We know Pelvic Health is not your standard physio session, but not all of our patients know
this before they walk in the door. Some have an idea that we might give them pelvic floor exercises, others are referred by their doctor and have no idea how a physio can help with their bladder. With this post we aim to step you through what to expect from your first appointment.
Lots of Talking:
Your first pelvic floor physio session is usually 1 hour. We will probably spend the first 20 minutes talking, asking questions and getting to know what's going on. Whatever you're here for, the questions we'll ask will be about all the things to do with your pelvis. So we'll ask about your bladder and your bowels, any previous surgeries, sexual function, pelvic pain, and any previous injuries. We'll also ask out about your occupation, hobbies and what you do for fitness and for hobbies. This last one gives us an idea of what we're trying to get you back to, or what we need to keep you doing while you recover. The last thing we'll want to know is your goals, what you want to achieve from physio.
Assessment:
From there we will offer a pelvic floor assessment.. There are a few different ways we can do that, and each way gives different information.
- Vaginal Assessment:
For those with a vagina, the assessment that gives the most detailed information is a vaginal assessment. After explaining the procedure to you, if you consent to the assessment you will be given privacy to change out of your trousers/skirt and underwear, and given a towel to cover yourself. You will be directed to lay on your back with your knees bent. The physio will then come back into the room.
With your consent, the physio will first check the skin and tissue at the entrance to the vagina, looking for dryness, redness, scaring or skin issues that we may want to refer to a specialist for. After that you will be asked to tense and relax your pelvic floor, and then to bear down (as if you're pushing out a big poo). This is to check how the muscles are behaving, to look for symmetry and to check for obvious prolapse. From there (only with your consent) the physio would use a gloved finger to lightly apply pressure to the entrance of the vagina to check for pain and sensitivity. If you are happy to continue after this, the physio will then insert a gloved, lubricated finger into the vagina. Internally, the physio will check for pain, muscle tension, muscle tone, strength, endurance, co-ordination. If it's relevant to you, the physio can also check for prolapse and for any muscle injuries that may have been sustained during childbirth.
- Perineal Assessment:
For those with a penis, the assessment that gives more information to help us treat you is a perineal assessment. The perineal area is the skin that sits between the testicles and the anus. After explaining the procedure to you, if you consent to the assessment you will be given privacy to change out of your trousers and underwear, and given a towel to cover yourself. You will be directed to lay on your back with your knees bent. The physio will then come back into the room.
With your consent, the physio will first check the skin looking for dryness, redness, scaring or skin issues that we may want to refer to a specialist for. After the physio would use a gloved finger to lightly apply pressure to the muscles in the perineal area to check for pain and sensitivity. If you are happy to continue after this, the physio will keep that light pressure and ask you to contract your muscles in different ways to check strength, endurance, and co-ordination. Your physio may also ask if you are comfortable to use ultrasound on the perineal skin so you can see your pelvic floor muscles in action.
- Ultrasound Assessment:
For those who are uncomfortable with the idea of a vaginal/perineal
examination, your physio can assess with ultrasound over your tummy. This can't tell us about prolapse, muscle tension, tone, pain or strength but it can give us a good idea of if you're switching on your pelvic floor muscles the right way. Ultrasound can also give an idea or coordination and endurance. The ultrasound assessment can give your physio plenty of information to start your treatment plan, but they may discuss with you that a more in depth assessment done in a future session could help you in other ways.
- Other assessment:
Depending on why you booked in, you physio may assess other body parts that can impact on your pelvic floor such as your back, hips and pelvic bones. This would be like any normal physio assessment.
- Exercise, Exercise, Exercise:
Of course, coming to see a physio will always mean exercise! While we are assessing your
need to learn to relax the pelvic floor. You may also be given glute, ab, back or breathing exercises to complement your pelvic floor exercises. For people with pelvic pain you may get stretches. For someone who has recently had a baby, or had a prostatectomy your physio may give you a whole body exercise program.
- Knowledge is power:
Pelvic health physio is more than just exercise. We will also make sure you leave with information on other ways to improve your bladder, bowel, sexual or general health. This may include:
eating more fibre,
starting some bladder training,
keeping a bladder diary to help understand your bladder's behaviour,
how to sit on the toilet to ease constipation,
balancing rest vs. activity if you have pain, prolapse, or just had surgery
penile rehabilitation for those who have had prostatectomy
Basically there's lots more to pelvic health physio then just pelvic floor exercise!
After session 1:
You can expect your first follow up to be 1 to 2 weeks later to check to progress along your program. For most people with incontinence or after prostatectomy, you'll have 4-6 physio sessions over 3-6 months. For people with pain or prolapse we might see you between 6 and 10 times over 6-12 months. That being said, we will always try our best to work with what's feasible for you, so the sessions and timeframes may vary.