Welcome to Part 2 of our two-part series on Pelvic Physiotherapy. We asked Kate Jones of Hamilton’s Nest Physio to help us understand a little more about what happens during a pelvic physiotherapy. We know that pelvic floor health is important to postpartum recovery. Part 1 of this series is Do I Need To See A Pelvic Physiotherapist?

What People Imagine About The Pelvic Physio Assessment

Let’s be honest: pelvic floor injury or no, the thought of having a pelvic exam makes most women nervous.

This can be a major barrier to getting care when a new parent suspects they have a pelvic floor injury. Will it hurt? Are all the genitals on display under bright lights? Is there poking and prodding?

People just don’t know what to expect at a pelvic physio appointment.

Are there special vagina machines? Will a speculum be used? Do pelvic physiotherapists have head lamps to take a look inside?

Nope to all three of those. Let’s clear the air.

The Start of the Pelvic Physio Assessment

Before anything else happens, the client and the physiotherapist talk. A lot!

The physiotherapist starts off by getting consent first. They talk through what they would like to do in the pelvic physiotherapy assessment. They’ll explain why they think it is important, what any potential risks, allow client to ask questions. Another important part of this is to ask you which parts the client feel comfortable doing and not doing.

The clients decides what they want to do, and they can change your mind at any time.

Then they talk about what concerns specifically you are having, if any. We’ll ask about your overall health, any aches and pains you have, who else you seek care from, your exercise and health habits, your work/life balance, your stress levels, your fluid intake, and how life is going in general.

Then we’ll get real personal.

We want to know about your pregnancies and deliveries, your pee, your poop, and your sex life. We ask specific questions about these topics to clarify what your concerns are and make sure we don’t miss out on relevant information about your pelvic health that could indicate other things to address that you haven’t noticed. Some examples of questions we might ask are:

  • When you pee, does the stream start and stop or is it steady?
  • Do you find yourself straining or pushing when you try to poop?
  • If you are sexually active, are you having any pain or concerns with sex?

The Internal Exam

After getting a good background, we’ll move on to the pelvic exam. This is done vaginally and/or rectally depending on your concerns. We wear gloves, we use medical grade, single packaged lubricant, and we follow proper hand sanitization procedures before and afterwards.

For a vaginal exam, your pelvic physiotherapist would put one or two gloved fingers inside of your vagina if you were comfortable.

For a rectal exam, they would put one gloved finger in your rectum.

We would also take a look at your perineum and vulva to make sure the skin looked healthy and that any tears were healing well. Additionally, we check for pelvic organ prolapse, and check out your abdominal muscles.

The pelvic exam is an important way to figure out how the muscles are functioning  How strong are they? What is the muscle tone in various places? The physiotherapist will see if there are areas that are sore for you. They will assess if there are reflexes that aren’t working quite as they should be.

During the exam the client is in control.

If at any point you aren’t comfortable or you change your mind and want to stop, you just say so and the exam will stop.

No fancy or weird equipment and no scary stuff. The exam is always structured around what the client feels comfortable consenting to and nothing else.

If you know or suspect you have a pelvic floor injury, contact a Pelvic Physiotherapist like Kate at Nest Physio for embarrassment free care.