I am going to start by letting you know that pretty much everyone is nervous before their first Pelvic Health Physio visit. However, most people leave saying "Well, that wasn't nearly as bad as I expected!"
As we are physiotherapists first and foremost, the structure of the visit is similar to any regular physiotherapy visit with the main difference being that it is in a private room. The visit begins with taking a detailed history of your current symptoms and past history of injury or pregnancies, your pain and/or bladder and bowel habits. This is then followed by a biomechanical assessment of your lower back, pelvic and hip movements.
As the patient, you are in control of the entire treatment and do not have to give any more information or undergo any assessment unless you are comfortable with it. Both of these parts are important as they help to give us clues about the possible underlying causes of your symptoms. It also allows you to become more comfortable with the therapist. Often your physio will tell you what they suspect may be contributing to your problem at this point. I generally explain my thought process, along with the anatomy and function of the pelvic floor muscles and organs using helpful diagrams or models.
With your consent, the therapist will then begin the assessment of the pelvic floor. The therapist will usually leave the room to allow you to change as you take off everything from the waist down and sit or lie down on the treatment table with a sheet covering your lower half. Upon returning to the room, I generally start by assessing some of the external musculature, breathing patterns and further hip or SIJ assessment as needed.
I always emphasise to my patients that if they feel uncomfortable with the process or any physical discomfort that they should let me know and we can stop or change the assessment. You are always in complete control of your body and the visit.
Most often, I will test for sensation and neural irritability first, followed by observation of a pelvic floor contraction and prolapse testing. If the patient is comfortable with doing an internal assessment, the strength and tone of the muscles are then assessed by palpation via the vagina using gloved fingers. This does not necessarily have to happen on the first visit if you do not feel comfortable and can begin at a later time.
I always begin education and a treatment program on the first visit and encourage the patient to ask questions or phone/email if they think of any questions after they leave.
It is also important to know that every therapist has their own approach, even though we may have similar training. And there you go! You have survived your initial visit and assessment with a pelvic health physio. Keep in mind that we have most likely undergone similar assessment/treatments and have empathy for your situation. You can't just learn these things from a book!
