What Actually Happens At Pelvic Floor PT?

A detailed explanation of what to expect at pelvic floor physical therapy.

We understand that you may be nervous to attend your first session of pelvic floor physical therapy. While our practice may be slightly different than other practices, the general process should be the same. Either a Doctor of Physical Therapy or an Occupational therapist should be taking you through your course of treatment.

All pelvic floor physical therapy should take place in a private treatment room with your therapist, although there are some locations where pelvic floor therapy is occurring behind a closed curtain in an open gym. It is important that you get all of the details of the setup of the office prior to booking your initial appointment. Since the pelvic floor is a pretty complicated area of the body, your session should be at least an hour long. 

What happens at your first session of pelvic floor therapy?

Each session will will start out by doing a lot of talking with your therapist. The first session will include a lot more talking than follow up sessions, but regardless each session will start off with a good bit of talking. 

At your first session, your therapist will want to know the history of your symptoms such as when they started, and will screen you for any other pelvic floor symptoms such as bladder, bowel, sexual health, as well as any orthopedic symptoms.

After discussing your symptoms and history at length your therapist will then perform external (or outside of the pelvis) objective measurements which includes looking at how you are moving, squatting, walking, and bending. Based on how you are moving, she may then take a deeper look at a more specific joint such as your hip, lower back, or even your feet. This portion of the exam is 100% clothed and is similar to what you would receive at a traditional physical therapy practice. 

After performing the external assessments, your pelvic floor physical therapist may suggest performing an internal pelvic assessment. This is consented and discussed before proceeding. An internal assessment is similar to a gynecological assessment, however the therapist doesn’t use stir-ups or speculums. 

Your therapist will step out of the room and ask you to undress from the waist down. You will have a cloth sheet to cover yourself and will likely start by laying on your back. With your permission, your therapist will use a little lubricant and will take one gloved finger and insert it vaginally (or rectally depending on your symptoms) to feel the pelvic floor muscles. Your therapist will be looking for any tender spots, areas of tension, and the ability of the muscles to contract and relax. 

The ability of your therapist to perform an internal assessment is one of the benefits of seeing someone that specializes in pelvic floor physical therapy. Internal assessments allow for a much more comprehensive understanding of why you may be experiencing symptoms. If you are not willing to participate in an internal assessment, you can discuss this with your therapist and you can decide to forgo this portion of the exam. 

After the internal assessment, your therapist will step out of the room and ask you to get dressed and then your therapist will come back in to summarize their findings. Your therapist will give you some exercises or things to work on at home before your next session with them. They will also answer any questions that you may have. 

What happens at follow up sessions for pelvic floor therapy?

Follow up sessions are very similar to the first session, however your therapist will not need to spend nearly as much time talking. At follow up sessions, your therapist will review the findings from your previous session before proceeding with treatment. 

Depending on your therapist’s findings at your first session, follow up treatment may consist of internal treatment, or they may not. Asking at your first session about your therapist’s the plan for internal therapy will help prepare you for what follow up sessions will entail. 

Internal treatment at follow up sessions looks very similar to the first session, however your therapist will likely spend a little more time working on getting the pelvic floor muscles stronger, or more flexible. Similar to how a physical therapist or massage therapist can work out “knots” or trigger points in your neck or back, your pelvic floor therapist may need to release those knots in the pelvic floor. 

Your follow up sessions should also consist of some kind of exercise. This helps the effects of the manual therapy that the therapist did, last. Your therapist will instruct you on what exercises are appropriate for you to perform at home.

Each followup session will build on the last. As your symptoms decrease, the need for internal therapy will begin to decrease, and your exercise routine will begin to ramp up. The exercises are meant to be progressive so that the changes that your body is achieving with therapy last. These exercises are important to fuel the change that you are looking for. 

A common myth is that you will have to do your PT exercises forever. This isn’t true! As your body gets stronger, the need to perform the therapeutic exercises prescribed by your PT will lessen. If you feel that your symptoms come back because you didn’t do the exercises, it is likely that your body isn’t strong enough and resilient enough to stop therapy. 

We understand that the uncertainty of a pelvic floor physical therapy session can be daunting. We hope that this helped clarified what will happen during your first session of pelvic floor PT and at subsequent visits.