Your First Visit to See a Pelvic PT
I started writing this post a few different ways. Over the past several years, I have had handouts and brochures detailing out what is included in a first visit with a pelvic PT, but I liked the idea of something a little less formal. So, I started writing a letter to that new pelvic PT patient, and I hope it helps you (and your patients!!) feel more comfortable getting started!
Hello there soon-to-be pelvic health PT patient:
We are SO thankful you are trusting us in partnering with you in your healing journey. We're very glad you're here. I realize that taking this step and actually scheduling a visit with a pelvic floor specialist can be nerve-racking, and you should be quite proud of yourself for taking this important step! I want to take a few minutes to talk with you about your first session in pelvic PT. I find that much of the fear and uncertainty people may feel with a first visit is often connected with this "unknown." So, I hope today I can take some of that away, so you can feel more comfortable on that first day. So, let's get started:
Your arrival to the clinic
Before you arrive to the clinic, you likely had a good amount of paperwork to fill out (Sorry about that!). Some of it is the standard healthcare type stuff, but there also is a more specific questionnaire. This questionnaire gets fairly personal. You'll see questions in it about your bladder health (how often you pee? what do you drink? are you leaking urine?), your bowel function (are you constipated? do you strain when you have a bowel movement? do you leak stool?), your sexual function (are you sexually active? do you have difficulties with pain during sexual activity? problems with arousal or orgasm?), and any pain you're experiencing (where is your pain? what worsens or improves it? how much does it hurt?) I'll also ask you about your medical history, your medications, and if it applies to you, your history of pregnancies and childbirth, etc. I know this is a lot of detail, but this is very helpful for me in providing your care! Please feel free to put as much or as little detail on this as you feel comfortable doing. We will have a chance to discuss all of this in person.
Nice to meet you, let's get personal!
After you and I meet, I will take you back to a private room, and we will chat about what's going on. This is when we'll talk about your story, what brought you here, what are the challenges you have been facing, what has been your journey, and what are your goals you want to reach. We'll also discuss the questions you answered on that detailed questionnaire, and I may ask you some other questions to get more information about the challenges you have been dealing with. I know it can feel a little weird for some people to share details about your bowel habits or sexual function with a person you just met, but believe me, for those of us who practice in this specialty, we talk about these things all the time. As we are chatting, please feel free to tell me anything at all that you think might be important. Don't hold back...believe me, I most likely have heard all of this before. On that note, please know that I want you to feel comfortable and safe in the clinic, and if you would prefer not to discuss something, that is totally okay too. Just let me know!
Your Exam
After we chat, I will talk with you a little bit about what I think may be going on from a musculoskeletal, movement, and/or behavioral (habits) standpoint. At this point, I usually pull out some images, a model of a pelvis, etc. and will talk with you about what normal anatomy and physiology looks like in the pelvis and about what I think may be happening with the problems you are experiencing. Then, I will let you know what I am recommending we examine to get a better idea of your function. This often includes:
A "Big picture" movement exam: I will watch you walk, stand, sit, and move in many different directions. I will look at how your spine moves (from your neck down), your shoulders, hips, knees, and ankles. I also look at your balance and preferred postures, and I'll even watch how your breathe (yes, breathing really does matter!). While we do this, you'll also let me know if any movements are challenging for you or lead to any pain, and this helps me understand how your body as a whole is moving.
Specific tests/movements: After the global movement screen, we may go through some specific tests. This can include tests to see how you transfer forces or control pressure through your pelvis by lifting a leg or moving in a certain way, tests to see how the nerves in your spine glide and move, or tests to see what structures are contributors to pain you may be experiencing.
Myofascial palpation: Next, we'll see what tissues are tender or not moving well around your abdomen, pelvis, or elsewhere if we need to. This includes gently touching the muscles around the belly, hips, and legs to see if anything feels uncomfortable, and may include lifting and moving the skin and tissues under the skin to see where there may be restrictions in tissue movement.
Pelvic floor examination: After that, we will look more closely at the muscles of your pelvic floor. Because the muscles of the pelvic floor live inside the pelvis, the best way to examine them is by doing an internal vaginal or rectal examination. For this exam, you would undress from the waist down and lie down on a mat table, covered with a sheet. We don't tend to use stirrups for our exams (which most people are grateful for!). We start by looking at the outside tissues. We'll ask you to contract and relax your pelvic floor muscles, and gently bear down to see how your muscles move (Don't worry if you're not sure what to do, we can help teach you!). We may ask you to cough to see how the muscles move reflexively. Then, we often will lightly touch on the outside of the muscles to see if anything feels uncomfortable or sensitive to you. We may check how certain tissues move, if that applies to the problems you are experiencing. After that, we can examine the muscles in more detail by inserting one gloved and lubricated finger into the vaginal or rectal canal. We can then feel the muscles to see if they are tender or uncomfortable, assess the muscle strength and endurance, and assess muscle coordination. *NOTE: While an internal exam is a very valuable examination technique, some people do not feel quite ready for this, or would prefer not to have an internal exam. If that's the case, be sure to let me (or your pelvic PT) know, and we can offer some other options. Also, remember that our exam should not be a painful experience for you. Your pelvic PT should tailor the examination to your needs, so that you leave feeling confident and comfortable, not flared-up and in pain.
Our Plan
After we finish the exam, we should have a clear picture of what areas we can address to work together to help you achieve your goals (whether your goals are to have less pain, stop leaking, start pooping, or something different all together!). So, our next step is to talk about our plan-- what you can get started on today, and what our steps will be to help you reach the goal you want to reach. We also will talk about how often I am recommending you to come see me, and how long I think we might work together. Sometimes I'm really good at estimating this, but sometimes I'm wrong. We can adjust along the way if we need to.
I hope this helps you to feel more comfortable and more confident when coming in for pelvic PT! If you need help finding a skilled pelvic PT in your area, please check out this previous post.
Please let me know if you have questions at all I can help answer! Have a wonderful week!
~Jessica