The goal of a Pelvic Health Assessment is to gain information about how your pelvic floor muscles and tissues are functioning. As your pelvic floor is part of an entire system we cannot only look at your pelvic floor in isolation. Your pelvic floor makes up the floor of a cannister where your diaphragm is the top, your abdominals are the front and your low back, spine and muscles are the back.
Your physiotherapist will begin with asking you some detailed questions regarding your concerns as well as some personal information about: urine or fecal leaking or urgency, difficulty with voiding, vaginal heaviness, child birth if applicable, constipation or straining with bowel movements, sexual pain or discomfort, pelvic, low back or hip pain.
Following that your physiotherapist will want to look at how your low back, hips and pelvis move. They will want to look at your abdomen and see what muscles you use during different tasks. Some patterns of abdominal use can result in increased downward pressure while others patterns of contraction help to minimize these pressure giving increased support to your pelvic area.
Next your physiotherapist will ask your consent for a vaginal and sometimes an ano-rectal exam. If you give your written consent your physiotherapist will provide a gown for you to change into and give you privacy in which to do this. An internal vaginal exam gives us so much information regarding the state of your pelvic floor muscles and your ability to correctly contract these muscles and use them as part of a whole system. Your physiotherapist will assess your pelvic floor tone ( are your muscles too tight having high tone or too relaxed with low tone), your pelvic floor strength, and the integrity of your pelvic floor muscles ( did you have any tearing or avulsions?). Your pelvic floor muscles will be assessed for their strength, endurance, as well as their ability to relax. Your bladder, urethra and cervix will be palpated looking at positioning, mobility and areas of sensitivity. Your tissue mobility will be examined as this can be associated with pain and discomfort as well as bladder urgency. You will be cued to perform a bearing down movement to see how your tissues respond to increased downward pressure. ( Does your bladder fall down into your anterior vaginal wall?). You will be assessed both laying on your back and while standing. Standing exams are important as this is where gravity will have the greatest effect on pelvic organs and also where pelvic floor muscle use can be the most difficult yet most effective.
An ano-rectal exam can be beneficial to someone who is experiencing pelvic pain, constipation, fecal incontinence, previous trauma to their external anal sphincter ( such as in childbirth), rectal heaviness or want a thorough pelvic floor exam as more of the pelvic floor muscles can be palpated this way. This assessment will also look at the pelvic floor muscle strength, tone, external anal sphincter strength, ano-rectal angle, the presence of a rectocele ( the rectum falling into the posterior vaginal wall) and coccyx mobility.
Following your assessment you will have change to ask questions, as well as have exercises given to you so that you are able to work towards your goal at home as well.
If you would like more information please call me at 250 307-6670.
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