Your First Pelvic PT Visit: What to Expect - Episode 21

In this episode, Dr. Kari Roberts guides listeners through the essential steps of preparing for pelvic physical therapy. She emphasizes the importance of researching and choosing a comfortable therapist, filling out detailed intake forms, and understanding the physical assessment process. The discussion includes an overview of both external and internal pelvic assessments, with a strong emphasis on patient comfort and consent. Dr. Roberts also highlights the variety and personal customization of treatment plans based on individual needs, encouraging listeners to feel empowered and informed about their pelvic health journey.

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• Episode Transcript

  Dr. Kari: So you've decided to go ahead and try pelvic physical therapy. And now it's time to figure out what to expect. Welcome to the Marone Pelvic Health podcast. Hi, I'm your host, Doctor Kerry Roberts. On this show, we will be discussing a variety of things regarding your pelvic health. These conversations will be a mix of education, personal experiences, and a blend of tips you can apply to have a healthier pelvis. The goal of this show is to normalize conversations around pelvic health and help women stop suffering in silence. So let's get into this. What to expect when you go to pelvic physical therapy and how to prepare. So the first thing that you want to do is it's really important if you take the time to do some research and find who you think you'd be comfortable working with. Now, that could be asking a friend, asking a medical provider, looking on Google, reading reviews, but definitely find somebody that you think you can be comfortable with, because you're going to more than likely be talking about some intimate and some pretty personal things. After you find that person, of course you're going to want to call the office and speak to them. If you can't speak to them, then you can speak, speak to one of their representatives, their front desk person, just to kind of get a feel for the clinic. Are you going to be in a busy orthopedic clinic where pelvic physical therapy is just an offshoot? It's just a random offering that's aside from everything else? Or are you going to more of a boutique style treatment center where pelvic health is the main thing? There's no right and there's no wrong. But just based off of what you think is important, you can make that decision better based off of asking those questions and knowing what you're looking for. So you've decided, you've done your research, you've kind of felt them out. You've decided you want to go there, you make the appointment. Okay, you made the appointment. Now what do you do to prepare for the appointment? Please, please, please follow the instructions that the office sends you. For instance, if you come to more in public health, I ask you to fill out the intake form and I let you know up front. It takes about 15 to 20 minutes. The more information you can give that physical therapist about your history, regardless of if you think it's important or not, the better that physical therapist is going to be able to optimize their time with you and be able to hit the ground running with your personalized treatment plan. Do not skimp this step also. Yes, it's really involved. It's going to ask a lot more questions. We have to. As clinicians, we are taught to evaluate things above and below that joint. So if you look at the public floor, it's not a joint, but if we look at it as a joint, just to keep it simple, we want to look at things above. So we're going to look at the chest, what attaches to the chest, the arms. Then we're going to look below, the legs, the feet. We also know that pelvic floor helps manage our bowel system. So we're going to ask questions about bowel habits. We're going to ask questions about bladder habits because pelvic floor affects your bladder habits. We're also going to ask about your sexual function, because the pelvic floor helps manage your sexual function. And the pelvic floor is on the inside of your hips. So we're going to ask questions, ask questions specifically related to your hips and your lower back. So it's very important that you fill out the form. Otherwise, you're going to be spending about ten to 15 minutes answering those questions because either way, we need to know them. So you're going to spend ten to 15 minutes answering those questions in person when you could have just taken the time to answer them beforehand. So he or she can read them, and then you can hit the ground running when you get there. So you've made your appointment, you filled out your paperwork. Now you're walking into the space. What to expect. Hopefully you've gotten instructions of where to go and where to park. I would recommend getting there a couple minutes early, especially if you've never been to public physical therapy before, because it's just going to kind of help you put your mind at ease, maybe get there beforehand, grab a coffee, grab some water, just kind of take in the ambiance that is the clinic that you're going to be working in and wait for your name to be called. Now you get called in the back. Now, this is probably what you're really wanting to know, what to expect during the exam. First, your physical therapist is going to review your intake paperwork, and it's going to ask any questions that she or he has regarding the information that you've already provided. Then they're going to want to ask additional questions to add on to what you've already asked. And those additional questions are going to be based off of the information that you initially shared with them. Now we have to do the actual physical assessment, what all does that entail? We look at your body from top to bottom. So we're going to look the way everything moves, the neck moves, the shoulders move, the elbows move, the hips move, the knees move, the feet move. We're going to look at all of those things. We're also going to do a quick screen of your nerves, so we might do some reflex testing, we might even doing some soft touch, anything like that. Then we're going to get a little bit more involved into the pelvis. And we're going to look at your flexibility, your range of motion, your strength, especially with your lower body, but also with your upper body. We're also going to look at your range of motion of your Spine. We're going to look at some other Physical. I'm sorry, not physical. Some other functional movements, like how you're breathing, how you bend, how you lift, how you stand, looking at your posture, things like that. So all of that is pretty standard for a pelvic physical therapy assessment. The only difference is we're looking at you through the lens of a pelvic physical therapist. So we're looking at your back through the lens of you having pelvic pain, or we're looking at your feet through the lens of you having some bowel or bladder incontinence. So whatever your issue is, we're looking through that lens. But we are primarily orthopedic therapist first. So we're going to look at you in an orthopedic way and then go on from there. Now, I've said this before, but if this is your first time hearing this, your pelvic floor lives on the inside of your pelvic girdle, your pelvic joints on the inside. So how do we get an idea of what's going on with other parts of our body? We would touch and feel those muscles. We might touch the muscle. Then we'll have you do a movement and feel that muscle. Is it turning on? Is it turning off? The same thing can be true with the public floor, and we can assess the pelvic floor two different ways. We can assess it from the outside of your body, which means we're going to be using the pads of our fingers, and we're going to be feeling around your pelvis, feeling around those sit bones, feeling around your pubic bones, feeling around the front of your pelvis, near your edge. We might ask you to do have some cues like drop the flow of urine, stop the flow of gas, maybe even take a big breath, cough, any kind of thing like that we're going to ask you to do, because that gives us really good information on what's going on with your pelvic floor. Now, your exam might stop there, but your physical therapist might need more information. And if so, they're going to explain why they need more information, and they're going to explain that they would recommend having an internal assessment. Now, that internal assessment can be done on the first day, it could be done in a future visit. You and your physical therapist can work that out. But I do want to stress, you do not have to have a pelvic floor assessment in order to be seen by a pelvic physical therapist. I do have people here that can get internal for a variety of reasons. They may not be allowed to from a physician. They may not feel comfortable. They just may not want to, and that's totally fine. However, there's other people that are like, do all of the testing, grab all of the information, get as much information as you can, because I want the situation fixed. So either way is completely fine. But if you're in the second camp where you're like, okay, let's go ahead and do this assessment, then we will do an internal. We will do the external first, which I just explained, and then time permitting, and if it was deemed appropriate, we would do an internal assessment. Now, for those of us that are women, you have three openings through your pelvic floor. You have the urethra, the vagina and the anus. And then for those of you that are male, you have two, the urethra and the anus. So if you are a female, more times than not, the physical therapist will want to do an internal assessment through the vagina. Why? Because the vagina is designed to receive things in it and things go out of it, like babies in your cycle and things like that. Things in it when you're having intercourse, when you're going for a gynecological exam, things like that. It's not a foreign concept for things to go in and out of the vagina. Also, the vagina is self lubricating and is very stretchy, so it's not as invasive as going through another orifice. We would apply some nice small amount of lube onto our gloved finger, and we would use just one finger to actually feel around the multiple layers of the pelvic floor. Ask you to do different things while we're doing our assessment to give us more information. Now, if you are male or if your symptoms are otherwise, we might ask to do an anal a trans rectal assessment, which is the same thing, but it's going to be not a little bit of lube, but pretty copious amount of lube on our finger. And we're going to assess the external anal sphincter, the internal anal sphincter, and then the deep layer of the pelvic floor. Now, if you're a male, that's the only way that we can assess the inside part of your pelvic floor. If you're a female, we've got two options. Now, if you are a female, yes, you got two options, but they give us different information. So one, we're looking at things from the front entrance. The other way we're looking at things from the back entrance. And when we look at both, we can get the full picture of what's really going on and really give you pinpointed treatment in a plan. Now, all of this is optional. Coming to pelvic physical therapy is optional. Going through the assessment is optional. Getting the external assessment optional. Internal assessment optional. Then internal. You're looking at trans, rectal, transvaginal. Either way, it is optional. That's the main thing that I want to focus on in this visit. Those are some of the things to expect during an exam. But primarily, you should only expect what you feel comfortable allowing to happen during your visit. I don't want you to feel like you are forced to do something that you're not comfortable doing because that's not how we operate. We're always looking to do the least amount of things that can give us the most amount of information so that we can create your personalized plan. And that looks different for every single person. You might say yes today and no tomorrow. You might say no today and yes tomorrow. We're going to completely ride through it. But either way, you figure after we do our assessment, our physical assessment, with whatever that entails, then we're usually going to take some time and sit down and talk to you. This is what we found, and this is how our findings relate to your main concern. And then this is the plan that we're putting forth. And this is how often we think you should come. And these are the reasons why. And most times we will send you home with some sort of homework or something to do on your own, and then you can come back and report more information, information so that we can really fine tune that plan even further. So just as a recap, how do you prepare? First you want to do your research and find a therapist that you office that you think you feel comfortable. Then you want to give them a call to get a feel for the, for the, for the treatment center and make sure that the vibe you're getting from them is what you want for yourself. Then you're going to want to make sure you fill out your paperwork in its entirety to maximize the time that you have with the therapist. Then when you come in, we're going to review that paperwork briefly, make sure that we've got everything down pat, ask any additional questions that are needed. Then we're going to do a complete physical assessment from head to toe, looking at range of motion, your strength, your flexibility, all of those things. And then if needed, and if time permitting, we might decide to do an internal assessment of your pelvic floor, transvaginally or trans rectally with your permission, so that we can get even more information and finalize our get our findings all put together. Then before you leave, we're going to take some time and explain to you the findings that we saw, how those findings relate to what your issue is, and what our plan is to help you overcome your issues in a nutshell. So if that sounds like something you're like, okay, I can do that then good. Because if you feel like you need pelvic physical therapy, there are so many people out there that are, that are ready to help you. But also, I wanted to remind you I do see patients in person in the Atlanta area, as well as seeing people virtually. If you are anywhere that has Internet, then I can see you virtually. So I hope that this helps you feel more comfortable with knowing how to prepare for pelvic therapy. And if you do decide to get pelvic physical therapy, I hope this makes you feel comfortable with making that decision. Until next time, thank you for listening to this episode of the Morone Pelvic Health podcast. Please do me a favor and leave a review so that more people can find this content and make sure you like and subscribe yourself so you never miss another episode.