Pelvic Health Overview
What Does the Initial Assessment Involve?
The initial assessment takes approximately 70 min to complete. It involves a thorough history taking and physical exam. The assessment begins with a detailed discussion about the patient’s symptoms and history. We take a biopsychosocial approach, so your physiotherapist will get a very good understanding of you as a whole person. From there, a physical assessment is completed. This may include an observation of posture and functional movements, assessment of connective tissue, muscle tension, respiratory function, core activation, and neural involvement. If deemed necessary, additional tests will be carried out at this time. If the patient consents, a digital internal exam will be conducted to assess connective tissue, muscle tension and sensitivity, prolapse, and pelvic floor muscle strength/endurance and coordination. Please note that the internal exam is not mandatory, but does provide extremely valuable information which guides appropriate and effective treatment. Upon completion of the assessment, the patient will be given education, strategies and/or exercises to start their treatment plan.
The patient should wear comfortable, loose clothing for the assessment and treatments. No other special preparation is needed.
What Does the Treatment Involve?
Treatment will be guided by the findings from the initial assessment.
Treatment May Include:
Education
Internal/External manual therapy (tapping, stretch, release)
Stretching and strengthening exercises
Connective tissue and scar tissue mobilizations
Acupuncture
Electrical stimulation/TENS
Core strengthening exercises
Imagery exercises
Correction of pelvic asymmetry and SIJ dysfunction
Correction of Rectus Diastasis
Note: if you are doing a prenatal session there will also be education on stages of labour, positioning for labour and delivery, and perineal preparation.
Patients are typically seen for 45 min and 1x/weekly to start. Treatments will be tapered as appropriate.
Why Do We Perform Internal Palpation?
One of the most important reasons why internal palpation is performed is to help distinguish if the muscles are hypertonic (high tone/tight) or if they are hypotonic (low tone). Hypertonicity is typically associated with pelvic pain, urgency, and frequency, whereas hypotonicity is typically associated with stress incontinence and prolapse. However, we also know that tight muscles are also weak muscles so they may be contributing to leaking issues as well. It is important for treatment that we know what state these muscles are in, as we do not want to make a tight muscle tighter by doing contractions/kegels. We could actually make your symptoms worse by doing so.
The internal palpation also gives the patient better feedback on how to be doing appropriate exercises so that they know they are doing the exercises correctly.
Finally there are different internal manual techniques that allow the physiotherapist to help make changes in the pelvic floor muscles if they are tight or sensitive.
If you have any further questions or concerns please do not hesitate to speak with your physiotherapist.