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If I could shout one thing from the rooftops, it would be this: pelvic floor physical therapy is not just for pregnant and postpartum women! There are countless reasons why you may need to seek out a pelvic floor PT, and many of them have nothing to do with childbirth. 

In my own practice, I’ve seen and treated women for: 

• Pelvic or low back or hip pain during pregnancy or postpartum
• Pain and discomfort during intercourse
• Healing postpartum diastasis 
• Urinary incontinence or urgency
• Pelvic organ prolapse
• IBS
• Interstitial cystitis
• Endometriosis

And that’s not even a full list! Aging, dysfunction, injury, and pregnancy can all lead to the need for pelvic floor treatment. It’s more common than most of us realize, and there’s definitely no shame in seeking help. I decided to focus my work in pelvic floor PT because I want as many women as possible to feel strong and capable in their bodies. You are not stuck with your current symptoms for the rest of your life! It truly brings me joy to see my patients experience better functionality so that they can enjoy their lives and feel confident and strong. 

A pelvic floor PT appointment can feel scary and intimidating, especially if it’s your first visit. Maybe you’ve heard you could need an internal exam, and you don’t even know what that entails! If you’re feeling anxious about an upcoming appointment, I’m here to help. Today, I’ll walk you through exactly what to expect at your first pelvic floor PT visit.

The subjective part of your visit

Before any kind of physical exam begins, your physical therapist will want to learn about you. You’ll chat through your history, talk about your symptoms and goals, and share your story. Most pelvic floor PTs I know really want to hear from you and let you speak! You’ll likely find that your voice is heard here, even more than you may have experience in an MD office. 

When it comes to your medical history, expect questions about: 

• any previous births
• your menstrual cycle
• your history of pain or injury
• your current level of activity

 If you’re pregnant, we’ll talk about birth preferences. (Even though we all know the plan never goes exactly as you want, it’s good to have one in mind!) We’ll ask if you’ve had previous c-sections or been alerted to potential risks from your OB GYN or midwife. 

Lastly, we’ll ask about your past PT experiences! We want to know what you’re nervous about, what you came to see us for. We’ll probably ask if you’ve had PT before, if it was successful, and what those appointments involved. After that, we’ll get into your current symptoms that led you to seek treatment. 

The entire focus of the first part of your visit is getting to know you. Every woman is different, and her experiences, history, and goals will be too.

The objective part of your visit

Once we’ve gotten to know you as an individual, we’ll get to the part of the visit that looks almost the same for everyone. Through testing and examination, we’ll get valuable information that helps us treat you effectively. This may include: 

• Muscle strength testing
• Mobility testing
• An internal examination 

Two important notes: a good pelvic floor PT will look at the full body, not just your pelvic floor! Everything works together, and it’s important to get a good overall picture to provide effective treatment. And most importantly: an internal exam will never be performed without your consent. If you’re not comfortable, we don’t have to do it. However, it’s often a very helpful tool that can guide us to the right diagnosis. 

Your PT may not get all the information they need in your initial session – that’s normal. Your body is complex, and we want to get it right! You might have time for the internal exam at your first visit, and then a full body assessment next time – or vice versa depending on your comfort level. 

How internal exams work 

I know this is the part of any pelvic floor PT visit that can cause the most anxiety ahead of time, so I’m going to spell it out step by step. If you agree to an internal exam, this is what you should expect. 

1. Your PT will explain everything that’s about to happen along the way. No surprises here, we promise! 
2. They will perform pelvic floor muscle testing with one gloved and lubricated finger. 
3. They will palpate the pelvic floor muscles internally and externally looking for points of tension. 
4. They will assess pelvic floor coordination through directed exercises like kegels, bearing down, contracting your deep core, and diaphragmatic breathing

The assessment part of your visit

Once we’ve gotten to know you and we’ve finished your initial exam, we’ll take a few minutes to determine what might be going on and diagnose if you are in pain. If you’re visiting for preventative care during pregnancy or postpartum, we’ll review your current health status and what areas need to be addressed for strength and mobility. 

After we’ve assessed where you are, we’ll come up with a plan! During this talk, we’ll determine the best visit frequency and schedule your follow up visits. We’ll discuss and review any homework through exercise videos. Homework is always customized, taking your goals into account and making sure your work at home will help you achieve them. And of course, there’s always time for questions. We want you to feel educated and empowered!

What to know before your visit

Before you step foot inside your PT’s office, know that open and honest communication is always best. Come ready to share openly, and don’t be afraid to ask questions about what your provider is assessing. There’s no such thing as “too much information” when it comes to pelvic floor PT! Feel free to share it all, and know that you’re in a safe space with someone who really does want to help. 

If you’re still feeling unsure, you can always call your provider or clinic ahead of time to ask questions and make sure your PT is a good fit for you. Keep in mind that occupation therapists can also specialize in pelvic floor, so you may be seeing someone with an OT rather than PT title.

If in-person PT isn’t an option for you, my courses cover lots of the same information! Movement through Pregnancy is an online workout and education program designed to strengthen your full body, pelvic floor, and core throughout each trimester. And Movement through Early Postpartum helps new moms recover from vaginal or cesarean deliveries, strengthening and healing week by week. If you are ready for in person PT, you can find a provider near you to get started. I’ve seen firsthand how life-changing these appointments can be, so don’t be afraid! When you find a good PT, you’ll have someone truly cheering you on.

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