What to Expect at a Pelvic Floor Physical Therapy Evaluation

A lot of people gasp in awe when I tell them what exactly I do as a pelvic floor physical therapist. Physical Therapists treat muscles and nerves, and guess what? You have muscles and nerves in your pelvis and we treat them like anywhere else in the body.

First, let me just say your evaluation is on your terms. If you are having symptoms that are likely due to a pelvic floor dysfunction: leaking, pain with sex, pelvic heaviness or pelvic organ prolapse; there are always other things going on as well. Posture, weakness, tightness, diet, stress and body mechanics are all factors that contribute to what’s happening at the pelvic floor. Translation: I look at the entire body and person in front of me, not just the pelvic floor. If you see a Pelvic Floor PT and all they do is assess your pelvic floor, find a new PT.

After a thorough discussion about your symptoms, lifestyle and goals, I will go over in detail anatomy of the core and pelvic floor with my model, as well as what the evaluation will consist of. 

I will perform a comprehensive orthopedic screen looking at your posture, how you move, how strong and stable your pelvis and abdominal muscles are, how you breathe as well as muscle tension and soreness in your “bike short” region (upper legs to below your ribs).

I will step out of the room while you undress from the waist down and you will get under a sheet (I do not use stirrups or a speculum). I will then look at your vulva, have you perform a “kegel” and cough to see how your muscles respond. I will test for sensation and reflexes. Then using one gloved finger, I will “map” your external pelvic muscles to see if you have any tender muscles. Given you are still doing o.k., I will use lubricant and place my finger inside the vagina to assess the pelvic floor internally.

The pelvic floor muscles are made up of 3 layers of muscle. At each layer, I will assess strength and quality of your kegel as well as muscle tone and tenderness. Finally, I will assess for pelvic organ prolapse. The pelvic floor portion is fairly quick lasting from 10-15 minutes (or less if you are experiencing pain). After you get dressed, we’ll review all of my findings and determine what makes sense to reach your goals.

The internal evaluation is so helpful in determining if you have a weak pelvic floor, an over-active or “tight” pelvic floor or a little of both. It gives me a much more accurate presentation of what is going on and how to treat it. It is invaluable in teaching correct pelvic floor muscle contraction, as well as relaxation so you can be confident when you do your work at home. That being said, it’s does not need to be done on the first visit, or ever if you’re not comfortable with it.

It might be a little strange to the outside world, but keep in mind I do this for a living and it is just a part of your body. In my training, we are the patients, so I have been in your shoes (in a conference room with 50 other women) and know the anticipation that goes with the first evaluation. My goal is to make it as comfortable as possible and give you information on what’s happening in your body.

Still have questions or reservations? Get in touch so we can discuss your concerns.