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The Value of a Pelvic Floor Physical Therapy Evaluation

So you went in for your postpartum follow up with your OB-GYN. They assessed your scars, maybe did a pelvic exam to assess your organs, and then gave you the all clear to resume regular activities. But things don't feel right. Maybe it's a new feeling of heaviness, or it's leaking, or weakness, or pain and tension.  Now you aren't sure where to turn.

OB-GYNs are great, but they are not pelvic floor rehab specialists. We assess different things. Their pelvic examinations look to rule out organ pathology or diseases, infections, hormone changes, or structural damage. Pelvic Floor Therapists are looking at muscles and connective tissues and how well they are functioning. That means we are looking at nerve and muscle function, coordination, strength, flexibility. A great therapist will look at the whole body, how well it is all working together, the movement patterns and postural preferences we all have. 

So why should Pelvic Floor PT be a more standard part of postpartum care? Many women experience problems with leaking, prolapse, diastasis, scar adhesions, tension, nerve injury, and it all goes untreated. Many moms hear they have the "all clear" and assume that what they are feeling is just their new normal. I want you to know all those complaints are common but not normal! And the sooner they are addressed, the better the outcomes.

What happens in an eval? All therapists will approach evaluations a little differently, but here is what I like to focus on with my patients and clients: 

1. Tell me your story: I want to hear your history, your goals, your birth story, your prior level of activity, past injuries

2. Posture assessment: How you hold your body impacts how you move and where pressure goes. We can see what needs length, what needs strength, what you need to be more aware of

3. Movement screening: How's your form with basic movements like squats, deadlifts, running, jumping, whatever it is you like to do. Do you have good patterns, or do we have a lot of work to do?

4. Breathing assessment: The pelvic floor is intimately connected to the core and diaphragm. This can help us see how well coordinated your core and pelvic floor are

5. Abdominal wall check: If your have abdominal scars from a scope or c-section, I look at how well they are healed, how well they move. I also check for diastasis recti. I have you do a small head lift while laying on your back and feel along the midline of the abdomen. I am looking for how wide the space is and how soft it may be. 

6. Pelvic Floor External Assessment: (I need to stress that all steps of this process only occur with patient consent, sometimes we hold parts of the assessment for another day or skip it all together, the patient is in the driver's seat always) You can undress from the waist down and use a drape sheet or a gown. Then I guide you through how to contract, relax, and lengthen the pelvic floor. I also ask you to cough and see if the pelvic floor lifts or drops. This helps gauge coordination. Next, I look for any signs of infection, skin changes from scars or hormone changes, etc. With a gloved finger I feel more superficial muscles of the pelvic floor on the outside of the body. Sometimes I will use a Q-Tip to assess sensation.

7. Internal Pelvic Floor Assessment: Internal assessment again is heavily dependent on patient consent and comfort. With a gloved and lubricated finger I assess each layer of pelvic floor muscles. There are 3 muscle layers, we know where we are based on depth, the first layer is at the depth of the first knuckle, the second layer is at the second knuckle, the third is at the layer of the third knuckle. In each layer we work around in a circular clock like motion to assess each muscle for tension or tenderness. Pressure is light, there is a lot of communication, we work to keep you in your comfort level. After checking each level I test strength and endurance test by having you perform a pelvic floor contraction (Kegel). For those with concerns of prolapse, we may also do some bearing down to check mobility of the pelvic floor structures. 

8. Treatment: I like to finish with tools that you can start using at home on day one. We might chat about self-care tools like pelvic wands or trainers. We may start with breathing exercises, strength training or stretches. 

What we find in an evaluation guides treatment. Not everyone who leaks is going to have the same exam findings. Someone may have profound weakness and major muscle tearing causing leaks, another may have too much muscle tension. Someone may have a low grade prolapse that is majorly symptomatic, others may have a higher grade well managed by a pessary. There are some things we cannot diagnose without internal evaluation, but for those who do not want to complete one it is OK! I look for clues from other parts of my assessment to make the best treatment plan possible. 

Have more questions on what to expect? Email, message, or call. Even better, schedule a free consultation so we can talk about your unique needs!