What Happens At a Pelvic Physical Therapy Assessment?

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I would like to answer the question now, that many people ask and are curious about. And that is what is a physical therapy assessment for the pelvic floor? This would be something that would be needed if someone had an issue with pelvic pain, if they have an issue with a bladder that's not controlled like a person wants, and other issues. But if someone were to need a pelvic assessment or they were sent to a pelvic physical therapist, there's usually a lot of anxiety related to that. People are pretty nervous thinking what in the WORLD will happen.

I want to talk through that with you, but I want you to know that it really matters how the rest of your body is too.  How it is lined up, how it functions, how strong it is, how tight it is. A PT's first visit with you, if you were seeing a pelvic PT, would actually look a whole lot like a low back assessment.

Only AFTER we talk about you and your health history for around 15-20 minutes, we would THEN start to actually assess anything physical.  We would ask you to bend forward, touch your toes, stand on one leg, twist your body, side bend. We would check how strong your leg muscles are, your core muscles are. We would assess things like your balance, how good of a squat you could do even.

We would probably have you lay on a treatment table, checking your hamstring flexibility. That's the back of your thigh. Looking at how your hips move. We would ask you to take deep breaths. Watch how your breathing looks. Oftentimes, especially women, we breathe a lot in our chest. We hold a lot of tension up here, and that doesn't do our pelvic floor any favors, so we really care about breathing well as it impacts our pelvic floor function so greatly. We then talk you through a whole lot of stuff, like, "What does your pelvic floor do?" We teach you about how it functions with the rest of your core muscles.

We even can sometimes give you some hints on how your muscles work by asking you to blow up a balloon or blow through a straw to see if you can contract your pelvic floor with that. At the very end of an assessment, once we've done all the tests and measurements we need to, because we're really solving a puzzle when we work with each patient. We then spend maybe five to 10 minutes doing a pelvic floor assessment. This is going to look a lot like maybe an OBGYN annual visit. Yes, we will have a patient be on a treatment table.

We have patients undressed from the waist down. I give them a Hawaiians sarong to put over their legs so that they are completely covered. I let my patients change after I leave the room, sanitize, wash hands, come back in when they're ready. We do a visual assessment of the pelvic floor muscles first. Patients are on their back with their knees bent. I ask them to take a deep breath. And as they exhale, I cue them to close squeeze their openings. We begin to get an idea of, "Does it look like the muscles are doing what they should do?"

We ask them to do one of the other three jobs that these muscles have. That's to lengthen and release, which is hugely important by saying take a deep breath. As they inhale and inflate their belly, they also want to inhale, lengthen their pelvic floor and move their muscles outward. We're getting visual idea if they can do this. Then with a gloved index finger, we're actually usually touching the outside of either side of the vaginal opening because the muscle here can often be tender and tight for some women.

From there, with a gloved index finger with lubricant on, we're actually inserting our finger into the vaginal opening. Realize that the thickness of these muscles is really not that thick, so we don't really need to go that far to assess them, but we do need to internally assess them because these muscles are hidden from the outside. We can't see them function. There's no muscle function or strength tests that we can get an idea from the outside. Once we're here, there's a finger inserted just at this opening. We lightly press downward. We lightly press to either side. We're checking to see if the muscles and tissue are tender.

We're continuing to talk with our patient and go, okay, "Is that tender? That feels tight to me, or that actually doesn't." The whole time, we're just talking through what we feel. From there, we go just a little bit deeper so that we can get to that deeper layer of muscle we can hook our finger around, and we can feel the different parts of that deeper layer muscle. Once we've gotten an idea of what's going on, if there's any tender spots or scar tissue, we can then just be inside there about this much (2-3 inches) and listen to what your muscles do. We will walk you through things like taking some deep breaths.

We're listening to the muscle to see if it changes its tension at all when you take a deep breath. Realistically or ideally, it should lengthen or soften a little bit when we inhale, and the muscle should recoil gently as we exhale on their own. Sometimes, we have to coach people. Actually a lot of times, I need to coach people to actually choreograph or override their bodies' tendency to not do anything down here and help them learn what should happen, and they practice it. Then from there, we have them do a series of contractions to get an idea of not just how strong they are but how many counts can they hold one contraction before the muscle gets fatigued, and then how many times they can repeat that.

We ask them to do some fast contractions as well. We also ask them to bulge and lengthen, so we usually do that with the cue to take a deep breath and try to open up, maybe separate the sits bones. There's a lot of different cues that we use to help our patients. We're all individuals. It's really important that we know from this assessment if there's pain, if the muscles are in spasm or they're actually really too relaxed or loose, which is not often the case. If these muscles can contract, relax and lengthen, does the person have good conscious control of these muscles or are they just doing their own thing or spastically contracting?

Once we get a lot more information, sometimes we do some other tests, then we can really get an idea of what's going on to better help them. When we don't have this assessment, we do our best to figure out what's going on, but there are a lot of times with patients, I will test absolutely everything else that I can, their hip range of motion, their strength. What do the muscles feel like in their hips that joined right up to the pelvis? But sometimes, I still won't know until I can assess those muscles to figure out what really is going on.

If that makes sense to you, that’s awesome!  But this is a question that a lot of people have... they really don't know what we do! This internal assessment portion is a part of a larger exam that can actually be delayed to a second, third, or fourth visit. In the end, it is our patient's choice whether they have that part of them assessed. It's their body at all times. We're just there to be a guide in the end and guide them towards resolving their problem.

If you have any questions, you can always message me, and I hope that helped clarify things for you!