Going to see a women’s pelvic health physiotherapist? Find out what to expect from your appointment and five top tips about how to make the most of it.
Be prepared to talk about your symptoms, decide which ones are most ‘bothersome’ and how long they’ve been an issue in your life.
Understanding the types of symptoms you experience and hearing you describe them is a really important part of the assessment process. It helps your physiotherapist begin to piece together a ‘clinical picture’ before your physical examination. Women often find it a huge relief to be able to talk openly about problems they may have been silently coping with for years.
Now some of your symptoms may be absolutely toe curlingly embarrassing to you but it’s good to understand that an experienced pelvic health physio will have heard them all before!
This word cloud gives examples of the kinds of symptoms women describe.
Be prepared to take some information about your bladder habits.
This is really important if your main issues are with, what we often call, an ‘overactive bladder’. This is when the feeling of needing to wee is constantly on your mind and when urgency stops you reaching the toilet on time.
A diary can also help to identify ‘stress leaks’. These can happen with any activity that puts pressure on a bladder that’s not well supported.
A diary shows how your bladder behaves on a day-to-day basis. Measurements such as how much urine your bladder holds, how often you have to pass urine and the circumstances that cause you to leak all add to your ‘clinical picture’.
F – Fluid intake
Record how much fluid you drink in mls and whether it’s coffee, tea, water, beer etc.
U – Urine passed
It’s really important to record the amount of urine passed in mls. Use a measuring jug if you’re at home. If you’re out and about and it’s impossible to measure, then just tick the box instead.
W – Wet
Record any wet episodes, simply tick the box.
Bowel problems are incredibly common and people find it very difficult to seek help often because they don’t know whom they could approach. It’s tempting to search the internet for answers but seeking guidance from a professional is safer.
There are a number of ‘red flag’ symptoms that a health care professional would be able to screen for and then often simple strategies can sort out bowel symptoms that have been bothersome for years.
Both bladder and bowel diaries are downloadable from the internet and are set out in a format that helps you to capture the details easily as well as helping your therapist to easily pull out all the relevant information.
When going to see a women’s pelvic health physiotherapist, be prepared for a physical assessment that will include more than just reviewing your pelvic floor area. The examination may begin in a standing position where your postural alignment, spine and pelvic movements can be viewed.
We do know that no-one is symmetrical and that as far as alignment is concerned it’s ‘normal to be abnormal’.
The aim of the assessment is to see if the muscles of your core and pelvic floor are able to work in a co-ordinated way.
So expect your therapist to be looking at the bigger picture of how your body puts movements together and whether it’s able to co-ordinate effective patterns of breathing.
Be prepared for the pelvic floor examination to be ‘interactive’ and take a few minutes to complete. Don’t be embarrassed – remember your therapist is likely to have examined hundreds of women and will have a wealth of experience in ‘pelvic floors’.
You should be comfortable, relaxed, have been given a clear explanation of what the internal vaginal examination will involve and know that you can opt out at any stage.
The assessment is likely to include;
- Checking the skin condition of the vulva and vaginal area
- Assessing for weakness of the front and back vaginal walls (prolapse) on coughing
- Palpating the resting background tone of the pelvic floor
- Assessing the co-ordination of the pelvic floor movement with abdominal, diaphragm and other core muscle activity
- Ability of the pelvic floor muscles to fully release and relax
- Evaluate the power, speed and endurance of the pelvic floor muscles
- Check your technique and ability to perform an effective contraction
- Note areas of sensitivity, tension and tightness
- A test to see if there a reflex contraction of your pelvic floor when you cough
So the internal examination may take five minutes or more but the information that’s gathered combined with the discussion about your symptoms means that your physiotherapist is likely to be able to give to an accurate diagnosis and put together an effective treatment plan.
Be prepared to be given a rehabilitation plan that may include anything in this word cloud.
Pelvic physiotherapy can lead to a steady improvement in your symptoms but not usually a ‘quick fix’. The general guidance is that it can take around three months to see an improvement but that can very much depend on what your main problem has been.
Some women do notice a faster improvement especially if their main issue has been leaks on coughing. Once they learn to engage their pelvic floor effectively before a cough they stay dry!
Do be patient with yourself. We know even simple lifestyle changes or short exercise programmes can be a challenge to stick to. Changing behaviour is never easy but remember that with a personalised treatment programme you’re on the right path to recovery!
de Smit Medical has been working alongside Chartered Physiotherapist, Jane Appleyard to create a blog for advice and thoughts on a range of topics relating to the pelvic floor. Return to our blog for more articles and videos.
Jane Appleyard has over 30 years' experience as a Chartered Physiotherapist and specialises in pelvic health. You can read Jane's bio here.