A lot of what we will go over for a Pelvic Health Assessment will be like a ‘regular’ Physiotherapy assessment – a thorough history including current lifestyle and support factors, looking at clothed movement and palpating (touching) muscles and joints externally, depending on your concerns.

Because I have taken many additional courses in Pelvic Health Physiotherapy, this means I am able to perform internal pelvic floor assessment and treatment, when appropriate and with your consent.

The pelvic floor muscles are at the bottom of the pelvis and run from the pubic bone at the front to the tailbone at the back, as well as attaching to the sit bones and the hips at the side. The best way to assess these muscles to find out if they are strong, flexible, sensitive/tender or extra stretchy (just like any other muscle in the body) is through an “internal digital exam” which means inserting a gloved finger(s) into the vagina or rectum, depending on your concerns and anotomy.

This is different than a pelvic exam you get at your doctors office (for those with vaginas). I am not using a speculum (plastic or metal device that opens the vaginal canal), unless you are coming in for pessary check in’s. I am not performing a PAP smear. My goal is to help address whatever concerns you have, which may include pelvic pain or discomfort, so we are always working within your comfort level. This means you do not need to “put up with” discomfort until it is “over with” like many do with a PAP, intercourse or other internal exams. In fact, we want to address and decrease any discomfort you may have, physical or emotional, to help you address your concerns.

Unfortunately, it is not uncommon for people to have history of trauma, negative experience or abuse that involves the vulva, vagina or rectum. Not everyone is comfortable disclosing that this has occurred, whether to your physio or others in their healthcare team. This is an important piece that I always keep in mind as we progress through the internal portion slowly, always communicating together, and working within your comfort.

This internal exam is how we can get the most accurate information about what is going on for you, however it is always completely optional. Reminder – any internal or external exam is always optional and based off of your consent – even at the doctors office, even at the hospital, even during birth. Consent means you are given the pros, cons/risks and alternatives to undergoing (or not undergoing) an assessment, test or treatment, and that you are able to make a decision based off your wishes and desires without being under duress or feeling pressured. You are able to withdraw your consent (stop the assessment, test or treatment) at any time. There is continual chat occuring between you and I during an assessment to ensure we are both staying on the same page and working towards YOUR goals in way that YOU are comfortable with.

Our Pelvic Health Physio treatment plan will be a colloborative effort based around your goals and may include:

– breathing and movement strategies

– pelvic floor strengthening or relaxation exercises

– using a pessary to help with prolapse or bladder leaking concerns

– gentle internal or external touch performed by you, me or a partner at home if there are pain concerns,

– lifestyle modifications around sleep, stress management, nutrition and coping strategies.

I hope this has clarified what is involved with a Pelvic Health Physiotherapy assessment. As you can see, we’ll work together to address your concerns through a holistic, trauma-informed, collaborative approach. Let’s connect and get started.