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What to Expect at Pelvic Physical/Occupational Therapy

What To Expect from Pelvic Therapy

General things to know about going to pelvic physical or occupational therapy:

Female clinician interviewing a patient

It’s normal to feel nervous (or not) about your first visit to pelvic therapy. Your pelvic therapist is familiar with people not being sure what to expect and will be ready to answer your questions. They will also be ready to share what to expect from your time together. However, you can get a head start on your expectations by reading through this information.

The process of getting in to see a pelvic therapist:

  • Depending on your insurance needs, a referral may be needed.
  • Some providers are not as familiar as others with pelvic therapy so asking directly may be needed.
  • If you have a therapist in mind, make sure you know what profession they are. If they are a physical therapist, you need to get a referral to PT. If they are an occupational therapist, you need a referral to OT. Some facilities and/or insurance companies will not allow you to see a pelvic OT if you have a referral to “pelvic PT” and vice versa. 
You may need a referral.

Can I choose where I go to therapy?

  • Often medical professionals will have a practice (or several) that they tend to refer to. However, if you have a therapist in mind, speak up and request where you would like to go.
  • The PelvicGlobal.com directory can help you find providers near you.
Can I choose where I go to therapy?

Is this only for women?

  • Pelvic Therapy is for ALL genders. However, the clinic you are attending might specialize in “women’s health” and may or may not be inclusive of men and/or transgender people.
  • Check their website and/or call to figure it out.
Pelvic Therapy is for all genders.

What should I wear to my first visit?

  • Wear something comfortable that you can move in.
  • Something that is easy to change in an out of may be helpful as well.
Wear comfortable clothes to your pelvic therapy visit.

Consent during your visit

  • It’s important that you understand the way in which your therapist might interact with your body. If you have any questions, please ask them.
  • You can say “no” and ask to have an exam ended at any point. You are always in charge of your body during your exam.
  • Your therapists needs you to be mentally present during the exam because we’re trying to understand your whole body. If you feel like you’d need to “check out” for the exam, it might be best to wait for any internal work. Discuss this feeling with your therapist to determine the best way forward for your examination and treatment.
  • If you tend to disassociate to a nonverbal place for genital examinations, also discuss this with your therapist. You may be able to keep talking through the exam or plan verbal check-ins so that if there is a change in the way you verbally communicate, they’ll take that as a cue to end the exam or treatment. Discuss this with your therapist if you’re concerned.

Screens and Assessments

  • Even bowel, bladder, pelvic, and sexual function concerns are tied to your whole body.
  • Your therapist will likely want to take a look at how your body is put together and how you move to see if there are any larger themes that might be playing a role in your concerns.
  • Sometimes some easy changes and ideas can be found here that can make a big difference for how quickly you meet your goals!

The External Exam Components

  • There might be an assessment of your trunk, legs, arms, and an exam of the outside of the pelvic area.
  • An external assessment of your pelvic area may involve palpating (using their fingers to feel what your muscles are doing) your perineal area (over or under clothing).
  • Sometimes it might involve a visual inspection of the genitals (especially if there are complaints of pain).
  • Our goal is to figure out what is causing your issues and help you solve them. Multiple angles on the evaluation give us a better idea of how to help you with your issue.

The Internal Exam Components

  • The therapist will help you into a comfortable position with appropriate coverage for your body.
  • The therapist uses gloves and examination lubricant.
  • The therapist will feeling for several things: abnormalities in the tissue, your ability to control (squeeze and relax) different parts, and noticing if there is any pain or discomfort present.
  • The therapist will explain your anatomy to you as they are doing the examination which is often a really empowering experience for people.

FAQs about the Internal Assessment:

FAQs about internal pelvic examinations.

What is the purpose of an internal pelvic floor assessment?

 

  • For many pelvic floor and pelvic area issues, having a more thorough idea of what the muscles and internal structures are doing (or where exactly pain is elicited) can be extremely helpful in the diagnosis and treatment of your condition.
  • During an internal exam, your therapist can also get an idea of how your nervous system works and create ways to help you calm it.

 

Do I have to have an internal exam?

  • No. You have the right to make decisions about your body at all times.
  • If your therapist is recommending one and you are not sure if you’re willing, talk to your therapist about your boundaries and/or barriers so you can weigh the benefits and risks as you make your informed decision.
  • Some conditions may not need an internal exam at all.
 

What if I have pain? Won’t the exam make it worse?

  • It can be helpful for your therapist to see or feel where the pain is located.
  • Some types of pain can actually be helped with some understanding of how to relax the area that is painful (and that can happen during the exam).
  • Sometimes topical pain medications can make the assessment more comfortable. Your therapist or referring clinician might be able to help with this option.
 

Is there an internal component to EVERY visit?

  • Some people benefit from internal techniques to address their issues and so internal work might be more of a regular occurrence.
  • Some people need an assessment and then external only treatment, and then possibly a reassessment internally after progress is made.
  • If you have concerns, talk to your therapist to come up with the best plan for YOU.

Establishing your plan and knowing your role in therapy

Know your role as a patient in pelvic therapy.

Your Treatment Plan

  • Your therapist will need to understand as much as they can about your time availability, motivation, privacy, and home situation to create a plan that has the best chance of being something that works for you.
  • You and your therapist will come up with some ideas that will work with your life to help you meet your goals
  • Depending on what your issues are, some of the things you’ll be doing may be:
    • Some changes to your home environment
    • Some changes to the way that you drink/eat or urinate/defecate.
    • Stretches and exercises
    • Hand-on (manual) techniques
    • Breathing techniques
    • Pelvic floor training
    • Recording more data about your concern
    • Having conversations with partners who may need to adjust for some temporary changes with sexual activity
  • You will likely get some handouts and written material to help you remember what to work on.

Your Role in Your Treatment Plan

  • Be as honest as you can with your therapist about what you are able to do at home and what the barriers are to some of the things they suggest.
  • If possible, get into a curious and creative place with them and explore some of the “What if…” suggestions they may have for you.
  • If they ask you to track some thing, do it.
  • Following up with the program that is created to the best of your ability is really helpful to be able to understand “what’s working and what’s not working”
  • Make a commitment to show up and stay as consistent as you can while letting your therapist “be on your team” to help overcome unforeseen barriers to your healing.
The plan is for YOU. Please speak up if any parts of it are confusing or don't seem possible with your current situation.

For PDF friendly versions of this blog in a one-page, and multipage workbook style, the Global Pelvic Health Alliance Membership offers it!

There are so many incredible resources available to you as a member of the Global Pelvic Health Alliance.
  • Webinars
  • Handouts
  • Illustrations
  • A support community of pelvic health experts
  • Podcast
  • Progress Pods
  • Resource Library
  • Discounts on courses

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