Pelvic Floor Physiotherapy is a very specific and specialised field of Physiotherapy, with a particular emphasis on not only optimising pelvic health, but also general wellbeing.
In the initial consultation with your Pelvic Floor Physiotherapist, you can expect that your Physiotherapist will take a comprehensive medical history from you and may ask specific questions relating to your bladder/bowel/sexual and obstetric history. They will also ask what led you to making the appointment, as well as what your goals are for Physiotherapy. This will all help with individualised and holistic treatment planning.
One very important component of the initial consultation is the examination of your pelvic floor muscles. The ultimate goal with any pelvic floor assessment is to evaluate how well you are able to contract and relax these muscles, to determine how strong these muscles are and their level of coordination and timing. The assessment will assist in improving your awareness of these muscles and give you confidence to perform exercises for these muscles independently and with the correct technique.
There are many ways in which we can assess your muscles, and making sure you are well informed of each assessment technique and the strengths/weaknesses is important. We are committed to ensuring your experience is comfortable and, therefore, we will only use the methods of examination that you are most comfortable with.
The gold standard for assessing pelvic floor muscles is via an internal vaginal or rectal examination. This is a gentle and sensitive assessment, where a gloved finger is inserted into the vagina or rectum, to assess the pelvic tissues and pelvic floor muscles. No equipment is needed, so it is very different to having a PAP test for example, and no pain should be experienced. The test is performed whilst you are lying down with your knees bent and supported, and your privacy and comfort is protected by using towels to drape over you.
If you do not feel comfortable with this form of assessment, or if there are other reasons why this cannot be performed, your Pelvic Floor Physiotherapist may suggest an external examination or ultra sound examination of your muscles instead.
An external pelvic floor muscle examination is where your muscles can be assessed externally by feeling the muscles around your pelvis. This is very similar to how other muscles in the body can be assessed. This examination is often performed with you either lying on your back, tummy, or side, and wearing thin clothing or underwear.
Real Time Ultrasound imaging is the other external examination option. This is where a probe is placed over the lower region of your abdomen to visualise where your bladder sits above your pelvic floor muscles. As your pelvic floor muscles contract, a small lift up of the bladder may be seen.
Both of these forms of assessment may be helpful in assessing whether you are performing the correct exercise technique.
You are always welcome to ask your therapist more about the pros and cons of each method of examination and ultimately your preference is always considered when determining the approach.
By Melissa French, Pelvic Floor Physiotherapist