What to Expect
from seeing a Pelvic Health Physio
by Nicky Travlos
I am hoping that reading about what happens at a pelvic health physio assessment will put women’s minds at ease and make seeking help easier and the thought of discussing pelvic issues such as bladder and bowel problems, pelvic pain and incontinence much more comfortable.
Some women may be concerned about the physical examination but please remember by the time you get to this point, you will hopefully be at at ease with your Physio, have had an explanation of exactly how they will be going about the examination and a reminder that there is always ongoing consent, so that if you feel uncomfortable at any time during the examination you can ask for a break or stop if necessary.
An assessment usually starts with a subjective assessment. This is an in depth questioning and discussion about your history, including your medical history, any history of illness, accidents, surgery, your muscle/ joint aches and pains, pregnancy/childbirth, your menstrual health and hormones, your diet and lifestyle, your bladder and bowel, your sexual health, medications, supplements and any other concerns you feel are relevant. This is a significant part of the assessment and this will be an opportunity for you to talk about any relevant health and well-being issues. A pelvic physio will give you the time you need and create a safe, non judgemental, confidential space for you to share information that may be challenging for you and be associated with difficult feelings. It is important for your physio to find out as much as they can about what you’re experiencing so that they can make an accurate diagnosis and know how best to help you.
A full history can take a whole session or more than one, depending on the complexity of your history, so whilst you may have a physical assessment on your first session, it may be appropriate to wait until your second session or later. A physical examination will likely involve a look at your posture, breathing and movement as well as examining your abdominal area and any scarring from previous surgery or assessment of abdominal muscle separation from pregnancy. For the pelvic examination you are usually undressed from the waist down and covered with a towel/couch roll for privacy. Initial examination usually takes place in a lying position with your knees and feet comfortably apart. Your physio may give you an opportunity to get undressed and covered in privacy if space and time allows. The first part of the pelvic examination usually involves a visual assessment of the external genital area and this is so that we can look for any signs of infection, age related changes of the vulva, skin changes, prolapse and any scarring from previous surgery/ tears/ episiotomy or childbirth. Some women feel it is necessary to be shaved or waxed and this is purely your choice.
An internal examination may be performed with consent. Your physio will use gloves and a water-based or oil-based-based lubricant gel and one or two fingers inside the vagina to evaluate your conditions. If you are worried about any allergies please let your physio know. A full explanation of what will happen during the examination will be given and you may be given the opportunity to ask questions, express concerns and express ongoing consent and to give feedback verbally during the examination. Examination includes palpation, which is feeling the muscles of the pelvic floor for tone pain and discomfort, checking for muscle tears, scar tissue, prolapse, muscle tightness or spasm, and teaching and evaluation of the pelvic floor contraction.
Your physio may evaluate your pelvic floor during diaphragmatic breathing as well as evaluating, explaining and correcting contraction and relaxation of your pelvic floor. This is to check for weakness or reduced tone in the pelvic floor or sphincters, and /or whether you have an overactive pelvic floor. They will likely assess the pelvic floor under pressure with cough and valsalva (which is when you bear down) looking for behaviour of your tissues under pressure.
If you have issues with bowel movements, constipation or incontinence and difficulty with evacuation, you may be asked to consent to a rectal examination but again, this will be fully explained to you and you will have the opportunity to accept or decline consent. A rectal examination is usually done in left side lying and can be incredibly helpful for people who have suffered from long-term bowel issues and can help with creating strategies to deal with this.
In some instances women explain that their prolapse is only visible or able to be felt in standing or at the end of the day and thus we may do an examination in standing and at the end of the day as often this is the only way to evaluate and understand her symptoms. Evaluation may be done in other functional positions such as squatting.
Your Treatment Plan
Once you’ve had a full assessment then a plan of treatment will be put into place. This will be based on your goals of treatment and what you want to achieve with physiotherapy management. Treatment goals may be based on lifestyle changes including diet and fluid intake, sleep and stress and energy management and exercise to suit your lifestyle. Your physio will also be able to point you in the direction of any further investigations that may be needed such as through your GP or pharmacist or recommendations for referral to consultant specialists such as a Urogynaecologist or a urologist.
Physios do 3 to 4 years training at University and often come into Women’s Health with many years of experience. We are highly skilled professionals with a large network of professional and peer support. We are trained to evaluate a patient's medical history, to pick up “red flag” symptoms (symptoms which should not be ignored) and to determine whether further investigation is necessary. If you have concerns or worries, don’t delay and do seek help from your GP, physio or other health professional.
Disclaimer: All content in this document is for information and educational purposes only and does not constitute medical advice. This document may not reflect the treatment you receive from ALL pelvic physios nor from Invictus Pelvic Health. The information provided here is not a substitute for any kind of professional advice and you should not rely solely on this information