Don’t show up in work out pants. They’re just going to come off. That should put the “what do I wear” question to rest. Pelvic floor physical therapy is unlike any other physical therapy you have been exposed to. This is a much more invasive and intimate type of physical therapy. On your first visit, we sit down with you and get to know your story. Why are you here? What do you want to get out of this course of treatment? In understanding your symptoms, their source and how to intervene, we need to ask all sorts of socially inappropriate questions. We need to know about your bladder, your bowels and your sexual function. These three things go hand in hand. Often when someone is constipated, they also have issues with urinary leakage. When someone has painful sex, they might also feel the need to urinate all the time.
Within the first 60 seconds of meeting us, we’re going to get right to it. Why are you here? What’s up…down there?
We’re going to ask the following questions about your bladder:
- Does it hurt to pee?
- Does it hurt before or after you pee?
- Do you pee too often?
- Do you get intense sensations to pee?
- Do you leak urine?
- Do you wake up too much to pee?
- Does your urine spray all over the place?
- Does your bladder or urethra hurt?
- Do you even know where your bladder and urethra are?
We’re going to ask the following questions about your bowels:
- Does it hurt to poop?
- Does it hurt before or after you poop?
- Do you poop too much? Not enough?
- Do you have to wipe forever?
- Do you get intense sensations to poop?
- Do you leak poop?
- Does your anus or your rectum hurt?
- Does your tailbone hurt?
We’re going to ask the following questions about sex:
- Does sex hurt?
- Do you have weird symptoms or pain after sex?
- Can you orgasm?
- Does it take forever to orgasm?
- Are your orgasms like “pfff” or are they like “oooooh yeah!” or are they non-existent?
We are going to ask random questions like:
- Do you have any itching around your genitals, anus or in your rectum?
- Do you get a lot of infections? Real infections or “fake” infections?
- Does it bother you to wear certain types of clothes or underwear?
- Does it hurt to sit?
- Do certain food or drink make your symptoms worse?
- What medications have you been on?
- Do you have any hernias or hernia repairs?
All of this helps us get an idea of the root of your symptoms. We want to figure out not just how to quiet the symptoms that bother you, but also how to squash the problem that is creating the symptoms in the first place. After this painless interrogation…we ask for consent to do a pelvic exam.
This is unlike a gynecological exam and unlike a prostate exam. This exam is done with primarily your comfort in mind. If we were to impose pain during an exam, we’d get misinformation. For example, when you are in pain, your pelvic floor muscles tense. This is a primitive and reflexive reaction to pain. We want to know how your muscles behave when they are as relaxed as possible…that is, as relaxed as possible while you are getting a pelvic exam.
So, what is the pelvic exam?
For a female, this is an exam of either the genitals and/or the tension in the vagina and/or the rectum. If only the genitals are being examined, then a thorough screening with light and magnification is performed from the top down. Checking out the hood of the clitoris, the clitoris itself, the flaps of the labia and the appearance and tenderness of the tissue at the opening of the vagina all tells a story. What exactly is the story? It’s different for everyone. For some, it’s a story of how time has gone by and now perhaps some supplementary hormones could be helpful. For others, it’s a story of how using soap on the genitals is cleaning too much, the good and the bad. One of my favorite things to do is to guess the story before I see it. It is one of the most exciting parts of my day. I kid you not.
For a female vaginal exam or a rectal exam for either a female or a male, one gloved, lubricated, warm-hearted finger is gently inserted into the orifice most likely corresponding to your symptoms. Orifice. That’s right. It’s not a beautiful word, but, it does encompass the body parts I need it to encompass, so…orifice it is. The pelvic floor muscles of the vagina and rectum are the same muscles. They are just different aspects of the same muscles. If I were to put pressure in the vagina or rectum and that created some discomfort, I would know that that is a problem. A pressure on the muscles should feel like exactly that – a pressure, not a pain. A pain means there is too much tension in the pelvic floor muscles. Too much tension means not enough movement. Not enough movement means not enough blood flow. Not enough blood flow means not enough oxygen. Not enough oxygen means too much lactic acid build up. I’ll stop there. Sometimes, this pain is actually the pain that you are seeking medical treatment for. Sometimes the pain isn’t a “pain”, but it is your symptom, i.e. your intense urge to urinate or your tailbone ache. I might be figurative miles away from the bladder, urethra or the tailbone, and yet the muscle I am putting pressure on feels as if it is your actual bladder, urethra or tailbone. And this, my reader, is where the magic begins. The call is not always coming from the body part that talks the most. And on this thought, I will leave you to think….
Got a question? Cool. Hate what I wrote? Cool.
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Written by Sara Sauder, PT, DPT
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