One of the first questions a pelvic health specialist must ask is why you are coming in for physiotherapy. These questions are often of a very personal and intimate nature, and require a very compassionate, caring and thoughtful approach. To be well-informed; you need to know that in order to provide you the best pelvic health care, there is the possibility of an internal exam. 

Here is what to expect when booking a pelvic health assessment:

Confidentiality: All interactions between a therapist and client is bound by confidentiality. Informed consent is required for the initial assessment. Verbal and signed consent is required before any information is shared  with the family doctor, specialist or other health professional.    

Direct Access: Unfortunately, many people wait months to a year to see a gynecologist, urologist or gastroenterologist before being referred to a pelvic health therapist (PHT). This doesn’t need to happen. You can have direct access to physiotherapy for your pelvic issues. You don’t require a referral to see us, but many insurance companies require a doctor’s referral to reimburse you.  

Compassion:  Pelvic health issues bring with them frustration, stress, anxiety and depression. We take a biopsychosocial/spiritual approach to understand you as a whole person.  

Medical History: A good understanding of the current problem and any other health issues is very important. We send out a questionnaire before the initial assessment to gain an understanding about all the issues that might be affecting you.  Our intake questionnaire might seem a bit lengthy but each part of it is very important. Your issues and goals are explored while the physiotherapist reviews the completed forms during the initial assessment.  

Orthopedic Assessment:  Most pelvic health specialists have orthopedic training. And we don’t leave our orthopedic thinking at the door. A good postural screen, spinal movement analysis, gait analysis, pelvic girdle and lower extremity motion and strength testing is part of the assessment. 

Breath assessment:  Analyzing your breathing pattern and breath awareness is important because the diaphragm, core and pelvic floor work together. Many people breathe incorrectly and also hold their breath, which profoundly affects the function of the pelvic floor. 

Myofascial tension: We’ll examine the abdominal wall and all the muscles externally around the pelvis for excessive tension. Any dysfunction of these muscles can affect the function of the pelvic floor and vice-versa. 

External exam: The skin and external musculature of the perineum are examined to look for skin irritation and any other issues. The perineum is examined for any prolapse, vaginally or rectally.  

Internal exam: This is the most difficult part of the exam for most people to understand. It’s not like a pap smear, ladies. There are no stirrups or speculums used. And gentleman, it also isn’t like a prostate exam. You lie comfortably on your back and are discreetly covered with a sheet. We  need consent to perform every internal exam and you are always in control. Pelvic health treatment is best with an internal examination, but it can be done with external examination only.  The purpose of internal palpation is to determine if there is lo or high tone of the muscles. The internal connective tissue and skin are examined to ensure health and proper movement. The internal should be comfortable and not painful.   

Strength testing: The strength is determined by contraction of the pelvic floor during the internal exam. Coordination, endurance and fatigue-ability of the muscles will also be tested.  

Summary and explanation: At the end of the assessment the findings, issues and goals are summarized and explained. You will leave the appointment with specific education, exercises and strategies to help you manage your individual problem and issues. 

Pelvic health issues are often of a very private nature – and we understand. Your care and health is our top priority.