What to expect at your pelvic floor physiotherapy appointment

Here at Gastown Physio, we know that coming in for a pelvic health assessment may be scary and you probably have some questions. We want you to feel as comfortable as possible during your time with us. Here is a breakdown of what to expect at your first appointment.

1. We will listen to you without judgement.

2. We will ask you questions. Sometimes these questions may seem odd or embarrassing, but they are relevant to your pelvic health and trust us, we have heard it all before! 

3. We may assess breathing, posture or other joints and muscles to determine if there are any non-pelvic floor contributors to your symptoms.

4. We will explain what we are doing and more importantly why we are doing it along the way.

5. If an internal exam is appropriate for you, we will go over it with you in detail and get your consent before proceeding. If you are not comfortable having an internal exam we can discuss alternatives. 

6. The internal pelvic floor exam will have you comfortably lying on your back with your knees bent and your feet flat on the table. We will use a gloved finger with lubrication and access your pelvic floor muscles vaginally. First, we will assess how tense or relaxed the muscles are. Second, we will assess the strength, coordination and reflexes of the pelvic floor muscles by asking you to perform various types of kegals and movements. 

7. If indicated, we can also assess for prolapse vaginally and/or rectally. 

8. Following the internal exam we will go over our findings, we will educate you about your condition, we will provide our specific recommendations, and together we will come up with a plan to achieve your goals. 

If you have any further questions about what to expect, please feel free to contact our pelvic health physiotherapist Chelsea Emslie.

FAQ’s

When should I have my pelvic floor assessed after I deliver?

It is recommended to have an assessment any time beyond 6 weeks postnatal.

I had a C-section, should I still have my pelvic floor assessed? 

It is recommended that all women, regardless of how they deliver, have a pelvic health assessment to evaluate strength and function of the abdominal and pelvic floor muscles. These muscles are often impacted by pregnancy and all methods of delivery.

Can pelvic floor rehabilitation correct a prolapse? 

There is good evidence that pelvic floor rehabilitation can help reduce the severity of prolapse as well as prevent it from worsening. Although it may not completely correct the prolapse, there are many things that can be done to help manage your symptoms. 

Can my pelvic floor become too strong that it will interfere with labour? 

No, strengthening the pelvic floor muscles will not interfere with labour. Not only will we work on getting a strong contraction, but also ensure that you are able to completely relax those muscles when needed during labour. 

Isn’t it normal to leak a little bit after having children?

It is common, but not normal. There is help available! 

Can prenatal pelvic floor rehabilitation prevent tearing?

It may reduce the likelihood of grade 1 or 2 tears, however, if a grade 3 or 4 tear occurs they are usually not preventable.

If I just do my kegals without seeing a pelvic floor physiotherapist, can I reduce my symptoms of leakage or pain on my own?

Maybe! For some women it may only be that their pelvic floor needs to be strengthened. In this case, the goal would be to hold a kegal for 10 seconds and perform 3 sets of 10 repetitions every day for 3 months or until your symptoms go away. You can also try adding “the knack,” which is performing a kegal right before you cough, sneeze, or jump to prevent a leak. 

For some women, their reason for leaking may be that their pelvic floor muscles are too tight and therefore are not in an effective position to perform a good contraction. And furthermore, up to 50% of people aren’t doing their pelvic floor exercises/kegals correctly and need additional guidance. 

When can I start running again after I deliver?

Return to running is not advisable prior to 3 months postnatal. Return to running should include a low-impact postnatal rehabilitation followed by a graded return to your running program assuming there is no pelvic floor dysfunction. 

What is prolapse?

Pelvic organ prolapse is a subjective disorder described as an annoying protrusion at or near the vaginal opening. This may also be accompanied by perineal pressure. These sensations are caused by the pelvic organs descending by various degrees into the vagina. There are many different types of prolapse, but more commonly: bladder, uterine or rectal. It has been shown that 50% of women who have experienced a pregnancy have some degree of prolapse.