What should you expect when you go and see a pelvic health physiotherapist for the first time?

This is a great question and one that many are not familiar with, including physiotherapists who do not specialise in this domain.

A physiotherapist is widely known (often for the wrong presumptions) for their hands on skill and many people today still believe we are massage therapists. However, we are not. Yes, it is part of our undergraduate training but I’m pretty sure the three hours training we did, does not define us as massage experts!

Instead, physiotherapists in the UK, work to assess, diagnose and treat what they find from both listening to the patient and then looking at the patient.

Physiotherapists cover a huge array of ailments.

Some of us specialise in treating children, the elderly, orthopaedic problems like hip or knee replacements, fractures (broken bones), respiratory diseases (eg.asthma, COPD, CF, pneumonia) for example. Did you know there are physio’s who specialise in burns and plastics also?

There are many areas we operate within but women’s health, now referred to as pelvic health as men are also treated, is a specialist field of it’s own.

A pelvic health physiotherapist may see a variety of ailments that mainly link to problems relating to the pelvic area.

These can be related to toileting issues, pelvic pain, pregnancy ailments, post natal tummy separation issues and such like. So let’s take a look at exactly what they commonly “see” patients for in clinic.

• Musculoskeletal pain – mainly lower back and pelvic regions, but commonly wrists, hips and feet in pregnancy and post partum.
• Incontinence – urinary, faecal or wind related.
• Pelvic organ prolapse – heaviness, dragging or bulging feeling down below.
• Diastasis recti – tummy muscle separation issues.
• Scar tissue healing – post c-section, hysterectomy or perineal tears.
• Altered sensation relating to bladder and bowel function.
• Pain during intercourse or penetration.
• Increased frequency, urgency or hesistancy when needing to empty the bladder or bowel.
• Bowel health – constipation.
• Vagina health – unable to insert a tampon/menstrual cup, painful periods, feeling to loose/open, inability to have a smear test.
• Inability to feel, find or engage pelvic floor muscles.
• Incomplete emptying of the bladder or bowel issues.
• Exercise advise and guidelines for pregnancy and post partum.
• Labour and childbirth optimal positioning and pelvic floor education training.
• Recovery post gynaecological, bowel or abdominal surgery.

Hopefully that list gives you a bit of insight, but as you can see the pelvic health physiotherapist role is wide and diverse. Some may specialise in obstetric health (pregnancy) and others may specialise in continence health (bladder/bowel health), it really does vary but most will assess and treat both areas.

So what exactly should you expect when you actually go and SEE a pelvic health physiotherapist for the first time?

To begin with a pelvic health physiotherapist will want to know lots of information about YOU. What is bothering you? What has happened to you in the past obstetrically? (birth stories), gynaecological history? (any surgery or toileting issues) and what you would like to achieve from your physiotherapy session(s).

We would then always start with education. Education about the pelvis, your anatomy, your pelvic floor, your abdomen, whatever the area of concern we will explain it in more depth to help increase your understanding.

If you understand HOW you work and function then your treatment will be more relatable and your results with be significantly better as you will be motivated also.

Then with your consent we would LOOK at the bothersome part. Be that your stomach, your pelvic floor, your hips, your lower back, etc. We do a thorough examination of those areas.

Let’s talk about HOW exactly a pelvic floor examination is completed. It is an invaluable assessment to help put all the bits of puzzle together in terms of your symptoms and what is going on.

Firstly it is not like having a smear test, there are no instruments used to scrape your cervix. Yes you will undress your lower half including underwear and lay down on the plinth. We would normally assess you with your knees bent, feet flat on the plinth and legs apart (the same position you adopt for a smear test).

A pelvic health physiotherapist will want to examine your pelvic floor using a gloved finger and a small amount of lube in a lying (or standing) position based on your symptoms. One or two fingers are inserted into your vagina and the pelvic floor muscles are palpated and assessed for strength, range of movement and how they relax and lengthen.

If you have had any perineal scars these would also be looked at for healing signs along with an assessment for any pelvic organ prolapse.

It should never be a painful examination and although it can feel embarrassing as a patient, the physiotherapist is really not looking at, or interested in, when you last bikini waxed I can assure you. There is so much to think about when assessing the pelvic floor muscles – our brains flit to assessment mode and we are purely focussed on what information your body is feeding back to us.

Once the examination is completed, the findings along with the answers to the questions you gave us before it, would be utilised to make a plan based on a diagnosis of your symptoms. A treatment plan including lifestyle advise, exercise, manual therapy or even biofeedback can be used to help you feeling much more like you again.

I hope that gives you a bit of an insight into what to expect when you go and see a pelvic health physiotherapist. I also hope it helps you seek treatment sooner and be confident in what to expect. If you have any questions please do reach out and message me through my e-mail marie@mariefellthepilatesphysio.com and if you want to find a pelvic health physiotherapist near you take a look at my website www.mariefellthepilatesphysio.com/resources and the resources page.

Marie Fell is the founder of The Pilates Physio UK who now lives and works in Luxembourg. She is a qualified physiotherapist with over 12 years NHS experience in a wide array of specialisms and three years experience running her own business. Her passion lies in Posture, Pilates and the Pelvic floor! She is an enthusiastic pelvic health activist and uses her blog to highlight areas of pelvic health that are lacking to others.

She is passionate about improving post natal care for all ladies through education. Her mission is to empower, inspire and educate others to move freely and keep healthy and teaching Pilates with a clinicians hat on allows her the best of both worlds.