Pelvic Floor Physical Therapy (PFPT) is a specialized area of rehabilitation focusing on the muscles, ligaments, and connective tissues within the pelvis that support the bladder, uterus, and rectum. This therapy addresses conditions including incontinence, pelvic pain, and issues related to pregnancy or surgery. The primary purpose of the initial visit is to conduct a comprehensive assessment to understand the specific nature of your symptoms and how they relate to your overall body function. This session sets a personalized foundation for your treatment plan.
The Initial Conversation and Symptom History
The first part of your appointment is a detailed, verbal intake where the therapist gathers a thorough history before any physical assessment begins. This discussion creates a safe space to talk openly about sensitive symptoms, as all information remains confidential. The therapist will ask about your complete medical history, including previous surgeries, pregnancies, or chronic conditions relevant to your pelvic health.
A significant portion of this conversation focuses on the function of your bladder and bowels, including questions about frequency, urgency, pain, or trouble with complete emptying. Expect to discuss your lifestyle, such as your job, exercise habits, and fluid intake, as these influence pelvic floor health. The therapist will also inquire about sexual function, asking about pain during intercourse or difficulty with orgasm. This extensive interview helps identify the root causes of your dysfunction and determine the most appropriate physical tests.
External Assessment of Movement and Function
Following the conversation, the therapist begins a physical assessment focusing on areas outside the immediate pelvic region. This is based on the understanding that the pelvic floor muscles are heavily influenced by the surrounding musculoskeletal system. The external assessment often begins with observations of your posture, gait, and functional movements like squatting or bending over.
The therapist will analyze your breathing mechanics, looking for optimal diaphragmatic breathing, as the diaphragm and pelvic floor work together in a coordinated action. They will also perform external palpation, gently pressing on related muscle groups such as the lower back, abdomen, hips, and glutes. This helps identify muscle imbalances, tension, weakness, or trigger points in these supporting areas that may be contributing to your pelvic symptoms.
Understanding the Internal Pelvic Exam
The internal pelvic exam is a distinct part of the assessment that is always voluntary and requires your ongoing consent. This portion is crucial for gathering direct information about the state of the pelvic floor muscles, which run from the pubic bone to the tailbone. The therapist uses one gloved and lubricated finger, inserted either vaginally or rectally depending on your symptoms, to evaluate the muscles.
This exam differs from a gynecological visit; no speculum is used, and the focus is solely on muscle function, not tissue screening. Through internal palpation, the therapist assesses muscle tone, determining if the muscles are too tight (hypertonic) or too loose (hypotonic), and checks for pain trigger points. You may be asked to contract and relax the muscles to test their strength, endurance, and coordination. You have the right to ask the therapist to stop the exam at any moment, and it can be deferred to a later session if you are not comfortable proceeding on the first day.
Reviewing Findings and Planning Next Steps
The final segment involves the therapist summarizing all information gathered from the history, external assessments, and internal exam. They will explain their findings in clear language, discussing how observed muscle dysfunction or movement patterns relate directly to your reported symptoms. This establishes a shared understanding of the underlying causes of your pelvic floor issue.
Together, you and the therapist will set clear, achievable goals for your treatment journey, such as reducing pain or improving bladder control. The therapist will outline a preliminary treatment plan, including an estimate of the frequency and duration of future sessions. You will typically receive initial “homework,” which might include simple exercises like breathing techniques, gentle stretches, or behavioral modifications to begin implementing immediately.