What does a pelvic floor PT session look like?
A very good question to ask! Because, it's the pelvic floor which means... well you know...
Private parts.
So what exactly goes into a pelvic floor physical therapy visit? Let's go to a visit with Tiffany and see what pelvic floor PT looks like.
Meet Tiffany: First time postpartum mom
Tiffany started seeing a pelvic floor physical therapist at six weeks postpartum. She had an uncomplicated vaginal delivery at a local birth center and was attended by midwives. She had a small first degree tear that she was able to let heal naturally. However, at her six week follow up she mentioned to her midwife that she was still leaking urine when she coughed and intimacy was painful when she and her husband attempted to be intimate the day before her visit. Her midwife didn't want her issues to become chronic, so she recommended that Tiffany see a physical therapist.
At Tiffany's first visit, her physical therapist started with a number of questions about her current leaking and intimacy, as well as a number of questions about her delivery and her past medical and surgical history. Tiffany has been fairly healthy up until this point, so this part of their conversation didn't take too long.
Her PT made it a point to watch Tiffany move as she walked into her appointment and sat down and has already gotten a good sense of Tiffany's sitting posture and movement patterns. Based on this, her PT moves into doing a number of other assessments including looking more in depth at Tiffany's posture,
other functional movements, strength, and mobility of her spine and various joints that her PT thinks are important to her current situation. Her PT also makes a point to check Tiffany for a diastasis recti, as it is very common to still have one at six weeks postpartum, and the presence of one creates high suspicion for related pelvic floor issues. Sure enough, Tiffany still has a diastsis.
Then the physical therapist tells Tiffany that she would like to do an internal exam of her pelvic floor. She explains to Tiffany that she will start by observing the external tissues of her vulva and will ask her to cough and bear down to see how things respond. From there, she will be inserting one finger into Tiffany's vagina and will proceed with feeling for any tender areas and asking Tiffany to contract her pelvic floor so she can assess her pelvic floor strength and coordination. She also informs Tiffany that if she is not comfortable with this, they can proceed without the internal exam, but that may lead to important information being missed. Tiffany is nervous and feels a bit awkward but agrees to the internal examination. She wants to get back to normal!
The PT instructs Tiffany to undress from the waist down, but she may leave her socks on if she's cold or more comfortable with that, and to place the sheet across her lap. Then she steps out of the room so Tiffany can undress and get on the table. When she comes back in, the PT helps Tiffany position herself so she is comfortable but the PT also has access to her vulvar area. The PT asks if Tiffany is ready to begin, and Tiffany says "yes." Throughout the exam, the PT tells Tiffany what she is going to do before she does it and always checks in with Tiffany to make sure she is doing ok. The PT also encourages Tiffany to tell her if anything is uncomfortable, or if she would like to stop at any point for any reason. Tiffany's PT finds several trigger points in her pelvic floor that are very uncomfortable, but she gives the PT the go-ahead to try releasing them. They also work together on getting Tiffany to produce a quality pelvic floor contraction with a full relaxation.
After the internal examination is over, the PT removes her gloves and steps out so Tiffany can put her clothes back on. When the PT comes back, they discuss what she found during the examination. In Tiffany's case, she is holding a lot of tension in her pelvic floor which is making penetration during intimacy painful. This makes sense, but Tiffany is a little bit confused as to why then she's leaking urine if her pelvic floor muscles are tense. Wouldn't that mean they are holding everything closed?
Tiffany's PT explains that when a muscle is held tense for long periods of time, two things happen. First, the muscle can experience fatigue, so when it's asked to do it's job of holding things together when coughing or laughing, it's too tired to give more effort do so. Second, if it's already tense, it's got no where else to go when it's asked to do more, like when holding in the pressure from a cough or sneeze. Have you ever locked out your knees, hips, and ankles by squeezing all of your muscles as hard as you can and then tried to jump? Not going to happen! Same thing with your pelvic floor. If it's tense, it's not going to "jump" in response to laughing.
Her PT prescribes some stretches, relaxation techniques, and exercises that target Tiffany's specific problems. They also talk about proper body mechanics and posture to help Tiffany correct patterns that may be contributing to her leaking and painful intercourse. Together, they make a plan for how frequently Tiffany is going to come in to see her PT, and her PT tells her that most of their sessions will look similar and will be a combination of exercises/stretching and internal pelvic floor work.
That's not too bad, right?
It's totally normal to be nervous or apprehensive for pelvic floor physical therapy. We can get very personal in a session. But if you've had pelvic exams with a physician and that's your only frame of reference for what an internal exam is like, then I'm here to shout from the rooftops: pelvic floor physical therapy internal exams are nothing like that. There is no speculum, there's no digging around to find your cervix or to squash your uterus and ovaries to assess them. That's not to say there isn't often discomfort, just like finding sore spots in your back muscles is uncomfortable, but we do our best to make sure you have less discomfort when you leave than when you came in. And you can rest assured that your PT has been in the same place you are, on the table, knees out, with someone's gloved finger in her vagina. She knows exactly what it feels like to be where you are.
Interested in trying pelvic floor PT and don't want to have to go to a clinic? I can come right to you at home! Click the contact button below to send me a message and let's get you taken care of mama.