What should I expect at my first session?
Your Pelvic Physiotherapist will start off by collecting a detailed history of your symptoms. She will then ask about many other potential symptoms that often go with pelvic floor dysfunction. These include questions about sexual function, bladder, bowel, low back, hip and tailbone symptoms. These questions may seem very personal and unrelated, but if there are problems in any of these areas, it is important to tell your therapist as they are often related to pelvic floor dysfunction. Your Pelvic Physiotherapist may ask you to fill out further questionnaires which will give her a better idea of what is contributing to your specific symptoms.
Once your Pelvic Physiotherapist has gathered information about your condition, she will begin a physical assessment. These may vary depending on your symptoms, and may not all be completed on the first visit. The physical assessment may include assessment of your low back, SI joints, connective tissue of the abdomen and thighs, and a pelvic floor assessment. A pelvic floor assessment involves an internal exam looking for trigger points in the pelvic floor, and assessing the strength of the pelvic floor.
Once your Pelvic Physiotherapist has completed her examination, she will explain her findings to you. She will give you exercises or other homework to do, and explain how often you should return for treatment. She will explain what changes you should expect to see, and how long you should expect your treatment to take. She will give you time to ask questions.
Is an internal examination required?
An internal examination is the gold standard for assessment and treatment of conditions related to the pelvic floor. Without feeling the muscles, your pelvic floor physiotherapist will be unable to identify if you have trigger points, or if you can contract your pelvic floor effectively.
That being said, there are generally many parts of the assessment and treatment that can take place without an internal exam. Some patients have been treated successfully without ever doing an exam.
Though the most benefit will be derived if your pelvic floor physiotherapist completes an internal exam, you will still benefit from coming if you are uncomfortable with or unable to have an internal exam.
How many sessions are required?
This will depend on your condition and its complexity. In general, for simple incontinence or prolapse (without any exacerbating factors), you will require 6-12 treatments. If you have a complex pain issue, this will likely take longer.
Is there homework to do between sessions?
Yes, there is homework. Some examples of homework you may have include stretches, strengthening exercises or tracking things like bladder or bowel habits, diet, and fluid intake.
What if I already tried doing kegels and they didn't work?
Pelvic floor physiotherapy is so much more than just kegels (pelvic floor muscle training). If you have tried doing kegels in the past but have not noticed any improvement, there could be many reasons.
Firstly, up to 30% of women are unable to do a kegel when asked. Many women instead contract their abdominals, glutes, or adductors. Or they bear down (push). If this is the issue, you may have been attempting to do kegels, but you have actually been strengthening the wrong muscles. A pelvic floor physiotherapist will check vaginally or rectally so they can actually feel your kegel, and teach you how to locate and contract your pelvic floor.
If you have been doing kegels with no effect, the problem could be that your pelvic floor is actually too tight, or has trigger points. For a muscle to be effective, it needs to have strength, but it also needs to be able to relax. For instance, if you can’t open your fist, strengthening your hand is not going to help. In this case, doing kegels may have actually made your symptoms worse. Instead, your pelvic floor physiotherapist will release the tension or trigger points in your pelvic floor muscles, and give you stretches or other exercises to do at home. Your pelvic floor physiotherapist will also help you determine what other factors may be contributing to the tension or trigger points in your pelvic floor.
Pediatric Pelvic Floor Physiotherapy: What to expect
Evaluations are scheduled for one hour; treatment lengths vary between 30-45 minutes depending on the need of the individual child. All evaluation and treatment will be performed with a parent/guardian present in the room and with consent from both the child and parent/guardian.
At your first appointment, your physiotherapist will take a detailed medical history and listen to the current concerns of both child and caregiver. If you have had any medical testing, please bring the results with you (ie: urodynamics, x-rays, etc). If you have not seen a doctor, your physiotherapist may suggest that you schedule an appointment as needed. You do not need a doctor’s referral for pelvic physiotherapy, although it is often quite helpful for your physio to work cooperatively with your doctor to develop the best treatment plan. Your extended health insurer may require a doctor’s prescription.
Your physiotherapist will assess your child’s posture, movement patterns and coordination. Next, your physiotherapist will do an external examination of your child’s perineum to visually assess the movement of the pelvic floor muscles and check for any skin irritation or other concerns. Your physiotherapist will also check for sensation and reflexes in the pelvic region using light external touch. There are NO internal vaginal or rectal examinations done on children. Instead, the pelvic floor is assessed/treated visually or using biofeedback therapy. Biofeedback therapy is performed externally, using sticky surface electrodes on the sides of the anal muscles. These electrodes record the underlying muscle activity and transmit that data to a computer system to give a picture of how the pelvic floor muscles are contracting and relaxing. Biofeedback is used for both assessment and training of the pelvic floor muscles.
After your scheduled evaluation or treatment, you will be given homework based on your child’s individual needs. This may include exercises, diet modifications, or toileting schedules. Therapy works best if this homework is completed regularly! Your physiotherapist will discuss length and frequency of treatment recommendations after your initial assessment is completed.