What to Expect at Your First Visit with a Pelvic Floor PT

By Dr. Julieann Berg, PT, DPT

Many people don’t know what pelvic floor physical therapy is, let alone what to expect at their first in-office visit. Maybe your gynecologist referred you to treat some symptoms you’re having, or perhaps a friend who was having similar issues to yours had success with it and encouraged you to try it out. Or maybe you just had a baby and are having all these symptoms that no one ever told you about!

We know that there is a lot of uncertainty going through your mind as you step into the treatment room for your first visit. As pelvic floor specialists, we are used to answering a lot of uncomfortable questions and having conversations about awkward topics, and throughout it all, our top priority is to make our patients feel comfortable. 

Here’s what you can expect at your very first visit with a pelvic floor physical therapist:

The visit will begin just like any other visit with a healthcare provider, with a thorough subjective history. We will chat about your current symptoms, medical history, and daily routines. We will then create a game plan together for the physical assessment. Sometimes an internal assessment is necessary, other times it’s not. We will thoroughly explain the assessment with a model and answer any questions you have prior to beginning. Your physical therapist will provide a lot of education along the way to help you better understand what’s going on in your body. After the assessment, your physical therapist will teach you some exercises for home and provide recommendations for lifestyle modifications to help you meet your goals. 

Here are some frequently asked questions we get from patients during the first visit. 

What is my pelvic floor and what does it have to do with my symptoms?

Your pelvic floor muscles create a sling at the base of your pelvis. They contract and relax just like any other muscle in the body. These muscles support your pelvic organs, help to control bowel and bladder function, and play a role in sexual functioning and childbirth for women. 

Sometimes these muscles behave in a dysfunctional way that disrupts these every day functions or causes pain. A pelvic floor physical therapist can help you to improve the functioning of these muscles.

Do I have to do an internal assessment as part of my evaluation?

No, you don’t have to get an internal assessment as part of your initial evaluation! While the internal assessment gives us the best picture of the function of the pelvic floor muscles and what could be causing your pain or dysfunction, we can gain a lot of information through an external assessment as well. 

The internal assessment is done vaginally, and involves inserting a finger into the vaginal canal (no clunky metal speculum here!). In this position, we can assess the strength of your pelvic floor muscles as well as any tissue tension that may be causing you pain. 

If you aren’t comfortable with a vaginal assessment, we can assess the strength of your pelvic floor muscles externally around your sit bone (“butt bones”). Additionally, observing your posture, breath, functional movement patterns, and assessing your abdominal strength can give us a lot of information about what might be happening in your pelvic floor. 

It’s important to remember that you’re always in charge and can choose to have the internal assessment or not. You can also choose to stop the assessment at any time if you don’t feel comfortable. There is a lot of information to be gained in other ways if you don’t feel comfortable with the internal assessment. 

My doctor also gave me the option of surgery. Is pelvic floor physical therapy going to help my issue?

Conservative care, including physical therapy, should always be the first line of treatment prior to more invasive treatment, like surgery. The pelvic floor is a muscular sling that can be strengthened or trained to relax just like any muscle in the body. When the pelvic floor muscles contract and relax appropriately and when needed, it can help to normalize bowel, bladder, and sexual functioning that may be causing you issues. Strengthening the pelvic floor muscles can also improve pelvic organ prolapse and help you avoid surgical intervention.