What to expect during a pelvic floor physiotherapy assessment

Pelvic floor physiotherapy is a specialized branch of physiotherapy which addresses a range of conditions related to the pelvic floor, such as: 

• Post partum recovery
• Pregnancy related pain 
• Pre-partum education and  preparation 
• Pelvic organ prolapse management 
• Incontinence or bladder leakage  
• Sexual dysfunction or painful intercourse 
• Lingering back and hip pain  
• Pain related to the joints of your pelvis  
• Erectile pain or dysfunction 
• Management following prostatectomy  

Learning about your history 

An initial pelvic floor assessment begins with the therapist gathering a detailed history of the complaints and symptoms that brought you in to the clinic. This can involve some personal questions surrounding bladder and bowel habits, sexual history, medical history, pain, and other symptoms.

We understand that speaking about these topics can be difficult for some. However, this information is important to formulate an accurate diagnosis and treatment plan.  Know that everything you disclose to a therapist always remains confidential, and you only need to share as much as you are comfortable with!  

After the interview about your history, with your consent, the therapist will begin by performing a comprehensive external physical exam. This includes observation of posture and positioning, movement assessment of the spine, breathing pattern and hip and leg movements, as well as hands on palpation for points of tension through the glutes, hips, abdomen, and low back. The muscles and joints in the lumbo-pelvic region have influence and connection with the pelvic floor so that’s why we start there.  

The assessment 

The assessment typically moves on to involve an internal exam only with your ongoing consent. The specific muscles of the pelvic floor run from the pubic bone in the front to the tailbone at the back and are best evaluated internally. This is a manual examination using gloves and lubrication and is performed vaginally and/or anal-rectally, depending on the concerns and anatomy of the patient. Just like in the external component of the exam, the physiotherapist assesses points of tension, muscle strength, muscle relaxation, coordination, and quality of contraction.  

For the internal component of the exam, the patient is positioned comfortably on their back with legs bent, and a sheet is provided for coverage. The exam is done in a private room with a female therapist using only gloved hands and lubrication – no metal tools or speculum are used. 

Although including an internal exam gives us the most information to help with your current complaints, it is definitely not a requirement to see a pelvic floor physiotherapist. Your therapist will always work with you within your comfort zone – you are in control of your session! Consenting to the internal component on day 1, does not mean you have to consent to an internal on day 2, and if you ever want to stop part way through you are able to withdraw your consent at any time.  

After the assessment is complete, your therapist will discuss the findings and answer any questions you have. Lastly, you and your therapist will go over some educational information, exercises, and create a treatment plan.   

If you have any other questions about what these sessions look like, or if you are a candidate for pelvic floor physiotherapy, don’t hesitate to reach out to one of our clinics and we can answer any questions you may have.

For more information on pelvic health, watch our online webinar "Is your pelvic floor telling you something?"

Find a pelvic floor physiotherapist near you or book an appointment online if you’re experiencing symptoms and want to seek treatment.