PELVIC HEALTH PHYSIO QUESTIONS

What can I expect at the first Pelvic Health visit?


Your first pelvic health visit will last between 60-90 minutes. Pelvic floor assessments and treatments are conducted in a comfortable, private room. To evaluate and treat pelvic floor dysfunction, your pelvic health physiotherapist may assess your posture, breathing, orthopaedic function (assessment of the spine, hips, pelvis, abdomen), core stability, and perform an internal (ie. vaginal and/or ano-rectal) pelvic exam (with your consent). Once the comprehensive assessment is completed, your physiotherapist will inform you of her findings, provide education about your condition, and prescribe some starter home exercises. We use a combination of individualized treatment techniques to address your concerns and goals. These may include internal (vaginal and/or anorectal) and external manual therapy techniques, guidance on safe return to activities and/or sport, and prescribed exercises tailored to you.




What does an internal pelvic exam entail?


A complete internal pelvic exam consists of both a vaginal exam and an anorectal exam. It is important for your physiotherapist to get information about both the front and back portions of the pelvic floor in order to provide the most comprehensive evaluation of the function of this area so as to better guide treatment.




What if I don't want to have an internal exam/treatment?


While a complete internal pelvic exam is always recommended in order to provide your physiotherapist with the most comprehensive overview of the function of the pelvic floor and help guide treatment, it is always your choice when it comes to your health. If after discussing with your physiotherapist the reason(s) for your visit, understanding the anatomy and function of the pelvic floor, and what the assessment/treatment options may entail, you remain uncomfortable with having a pelvic exam, none will be completed and alternative options may be considered. Similarly, if at any point during the pelvic exam or subsequent pelvic floor treatments, you wish to withdraw your consent, that is no problem. Simply let your therapist know that you don’t wish to continue, and you can discuss alternative options.




My doctor/midwife already did a pelvic exam. Why do I need another?


Generally doctors and midwives have a different focus than physiotherapists during a pelvic exam. Doctors/midwives are mainly checking to ensure that there is nothing medically wrong with your pelvic floor (e.g. malignancy, infection). Meanwhile, pelvic health physiotherapists are more interested in function – muscle strength and recruitment, coordination of the pelvic floor muscles with the rest of the core, the alignment and mobility of the bones and joints of the pelvis, any scar tissue or adhesions in this region, and the position of the pelvic organs. Pelvic health physiotherapists then put together their findings from the pelvic floor exam with findings from the orthopaedic exam (how the rest of your body moves/functions) in order to determine the best plan of care.




Can I still come to my appointment if I have my period?


Yes. In some cases it may be beneficial for your physiotherapist to assess the effect of menstruation on your symptoms, especially if you’ve noticed a correlation between your symptoms and your menstrual cycle. However, if you feel uncomfortable you can reschedule your appointment.




Can I bring my baby with me?


Yes!




Can I have an internal exam while I’m pregnant?


Yes. However, if your doctor or midwife has told you to avoid sexual intercourse during your pregnancy we will not complete an internal exam.




When is it unsafe to have an internal exam?


Internal examinations and treatments should be avoided if you have:

  • Active hemorrhoids or infections
  • Rectal bleeding
  • Seed implants
  • Radiation injuries less than 6-12 weeks old
  • Undergone pelvic surgery less than 6 weeks ago
  • Undergone prolapse repair surgery less than 12 weeks ago
  • Been told by your doctor or midwife that you must abstain from intercourse or internal examinations during pregnancy




How soon should I see you after giving birth?


Generally we recommend you see us shortly after your 6-week check-up.




I already tried kegels and they didn’t work. Now what?


In many cases, kegels are inappropriate as your pelvic floor muscles may already be too tight. A kegel is only effective if the pelvic floor muscles can first relax, and continuing to do kegels with a tight pelvic floor can worsen your symptoms. It may be the case that the kegel is also being performed incorrectly. While you may feel as though you’re completing a kegel, you may actually be compensating with other muscles around the pelvic floor. Pelvic floor physiotherapy is so much more than a kegel, and your physiotherapist will help you determine which exercises are most appropriate for you!