Pelvic Floor Physical Therapy (PFPT) is a specialized area of rehabilitation that addresses the muscles, ligaments, and connective tissues within the pelvis. These structures support the pelvic organs, control bladder and bowel function, and contribute to sexual health. If you are experiencing symptoms like incontinence, pelvic pain, or discomfort during intercourse, a physical therapist with specialized training in pelvic health can provide a comprehensive assessment. The first PFPT appointment is dedicated to gathering information and establishing a baseline. This initial visit is an evaluation, not an intensive treatment session, setting a path for personalized care.
Initial Consultation and History Intake
Your first appointment begins with a thorough conversation. The therapist needs to understand the full context of your symptoms, which goes beyond a typical medical history. You will be asked specific questions about your bladder and bowel routines, including frequency, urgency, and any instances of leakage or difficulty emptying fully.
The discussion extends to your sexual health, covering topics like pain during intercourse (dyspareunia) or other related discomfort. The therapist will also inquire about your obstetric and gynecological history, including details of any pregnancies, deliveries, or abdominal surgeries, as these events directly affect the pelvic floor musculature. Lifestyle factors are reviewed, such as fluid intake, diet, physical activity, and any history of chronic coughing or straining, as these habits can contribute to pelvic floor dysfunction.
External Assessment of the Core and Hips
Once the history is complete, the physical assessment moves to the external body, focusing on areas that influence the pelvis. The therapist will first observe your posture and gait, looking for misalignments in the spine, hips, and feet that could place abnormal stress on the pelvic region.
A detailed assessment of the hips and lower back is then performed to check range of motion, flexibility, and strength, as tightness or weakness in these areas can directly affect pelvic floor function. The therapist will also evaluate your breathing mechanics, observing whether you primarily use your diaphragm or accessory muscles, since the diaphragm and pelvic floor work together. Finally, the abdominal wall is checked for muscle integrity and tenderness, including an assessment for diastasis recti, a separation of the outermost abdominal muscles.
Understanding the Internal Pelvic Exam
Following the external assessment, the discussion will transition to the internal pelvic exam, which is a defining feature of PFPT and is performed only with your consent. The therapist will first explain the entire process using anatomical models to ensure you understand what will happen and why. You can stop the examination at any point or decline it entirely, though the internal assessment provides the most precise diagnostic information.
Unlike a gynecological exam, a speculum is not used. The therapist uses a single, gloved, lubricated finger inserted into the vagina or rectum, depending on the symptoms being evaluated. The primary purpose is to assess the pelvic floor muscles directly for their tone, determining if they are too tight (hypertonic) or too relaxed (hypotonic) at rest. The therapist then evaluates muscle strength, endurance, and coordination by asking you to perform gentle contractions and relaxations.
The therapist also looks for specific points of tension, known as trigger points, within the muscle layers that may be referring pain to other areas. By palpating the three layers of pelvic floor muscles, the therapist gains a detailed understanding of how the muscles are contributing to symptoms like pain or incontinence. This assessment allows for an objective measure of muscle performance that informs the exercises and manual therapy techniques needed for a successful treatment plan.
Developing Your Personalized Treatment Plan
The final portion of the initial session involves reviewing the therapist’s findings and collaborating on your path forward. The therapist will explain the relationship between your symptoms and the assessment results, helping you understand the underlying cause of your dysfunction. Based on this data, a personalized plan of care is established, which includes setting short-term and long-term goals for your recovery.
You will likely receive your first set of home exercises, which are often educational, focusing on foundational concepts like proper breathing mechanics or simple muscle awareness movements. These initial assignments are techniques designed to build a mind-body connection with the pelvic floor. The therapist will then discuss the recommended frequency and duration of future sessions to continue active treatment and progress toward your goals.