FAQs – Pelvic Health Physiotherapy
What does an Internal Pelvic Exam entail?
A complete internal pelvic exam consists of both a vaginal exam and an anorectal exam. It is important for your physiotherapist to get information about both the front and back portions of the pelvic floor in order to provide the most comprehensive evaluation of the function of this area so as to better guide treatment.
What if I don’t want to have an internal exam/internal treatment?
While a complete internal pelvic exam is always recommended in order to provide your physiotherapist with the most comprehensive overview of the function of the pelvic floor and help guide treatment, it is always your choice when it comes to your health. If after discussing with your physiotherapist the reason(s) for your visit, understanding the anatomy and function of the pelvic floor, and what the assessment/treatment options may entail, you remain uncomfortable with having a pelvic exam, none will be completed and alternative options may be considered.
Similarly, if at any point during the pelvic exam or subsequent pelvic floor treatments, you wish to withdraw your consent, that is no problem. Simply let your therapist know that you don’t wish to continue, and you can discuss alternative options.
My doctor/midwife already did a pelvic exam. Why do I need another one?
Generally doctors and midwives have a different focus than physiotherapists during a pelvic exam. Doctors/midwives are mainly checking to ensure that there is nothing medically wrong with your pelvic floor (e.g. malignancy, infection). Meanwhile, pelvic health physiotherapists are more interested in function – muscle strength and recruitment, coordination of the pelvic floor muscles with the rest of the core, the alignment and mobility of the bones and joints of the pelvis, any scar tissue or adhesions in this region, and the position of the pelvic organs. Pelvic health physiotherapists then put together their findings from the pelvic floor exam with findings from the orthopaedic exam (how the rest of your body moves/functions) in order to determine the best plan of care.
What can I expect at the first Pelvic Health visit?
Your first pelvic health visit will last between 60-90 minutes; it will include a discussion of your health history and the reason(s) for your visit, a thorough orthopaedic assessment of the spine, pelvis, abdomen and hips, and an internal pelvic exam. Once the comprehensive assessment is completed, your physiotherapist will inform you of her findings, provide education about your condition, and prescribe some starter home exercises.
All pelvic health exams are done in a private room, one-on-one with the therapist.
Can I bring my baby to the appointment?
Absolutely. We understand that as a new Mom, you may not always be able to arrange for care of your baby in order to attend your appointments. Please come anyways – babies are always welcome.
Do I need a doctor/midwife’s referral?
No referral is necessary to see a pelvic health physiotherapist. However, most insurance plans will require a referral from a medical doctor or midwife for reimbursement of physiotherapy services. Check with your insurance provider to be sure.
Should I still come if I have my period at the time of my appointment?
Yes. Menstruation does not interfere with internal pelvic floor physiotherapy assessment or treatment techniques. Your physiotherapist is accustomed to conducting internal assessments and treatments on women who are menstruating.
Alternatively, if you are not comfortable with internal pelvic floor physiotherapy while menstruating, manual therapy, exercise, and other external interventions can be undertaken. Any internal work can be deferred to the following visit.
How soon can I come in for pelvic floor physiotherapy postpartum?
As soon as possible. Postpartum physiotherapy including breath work, postural corrections, gentle exercises and education can begin as soon as you feel up to it. We suggest you wait approximately 4-6 weeks after birth for an internal pelvic exam in order to allow any perineal tearing or C-section scarring time to heal. To be safe, we recommend you get clearance from your doctor/midwife post-birth for an internal exam.
Are there any risks to a pelvic exam?
While not common, the following adverse reactions to a pelvic exam can occur: bleeding during or after the exam, pain/discomfort during or after the exam, anxiety/emotional distress, skin reaction or irritation from gloves and/or lubricant gel, nausea/light-headedness.
Please inform your physiotherapist if you are experiencing any of the above. You may withdraw your consent at any time.
What hygiene standards are followed?
All pelvic health physiotherapists must adhere to the most current infection control standards as outlined by the College of Physiotherapists of Ontario for internal pelvic exams. Proper hand-washing and hygiene protocols are followed at all times.