What to Expect at your appointment with a Pelvic Floor Physiotherapist

Corinne Langford is a mom of two, a Calgary pelvic floor physiotherapist since 2004, and is currently studying yoga therapy. Thank you for writing this guest blog post for us!

Ok, you’re thinking about it. You’ve heard about pelvic floor physiotherapy, either from a friend, your mom, another health practitioner, or through a google search. It’s not uncommon for it to take a moment to sink in as you think “they do what?”.

It’s true. Pelvic floor physiotherapy is successful because there is no guess work, we assess and treat the pelvic floor directly. It’s really all just anatomy, albeit a very personal area of anatomy.

But we should be caring for our pelvic floor the same as we care for our shoulder, knee or foot. It’s an important area of our body that is often under treated, which is a sin because our pelvic region goes through A LOT over our lifetime.

So what exactly does an assessment look like? First of all, pelvic floor physios tend to have a looong intake and history form. It’s a very big umbrella for such a little area, so we will talk about your general health history, childbirth experiences, concerns with intercourse, and ask all about your bladder and bowel habits and symptoms. We will ask about your job, daily activities and your exercise regime. Honestly, my favourite tidbits of information often start with “this might not be related, but....”. Sometimes it’s not related, but I have found more jewels of insight from these statements then I can remember. Generally, its ALL related.

After we chat, I explain what the actual assessment will entail (keep reading for this insider knowledge). Then comes the most important thing for my client to understand: the consent form. The most important piece of information on this sheet is that the client can withdraw consent, at any time, on any appointment. Honestly, it’s ok. I always say “we don’t have to do this all at one time, if you feel overwhelmed, or uncomfortable at any point, let me know and we can do the rest next time. And this goes for any treatment session”. We have SO much education and externally based topics to go through (posture, toilet education, positioning), we can always concentrate on these things. But truly, the sentiment expressed after assessments is “ok, that wasn’t as bad as I thought”.

I want this to be a very gentle, respectful, educational, and empowering experience for each client, every time.

Sometimes the assessment will start with some screening tests looking at pelvic joint symmetry/pain with movement. In fact, if a client comes in with predominant concerns of symphysis pubis or sacroiliac joint pain, our initial assessment/treatment may be entirely external.

Our “pelvic floor assessment” starts off with assessing diaphragmatic function, which is so very closely linked with pelvic floor function. In fact, regardless of whether we will be working on strengthening the pelvic floor, or relaxing the pelvic floor, we will use the diaphragm. I then look at the abdominal musculature. I am primarily looking for muscle tension, muscle activation, scar tissue, and I will assess for a diastasis recti.

The assessment itself starts off with visualization of the external genitalia. I am looking for skin changes or discolouration, descent of the tissue, scarring, and the general health of the labia. I will complete a couple of other external tests, and then I gently palpate along the vaginal walls, feeling for increased or decreased muscle tone. Sometimes the muscles are so tight that I am not able to comfortably access the deeper pelvic floor muscles.

I always assure clients that I will NEVER push past tight and sore muscles.

If the superficial pelvic floor muscle are extremely tight, assessment turns into treatment and I start teaching my client how to connect with and relax the pelvic floor muscles. If there is not too much tension, I will assess for muscle activation/strength, balance, and endurance. I use this information to choose the type of “kegel” I would like my client to start with. Believe it or not, I have 9 types of kegels to choose from to recommend, including some that actually teach how to relax the pelvic floor.

The assessment may also include a rectal assessment, which will assess the integrity of the anal sphincters, as well as the rectal walls. I will ask the client to contract/relax these muscles, as I assess tone/tension. This is an excellent way to directly assess the position and mobility of the tailbone. Like the vaginal exam, this is a very gentle assessment.

After the assessment I leave the room so the client can get dressed, and then we go through the results, as well as the home exercise program.

Although there are some guidelines regarding reps and sets for kegels, it is ALWAYS quality over quantity.

So if the muscles are fatiguing after 5 repetitions during the assessment, then that is approximately how many will be in a set. Of course, this is if you even receive “strengthening” exercises, many people have come in for strengthening and left with a program that focuses on relaxing tight pelvic floor muscles (remember that tension and weakness often go hand in hand).

One of the most common mistakes made with kegels is trying too hard, you can’t bulldoze through these exercises. Initially, these exercises usually feel more like a “brain” exercise than a “muscle strengthening” exercise.

Eventually, within the program, clients can expect to have breathing exercises, postural exercises, and exercises that coordinate the pelvic floor with the transverse abdominus, and other muscle groups (ie. glutes).

One of the things that surprises many people, is how many topics we will address. For example did you know that constipation is a very common cause of pelvic organ prolapse, and urinary incontinence? Or that calf tension can contribute to pelvic floor tension? Honestly, the interconnection between different areas of our body is fascinating.

Other Tidbits:

• Assessments and treatments are all for 1 hour, although there are shorter appointment slots if we are near the end of a treatment program and doing more of a “check in”. But you’d be surprised at quickly an hour goes by.

• Initially, appointments are every 2 weeks, and then we start to stretch it out. The average number of visits is between 4-6. But to be honest this depends on how many things we have to treat, the severity of symptoms and of course how often you do your exercises.

• Clients are always welcome to bring their baby and kids. It is absolutely easier for the client if they are on their own, because then they can just focus on themselves. But sometimes this just isn’t feasible. Sometimes babies sleep, and sometimes they cry. It’s all good, we just work around their needs.

The overwhelming sentiment expressed after a couple of visits is one of empowerment.

People are often surprised at how much they learn about themselves and pelvic health. And many comment on how really, in an ideal world, every woman would have at least an initial assessment. Our bodies go through so much, and pelvic concerns are often under treated because many don’t realize that there are treatment options available for most conditions.

Remember, pelvic symptoms are common but NEVER normal.

.Corinne Langford BScPT Corinne is a pelvic floor physiotherapist with Inner Balance Physiotherapy, and the Lifemark Health Centre - Sundance. A pelvic floor physiotherapist since 2004, Corinne treats men and women with all pelvic concerns ranging from pelvic floor weakness, incontinence, pelvic pain, prolapse.  Inner Balance Physio offers one on one sessions of pelvic floor physiotherapy in Calgary, one on one in home sessions, pelvic health workshops, and classes.  Corinne is dedicated to helping her clients discover and develop their own inner source of healing and strength.