I'm thinking about starting pelvic floor therapy - but gosh, what are they going to do?
What's one reason we most often hear for why women have not made a call to a pelvic floor therapist? Being NERVOUS.
Nervous about finding something wrong.
Nervous about being honest with their bathroom habits.
Nervous to talk about sexual intimacy or pain.
And of course, there’s always the issue of finding the time and energy needed to get started.
Especially as busy moms!
We hear all your nerves and want to ease your mind and walk you through exactly what to expect with your first session.
When you first walk in ...
We make scheduling easy! Our convenient scheduling software sends you email/text reminders, and we have two lovely offices - when you arrive Anna or Kelly will greet you in our waiting room and then you can come on back to the treatment room!
Your first session will be 90 minutes - plenty of time to get to know each other, hear about what your main pain points are, and dive into some hands on assessment as well as starting exercises just for you.
Together we will go over concerns or details of your symptoms, pregnancy, or birth. This can include talking about onset of symptoms. If you just gave birth it may be discussing tearing, instrumental delivery or details about your c-section. Or we can discuss any pain or weakness you’ve been experiencing since pregnancy or birth.
After your health history, we review your pelvic health questionnaire.
This gives us insight into any symptoms you may be experiencing. Sometimes these questions spark great conversation. It shows patterns you may not realize relate to your pelvic health! (i.e. did you know chronic constipation can be related to your pelvic floor?)
The questionnaire asks about some details of your bladder and bowel habits. It also addresses any pelvic pain you’ve been experiencing. This can include pain with intimacy or intercourse. It also includes pain, heaviness, or irritation in your genitals or deep in your pelvis.
We understand it may feel awkward to go into great detail about such an intimate aspect of your life. But rest assured, we are here for YOU. Nothing is off limits! That said, you are always welcome to share what you feel is appropriate. If you find there is something you don’t feel comfortable sharing, don't worry. Your privacy will always be respected.
We will discuss where the pelvic floor muscles are using a pelvic model. As long as looking at where they are, we will discuss their functions and how they relate to your recovery.
I love seeing women begin to understand their anatomy. Seeing how the female body intricately fits together is beautiful in its own right!
Next we move onto your physical assessment:
Once again, I find it important to express that if you are uncomfortable at any point, we can stop. How the physical assessment progresses is completely up to you. Not all aspects must happen in the first session. You get to decide what you are most comfortable with.
We have a few options for getting information about what your muscles are doing. We can do one, two, or all three of these exams depending on your comfort level.
1.) One option is an external assessment. In this exam, I'm gonna look at your breathing. With this, I'll have a chance to see how your muscles are contracting, and how they're relaxing. This can be done with your clothes on.
I will look at your balance and posture. Some things we may have you try include how you get up and down from sitting in a chair. I also look at how you do getting up to standing from sitting on the floor. I may also look to see if you’re able to kneel and get into a hands-and-knee position. I look to see how your posture and pelvis change throughout these movements.
If you’ve given birth, I will also check your abdomen for diastasis recti. Here we look at the width or separation between the middle of your ab muscles at several locations. The depth of the separation is also noted. I will also assess your ability to engage your deep core muscles. I assess this while you are laying down on your back on our exam table. You are fully clothed, though we may ask if you can lift your shirt. This gives me the ability to see how your muscles are working. I will lightly touch the area to determine the width and depth of separation.
Then I assess if you have any tightness or restriction in your skin and muscles. Often I focus on your abdomen and low back, as well as your hips and thighs. I do this by palpating the areas and looking for any places that feel tense or restricted. If I come across some of these areas we may work on releasing them - this can feel like a nice gentle massage!
2.) Another option is that you can disrobe from the waist down. I can take a look at the muscles right around your vaginal opening. And we're gonna look at what happens when you breathe. We look at what happens when you bear down. We also look at what happens, or what does it look like when you do a Kegel? I'm gonna check to make sure that your muscles are coordinating during this. Not only within the muscle movement itself but with the larger system. This includes your core and respiratory diaphragm.
3.) Now yet another option would be to do an internal exam. During this I would leave the room for you to undress from the waist down, and cover up with a sheet. I don't use a speculum. I am going to use a gloved finger and you're gonna feel my finger at your vaginal opening. I will check for any pain or discomfort with light touch at the outermost pelvic floor muscles. Then again with a gloved finger, I'm going to check the strength of your muscles. We will look at the coordination while you contract these muscles as well as your ability to relax them. . We will move very slowly and you are cued the entire time. Usually, women have no more than mild discomfort with this. It feels much less intrusive than a pap-smear or assessment with your gynecologist. It’s important to note that while an internal pelvic floor muscle assessment is the gold standard it is not required.
All three of these exams give us information to help create a plan to reach your individual goals.
Putting it all together - your personalized plan
My goal is to help you on your journey to feeling confident in your body and restoring your pelvic health. I will be there providing you the tools for recovery! I want to help not only in the now but also in moving forward to fostering pelvic wellness for years to come. All goals are individualized to your needs. But if you would like examples of goals for pelvic floor therapy, they can include:
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Achieving a stable core. Being ready for the physical challenges of motherhood. Including being able to exercise and lift your kids. AND being able to do this without pain, leaking, or worsening a diastasis recti.
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Feeling confident in your ability to control your bladder. No leaking, running to the bathroom, burning or incomplete emptying.
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Returning to pain-free intimacy. Sex should never be painful.
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Providing relief from pelvic organ prolapse. This can be a sense of heaviness or dragging in the vagina. This often will feel worse at the end of the day or with extended standing or walking
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Healing pelvic pain. No more vaginismus, vulvar pain, painful sitting (coccyx pain) general back pain etc.
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Integrating healthy bowel habits. Getting a handle on constipation or leaking, and gas control.
Once we finish your initial assessment we will work together to create a plan to reach your goals. We will start with the exercises that are most important for where you are at the first session. The plan of care will include exercises or activities for you to progress to your end goals.
At the end of your first session, you’ll go home with the first exercises for your home exercise program (nothing overwhelming, I promise!). Your homework may also include modifying some of your daily activities. This may include diet and water intake. It may also include posture recommendations. Lastly, we may discuss changes to your bowel and bladder habits.
Taking that first step forward for your own pelvic health
Working with a pelvic floor therapist can help improve both your physical and mental health.
I hope that this helps ease your nerves about what to expect in your first session.
If you have questions or concerns if pelvic floor therapy could be right for you, please don’t hesitate to ask. I’d love to take the time to chat with you about what your experience has been and what you’re looking for! Here’s how you can schedule your free 20-minute phone consultation!