What to Expect on Your First Women’s Health Initial Evaluation at Body Gears Physical Therapy
To all the women who are scheduled to come in for an initial evaluation with a Body Gears Women’s Health Specialist – congratulations! You have taken a big step towards restoring quality of life regarding incontinence, prolapse, pelvic pain, painful sex along with any other symptoms you may be having. It’s absolutely normal to feel nervous, curious, scared, excited, or any other combination of emotions. You may also have countless questions floating in your mind:
How is this PT going to be different than when I had PT before for my sprained ankle?
Are they going to look inside my vagina?
How is this different than a pelvic exam I get from my OBGYN?
I don’t know what to expect – is anything going to be really painful?
I really don’t want anyone looking or touching my vagina. Can I tell them I don’t want that?
To help you feel more relaxed when you come in for your initial evaluation, we want to share the framework of the initial evaluation process with you.
Filling out the paperwork (We all hate it, but please take your time!): Tell us all about your past medical history and information regarding your current condition in detail. History regarding surgery, pregnancy (current and past) and childbirth, pain or conditions anywhere else in your body are important as they help us give a better picture of what may be going on, and how we can help you. Also make sure to write down any use of IUD, pessary, implants of any kind.
The therapist will begin the evaluation by first listening to your story. What brings you here today? Our first job is to listen, as we ask some questions along the way that can help us form a few hypotheses on what may be going on. Here are some of the rather “odd” questions we may ask you:
What do you do for a living? (Occupation can have a huge impact on how your pelvic region is being stressed)
What do you eat and drink? (Type of food and fluid intake can cause frequent urination, constipation, over-activation of your bladder, and other things!)
Do you have pain with sex, and if yes, what kind of positions are more painful? (Regardless of your complaint such as having to frequently go to the bathroom, your therapist may still ask this question as the muscles that support bladder/bowel function also support sexual function)
Are you able to use a tampon or does it seem to just slip out? (Gives us a clue on muscle tightness or looseness of your pelvic floor)
Do you get pain at your vagina when you wear your skinny jeans or tight underwear? (Even something like tight clothes can clue us in on possibility of soft tissues, joints or nerves being compressed and causing your pain)
By the time you and your therapist are done chatting, she will have a good idea on what may be going on. The goal of the next part we call the Objective, is simply a way for us to confirm or deny our hypotheses (or also called Diagnosis). This is the part where we actually put our hands on you, and ask you to do certain movements.
The important thing to know, is that by this stage, the therapist will have a very good idea on whether an internal pelvic examination is appropriate or needed today. She will ALWAYS ask for your consent. It will sound something like “ I think it will give us a lot of information on how we can help you if I do an internal exam today, which involves me placing one finger into your vagina and feeling your pelvic floor muscles to figure out what is going on. Are you ok with me doing an internal exam today? If you don’t want to, there are still a lot of great things we can work on externally as well.” Every physical therapy session during which internal work is indicated for, requires consent from you. You can always say no at any time throughout your time with us.
The summary below is based on you giving us consent to do an internal exam that day. Here are some of the assessments your therapist may go over with you:
Posture: Your therapist will take photos of your posture from the back, side and the front, as well as take a video of your walking. Again, they will ask for consent to do this, and the therapist will view these images to figure out how your posture affects your current symptoms. When the rib cage and the pelvis are not aligned efficiently on top of each other, it can put unnecessary tension or pressure into your pelvic floor muscle as well as your pelvic organs.
Core activation and postural alignment tests: The therapist will do three tests to assess how well you are standing (helps the therapist verify what she saw in the photos) and how well your core muscles kick in when you are standing erect and when you are in a staggered position. Since your pelvic floor muscles are core muscles, we test them to see how strong they are in functional positions such as in standing.
Lumbar spine motion and hip strength: Your therapist will ask you to bend forward, rotate and bend side to side at your back while in standing. This is important to assess, since sometimes you can feel pain around your groin or vaginal area (if that is your complaint), but the source of pain can actually be originating from what is going on in the lumbar spine. This is called referred pain. The strength of your hip muscles can also provide a lot of clues, such as if there is weakness of the hip that leads to over-activation of the pelvic floor muscles during jumping or squatting. This can lead to tightness and discomfort to your pelvic floor region.
Pelvic Floor Assessment:
The therapist will first prep the room before the beginning of the pelvic floor exam. She will drape a sheet over the table, and have another sheet ready for you. Before the therapist leaves the room, she will ask you to undress everything underneath the waist including your underwear and to lie on the table with the second sheet draped over you. When you are ready, the therapist will come back into the room.
Observation and external palpation: The therapist will first observe the pelvic floor externally while you perform pelvic floor muscle contractions (also known as Kegels), in order to assess how efficient the muscles are working together. The therapist will then palpate the pelvic floor region externally, looking for any areas of tenderness or soft tissue tightness.
Internal palpation and strength assessment: The therapist will then proceed to internal palpation of the pelvic floor muscles, which are divided into three layers. The therapist will proceed from the superficial (layer 1) to the the deep (layer 3) layer one at a time, as she asks you for feedback on pressure and how you are feeling. Even before she asks, you can ask the therapist to stop at any time if it is too uncomfortable or you are simply not feeling like it anymore today! While the therapist’s finger still rests internally, she will ask you to perform different types and holds of Kegel contractions to assess for strength and endurance.
Internal assessment for prolapse: Your therapist may assess for signs of prolapse, which is a condition when the pelvic structures such as the uterus or bladder slip out of its usual position. While the therapist maintains her finger internally in the vaginal canal, she will ask you to perform a Kegel contraction followed by bearing down. The therapist is observing and feeling for any positional changes.
Plan of Care:
Once the examination is over, the therapist will sum up the findings of the entire examination and explain the driving factor of the symptoms as well as what can be done in PT to make it better!
The Women’s Health Specialists at Body Gears Physical Therapy are here to empower, educate and to help you feel better about a variety of pelvic symptoms that you may have previously didn’t even know that physical therapy can help. If you have any further questions prior to your initial examination day, please give us a call so any of our women’s health specialists can help answer your questions!