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Pelvic Floor Rehabilitation: What to Expect

Posted on Aug 03 2020
Posted by: Dr Binal Dave

Many people who are recommended to participate in pelvic floor physical therapy have a lot of questions. They have often never heard of this type of therapy and frequently asked questions are… What is pelvic floor rehabilitation? What should I expect? What should I wear?

What is pelvic floor rehabilitation?
Physiotherapists (PTs) are engaged in this type of therapy.
Pelvic floor rehabilitation is a specialty in physical therapy that focuses on more than the pelvic floor and can include the muscles and fascia in the pelvis, hips, back, and thorax or rib-cage.
Physiotherapists (PTs) who specialize in pelvic floor treat a variety of patients and problems; this can include bowel/bladder/sexual problems, prolapse, abdominal pain, back pain/pelvic pain, and more. Most therapists see women, and not see men; additional training is needed to treat children. If you have any questions about your care and if the therapist treats your population and diagnosis it can be worth a call.

What is the difference between pelvic floor therapy, rehabilitation or physiotherapy?
There is no big difference. Different regions have different words for the same thing; like soda vs. pop.

What should I expect in the evaluation?
The basic formula for a pelvic floor evaluation is to take a history, evaluation, and assessment. Taking a history is a conversation between you and the therapist. What your complaints are and what you want help with will be the focus. But beyond that basic formula, it really depends.
In the first session, it is important for the individual to become comfortable with the therapist. Studies have shown that the most important factor for therapy treatment to be successful is how much the individual trusts the provider.
Beyond the basic formula, there are all sorts of variables. In general, most of the evaluation will be talking and taking a history. Some people have a more complicated history than others. The therapist listens and then often explains how your symptoms relate to pelvic floor muscles if they are related. Frequently, hip pain or back pain may be present and are asked about and later assessed. Generally, a physical therapist that specializes in pelvic floor muscles will ask you about bowel, bladder, and sexual function. He or she may ask additional questions to help paint a clearer picture about you; about your diet, exercise habits, stress levels, self-care, trauma history, what gives you joy, how long your problem has been going on for, what you have tried before and was that effective. If you have sexual concerns the therapist may ask you about your sexual activity, sexual orientation, gender identity, etc. After history conversation, the evaluation continues to a physical examination. Often there is an education section; the therapist teaches about the muscles of the pelvis; the actions of the muscles and how they work. Generally, a therapist will also show what the pelvic floor assessment looks like on a pelvic model. The physical examination may start with an orthopaedic assessment; looking at back/hips/rib-cage depending on the individual’s symptoms, and then may progress onto assessing the pelvic floor muscles. It truly depends on that individual’s presentation.
For example, if you have pain with intercourse and some urinary leakage, but only want help with the urinary problems because that is what affects you more in day to day life that will be the focus. The physiotherapist (PT) may still ask about your pain with intercourse as the muscles do both activities.
This can all happen during the first session or may be spread over the first few sessions. It depends on how much time and how complicated the case.
The relationship between the provider and the participant is a partnership. The analogy that I often use is that therapy is like going on a road trip; the individual or participant is the bus driver and the therapist is the navigator. The navigator knows where we are going and has a road map, but which roads we use is up to the driver.
If you feel uncomfortable with any part; say so; you are the driver. There are always other roads. A good therapist will ask for consent several times, if you have any questions, and will generally give you options on how to proceed.

What should I wear to pelvic floor therapy?
You can wear whatever you feel comfortable in and are able to move easily in. If you are coming from work you can always bring a pair of shorts or sweats to change into if that works better for you.

What else should I keep in mind?
This type of therapy can be challenging. Often there is a slowing down and pausing; which can be hard in our fast-paced culture. If you have a history of trauma (this includes medical trauma) it is not uncommon for flashbacks to occur. In general, it is strongly recommended that you have a good team working with you and on your side. Your therapist is only one member. Having additional resources like friends/family, a mental health therapist, your primary care provider, and others can help tremendously.

What should not happen during an evaluation?
Some discomfort is okay, and that level is “wow, this person is asking very personal questions” and “I don’t normally talk about this stuff” level is okay. It is okay to feel vulnerable. It is not okay to feel exposed or that you are doing something just for the therapist that you don’t feel comfortable participating in.
Pain can be a trickier concept. If pain is the reason that you are going to therapy, then you may feel some discomfort as the therapist learns about you and your pain; discomfort is more likely to be felt on the first day, but from then on the goal is to decrease your pain. Sometimes it can be a relief that someone ‘found’ you pain. However, if you feel pain or discomfort that you are uncomfortable with please tell your therapist. Therapists have lots of tools, and if you don’t feel comfortable with a specific exercise or technique ask if there is another way to achieve the goal.