understand all contributing factors. The PT will then explain to you how physical therapy can help your specific condition and why an direct assessment of your pelvic floor muscles will impact your treatment and clear understanding of your condition. Because of the location of the pelvic floor muscles, the best way to assess and treat them is through direct assessment. This can be through the vagina in the female or the rectum in the male.

The pelvis is just like any other area of the body; it has a lot of muscles, ligaments and fascia which PT's work on, just as they do in the other parts of the body. Physical therapists are licensed to treat this area of the body, just as they are licensed to treat your neck or back, however the therapist will make every effort to make sure that you are comfortable with a direct internal examination before proceeding. You have complete control over the physical therapy evaluation and treatment you experience and will always be asked permission and given options.

Do I have to have a pelvic floor exam—what if it is too painful or I am on my period? 

Our priority is that all of our clients feel safe and comfortable. If you are not comfortable with having an internal exam on your first visit, or at all, there are still some things that the PT can work on and advise you to do that will help your condition improve. Sometimes people need a little longer to establish a rapport with the therapist or even to reduce their general pelvic pain to be able to tolerate an internal examination or treatment. Usually by the time the history is taken and an explanation is given, many clients will understand why an internal examination provides essential understanding of the drivers of pelvic pain or leaking. Our priority is that you feel comfortable and in control of your treatment options.  You will never be pressured to have a direct pelvic floor assessment.  If you choose to not have a direct pelvic floor assessment, your physical therapist will let you know how this will impact your care.  It is important for you to know how assessing the pelvic floor helps your physical therapist understand the complex factors driving your pain and how to design a treatment program that is precisely what you need.

How do physical therapy pelvic floor exams differ from what a doctor does?

Physical Therapy pelvic assessments are different from the pelvic or gynecological exams performed by your medical health practitioner.  We do not use a speculum.  We evaluate the pelvic floor muscles, joints, ligaments, fascia and soft tissue structures and will  be very sensitive to any pain or other issues you may have. PT's are looking for what areas are painful, how much muscle spasm you have, what strength you have in your pelvic floor, whether you can do a good pelvic floor contraction and also whether you can release it. 

How often will I have to see the physical therapist?

Typically the visits are between 1-3 times a week although that may decrease over time as you get better.

Can I change to a different physical therapist at CorePhysio if I want a different match?

Of course! The best health care happens when the physical therapist's skill, personality and communication style is a great match for the client. It is natural for people to have preferences on what works best for them.  We encourage our clients to read about the clinicians and get to know them on our website before they come in.  CorePhysio has a team of highly skilled pelvic health clinicians and our priority is that you receive the care you need from the clinician who is your best match all around.  You don't have to worry about hurting anyone's feelings if you request to see a different clinician: creating a positive healing experience for you is our number one priority so we can support you in getting back to doing things you want to do.