Blog written by Robin McDaniel, PT, DPT - North Scottsdale Clinic Director and Pelvic Floor Physical Therapist
Are you looking into pelvic health physical therapy because you never heard of it before but your doctor mentioned it, you saw a Facebook reel or TikTok about it, or a friend recommended it? Trust me, that’s extremely common. Even though one in three women will experience a pelvic floor disorder in their lifetime, pelvic floor physical therapy is not commonly known in the US (even for many providers)!1
The pelvic floor is a grouping of muscles and as with any muscles in your body (picture), are subject to tension, weakness, strain, tears - you name it! With that can come all sorts of symptoms - pelvic, abdominal, or thigh pain, incontinence, stool staining on your underwear, or change in sensation. If you think about it - an athlete with a severe hamstring injury isn’t expected to go right back out and play… they would go to rehab first. Yet somehow we expect women to bounce back from any pelvic floor injury to their daily lives - even when the pelvic floor is crucial to our stability with standing, walking, or lifting. In addition, we all know a stiff neck can give us headaches - a tight/tense pelvic floor can cause a lot of pain in our daily lives or with intimacy with our partners.
What should I expect at a physical therapy pelvic floor examination?
First - you’ll meet a pelvic health physical therapist like me! We will talk with you about your symptoms, your goals, your daily life and how this impacts you. It sometimes feels awkward to talk about these things with another person, but my goal is always to ensure you feel safe in this appointment to share even the things you think are super weird. The more information I have, the better, so I can start narrowing down possibilities of what might be going on.
Second - (this part varies from person to person depending on what we talked about in step one) We start a traditional physical therapy examination. I might ask you to move into different positions, see you bend, squat, etc - particularly anything you’ve noted is difficult. Then often we’ll test your muscle strength of your abdominals, gluteals (hip muscles), and adductors (groin muscles). These muscles support your pelvic floor, so knowing what they bring to the equation is quite helpful.
Third - We may discuss your bladder and bowel habits. In particular, a component of urge incontinence can involve poor bladder habits such as drinking bladder irritants, not drinking enough water, urinating each time we have the urge. While the muscles can be the culprit of your condition, sometimes our habits are too. So we may discuss how this impacts you and I’ll give you a bladder log to track this. If you’ve filled out the online intake or I have notes from your doctor to know this is information I can use, I may ask you to fill it out even prior to your first appointment! Link to Bowel and Bladder Diary
Fourth - the internal examination. Now - it’s important to note - this does not always happen on the first day! Sometimes we find things we can work on in steps one through three without getting to testing the muscles internally and that’s a great place to start for the day. I don’t want anyone to feel overwhelmed and there can be a LOT of information in that first visit so sometimes we stop there and can address this at a later date. Or, sometimes it’s not even necessary. For instance, if you are processing trauma and have a lot of fear about this examination, we may work on the contributing factors and we get to know each other better before we get to this step.
What’s involved in a pelvic examination? Internal and External?
Robin McDaniel, PT, DPT preparing a patient for a pelvic examination
If you consent to a pelvic examination, you will disrobe your lower quadrant (waist down) after I step out of the room. You’ll lie covered under a comfy blanket while I come back in. I will walk you through each step again, and you are always encouraged to ask questions! We go at your pace.
External examination - I will lift the blanket to your waist and palpate the muscles externally. This will give me an idea of muscle tone (if you push on my arm and that of a bodybuilder, you’ll feel a difference) and it lets me know any muscles that are uncomfortable or painful. I may have you do some movements to put stress on the pelvic floor such as lifting your head, pretending to cough, and may ask you to do a pelvic floor contraction (some people call them kegels) to see how your pelvis responds.
Internal examination - Should we proceed to this step, I will insert a gloved, lubricated digit vaginally. I do not use a speculum and there are no stirrups. There are three layers to the pelvic floor and I will educate you on which muscles I’m checking and what I’m finding as I go. You also will let me know if there’s discomfort, pain, or anything that reproduces your symptoms. It varies from light pressure to fairly firm depending on your condition.
And that’s it! If we find some tight muscles, scar tissue, etc - I may treat that while I’m there with some pressure or light stretching to the muscles. Or if I think there is weakness or poor control, I may ask you to do the pelvic floor contraction (kegel) so my digit can feel the strength of these muscles and how well you recruit them as a unit.
Then usually we’re done! I will cover you with the blanket again, step out of the room and allow you to redress. There is a restroom nearby you can use at any time as well.
Then we will chat about what I found, discuss our game plan, answer any questions, and give you some homework to work on! Depending on what I find, we may not perform an internal examination every session and I try my best to let you know when to expect it. I am also available by phone, text, or email to my patients if you have questions between sessions.
Should I cancel my appointment if I am on my period?
It depends, but my answer is almost always - no, please don’t cancel! Again, there are usually many things we can do externally in addition to internal work. We also can still perform internal work depending on the flow you have currently - it doesn’t bother me in the slightest! If your flow is light, I don’t typically recommend anything different. However, if your flow is very heavy but we have been working internally, I would recommend a vaginal menstrual cup. The only instance in which I might agree you should reschedule is if you have extremely bad side effects of your period (severe cramping, nausea, migraines, dizziness) and don’t feel safe to drive or can’t get out of bed.
That’s it! I’m glad you’re looking into pelvic floor physical therapy - it can change so many lives! It’s amazing to me how quickly your bladder can take over your life (running to the bathroom all the time or stress of finding it in every building). And pelvic pain impacts our lives significantly too- pelvic pain can impact your daily tasks (lifting toddlers, going to the gym, sitting, wearing jeans) and pain with intercourse (dyspnea) can impact how you feel about your relationship. I’d love to help you Love Your Life again!
What other questions do you have? Reach out to me in the contact form and I’ll respond to you and add it on here to help out others looking into this as well!