What does a physiotherapy assessment involve?
Physiotherapists who are a member of the POGP will have a special interest in pelvic health. Some will have undertaken further accredited post graduate training to ensure they have in-depth knowledge and skills to assess all conditions described on this website – including, pregnancy related musculoskeletal pain, bladder and bowel continence symptoms and pelvic related pain. In some cases, they may work exclusively with men or women.
At the first appointment the physiotherapist will carry out a detailed assessment, including when and how your symptoms started, what may aggravate or make them worse or if there are any positions or situations that ease the symptoms. They may also ask about any previous treatment including hospital tests, investigations or scans you may have had related to this issue as well as your general medical health – this will ensure they make an accurate diagnosis and know the best way they can help. It is also helpful to know about your lifestyle – including any work, sports or hobbies you enjoy.
For many of us , the thought of talking about this area of your body or topics that are personal and intimate may be very daunting, especially if you have not discussed them with any other health professionals. A specialist pelvic health physiotherapist is sensitive to this and will do their upmost to put you at ease. Assessments are carried out in a private area so any discussions cannot be overheard and are totally confidential. Everything that you tell your physiotherapist is private and will not be discussed with anyone else unless you give your permission.
The specialist pelvic health physiotherapist will ask in detail about your symptoms, and what treatments or strategies you may have tried already.
They may ask you to fill in a bladder diary to look at what you are drinking, how often you go the toilet and how much urine you pass, usually over a three-day period. This will allow them to prescribe individualized bladder training strategies to help you to improve your symptoms.
They may ask you to fill in a diary to look at your bowel motions, and possibly what you are eating & drinking also – this diary may need to cover up to 4 weeks of your normal eating pattern.
For diastasis recti, back and pregnancy related pelvic pain symptoms, if you are happy and agree the physiotherapist may then assess how your back, hips and pelvis are moving and they may carry out some other tests to these areas of your body to try to find out what is causing any pain. They are also likely to look at the activation of your tummy/abdominal muscles.
If the physiotherapist thinks that your problem is not PGP/ LBP but some other cause they may suggest that you see another health care professional, such as your GP, to look into your problem further.
For bladder, bowel and persistent pelvic pain symptoms you may be asked if you are happy to undergo a vaginal or rectal examination, so that the physiotherapist can assess your pelvic floor muscles and check their strength, coordination and function. You may wish to take a friend or family member with you to your appointment or ask for a chaperone. The physiotherapist will discuss why this is necessary and what it involves and following the discussion it will only ever be performed with your consent. This is useful as not everybody will benefit from the same exercise program. You may be taught specific exercises to improve your pelvic floor muscle function if required
You may prefer not to have an examination there and then but to have time to think before you give your decision and that is absolutely fine. You may prefer not to have an examination at all, and you have the right to decline and does not mean you will not be offered treatment if the physiotherapist feels it will help you.
When an assessment has been completed the therapist will discuss their findings with you and the options available so that together you can plan the most appropriate treatment plan .
What treatment will I be given?
The pelvic floor muscles support your bladder and bowels within the pelvis and help to control when you open them or when you need to hold on. Research has shown that pelvic floor exercises done alongside lifestyle changes are the most effective way to help improve symptoms of incontinence. The good news is that pelvic floor muscle exercises are easy to perform and can be done anywhere.
Follow the links above to access free leaflets explaining how to do pelvic floor exercises. These have been produced by specialist pelvic health physiotherapists. If you are unsure how to do these exercises, then you should speak to a physiotherapist who specialises in this area.
Other treatments may include exercises to strengthen the tummy muscles, the diaphragm (your breathing muscle) and the pelvic floor muscles make up your ‘core’. Research has shown that exercises to strengthen your core, improving posture and lifestyle advice, will have the most benefit. Your Physiotherapist will guide you through a graded program for this, working at your own pace. It is important to follow this advice as some types of exercise may not be advised initially and it may be that you need to be helped to relax these muscles before strength work can start.
You may also benefit from some ‘manual therapy’ this may involve work to aid joint mobility, muscle length or tissue balance.
Some physiotherapists also use acupuncture for pain relief and symptom reduction – they will talk you through this if it is felt a good option.