What to expect at a pelvic floor exam?

Many people are nervous about going to see a pelvic floor physical therapist. What will happen? Will it be like a pap exam? Do I have to have an internal examination? So let’s break down what to expect during a pelvic floor physical therapy appointment! 

Typically, a majority of the appointment is spent fully clothed and talking. The clinician will want more background on what brings you to physical therapy. What are your primary symptoms? When did they start? Was there an event, such as surgery or childbirth, that is related to these symptoms? They may also ask you questions about your medical history and what your goals are for physical therapy. 

Based on that information, your provider will then perform a physical examination. This may include both an external and internal musculoskeletal assessment. A physical therapist may assess the range of motion and strength of your hips, legs and back. They may assess your core strength and they may check if you have abdominal separation or diastasis rectus. If you have had any surgeries, they may assess the mobility of the scar. 

They may palpate and assess the muscles and connective tissue of the abdomen, the back, the buttocks and the anterior, posterior, medial and lateral thighs. Since all of these structures attach and relate to the pelvis any impairments could contribute to a person’s symptoms. 

A lot of the external examination may feel like an average physical therapy appointment. 

In order to assess the pelvic floor muscles, an internal examination per the vagina and/or rectum may be recommended. Your provider will ask you to undress from the waist down and give you a drape or a gown to wear. The internal examination allows the provider to assess the tone of the pelvic floor muscles, as well as their strength, endurance, coordination and range of motion. They may also assess the position and mobility of the coccyx. An internal pelvic floor examination typically does not involve stirrups or a speculum. Instead, the exam is done with one gloved lubricated finger. 

Some providers may use a biofeedback machine that uses sensors to measure how well the muscles activate, in which case they may use a small probe or electrodes vaginally or around the anus. However, many providers do this manually via a gloved finger during the internal examination. Technology is great, but sometimes machines can give false information or malfunction. 

No matter what, your provider should always obtain consent prior to and throughout the examination, including the internal examination. If you would prefer to skip the internal examination, your provider should respect that request. However, your provider may encourage an internal examination as it is the best way to assess the pelvic floor muscles.

After the examination, your provider will review their findings and provide you with an individualized treatment plan. 

Follow-up appointments may feel similar to the initial visit depending on what is found on the examination, but your provider will review what to expect at each appointment, which may include treatment of the pelvic floor muscles internally either vaginally or rectally. 

Overall, pelvic floor physical therapy is considered a conservative and first-line treatment option for patients with numerous pelvic floor conditions including but not limited to: 

• Urinary Incontinence 
• Fecal Incontinence
• Urinary Urgency/Frequency
• Pelvic Organ Prolapse
• Pain with Sex 
• Vaginismus
• Constipation 
• Low Back Pain
• Vulvodynia (Pain in the Vulva) 
• Pubic Symphysis Pain 
• Hip Pain 

Basically, if you have any bowel, bladder, sexual dysfunction or pelvic pain consider seeing a pelvic floor specialist and they will recommend you therapy or product that may help.