As a pelvic floor physical therapist, KCP’s Ashley Williams knows that the initial pelvic exam / assessment can cause anxiety among both men and women. That uncertainty may cause them to delay scheduling much-needed treatment. Two of Dr. Williams’ biggest priorities in her practice are educating her patients and ensuring that they are comfortable at all times. In today’s blog, Dr. Williams answers some common questions that patients have prior to their first appointments.

Appointment Preparation – What Are We Going to Talk About?

I want clients to know that we always start by talking first! We don’t ask anyone to undress before we’ve had a chance to talk and come up with a game plan that we both agree to.

I assure them that they are not likely to share something I’ve never heard before! I know that we are discussing details that seem very personal that they don’t typically share with strangers – or even friends – but these are usually common conversations for me, and nobody should feel embarrassed to share!

We’ll start by discussing the issues that clients are having as well as their goals for treatment. I would suggest that clients bring a list of concerns and symptoms. I like to understand how long the issues have been around, what makes the symptoms better or worse, and what treatments they have tried in the past. I also want to understand what activities clients are avoiding and what they would like to return to.

What Should I Wear?

Clients can wear anything that they are comfortable moving in. Shorts or yoga pants and a T-shirt are great. We also keep extra shorts on hand if you’re wearing a dress, skirt, or restrictive jeans and would like to borrow a pair while you’re here! As part of our assessment, we’ll look at movement patterns, posture, and strength. Don’t worry – there’s nothing to prepare for and we don’t ask you to do anything difficult!

I will likely also ask you to perform some simple movements while standing and lying down. I’ll be palpating some of your bones and muscles, so it’s helpful if you wear something that’s not too thick.

What Happens with an Internal Exam

Again, I want to reiterate that we always go at the client’s comfort level. It’s often helpful for me to do an internal exam to examine internal muscle structure, but it doesn’t have to be on that first day. I’ll always make sure that clients are comfortable first.

That said, if we do determine that an internal exam would be helpful, I’ll provide a gown, ask them to undress from the waist down, and then step out of the room. Once they’re ready, they can ring a bell and I’ll come back in.

The internal exam is a one-gloved finger vaginally or rectally. There are no forceps or additional tools involved. I’ll look at some of the structures outside the vulva. I’ll look for skin discoloration and see if there’s any vaginal dryness or irritation.  I’ll also be evaluating muscle tension in the pelvic floor and/or the degree and positioning of any pelvic organ prolapse. As I’m examining, I’m talking clients through the whole process, letting them know where I am and what I’m doing and asking how they’re feeling.

If for whatever reason during the internal exam, if someone is uncomfortable, they can just say the word and we stop. Maybe it brings up past trauma or they just decide ‘I don’t want to do this anymore.’ Whatever the reason, we stop and it’s completely okay. Consent is always a priority!

Clean Up

Once I’ve finished the exam, I’ll leave the room again and provide wipes and tissues, allowing them to clean up and get changed again. I’ll tell them to crack the door open when they’ve finished, and then I’ll come back in and we’ll talk about what I found and what the game plan is moving forward.

Follow Up

Depending on what I find, I’ll suggest a plan of at-home exercises supplemented by in-person physical therapy. We may or may not need to do internal work on a weekly basis in the office; sometimes we’ll only have to do it again when we’re checking progress along the way.

Typically, we’ll schedule one to two visits weekly and monitor progress as we go. We’re always talking openly at each session with the goal of helping the client improve their quality of life. Pelvic floor dysfunction, like incontinence or painful intercourse, can be challenging issues for individuals to navigate. We want them to know that there are solutions to these challenges, we are there to help, and we love being a part of their journey towards greater freedom and abilities.

Who Should Schedule a Pelvic Floor Assessment?

There are many people needlessly suffering out there and dealing with pelvic floor dysfunction because they believe that their symptoms are ‘normal.’ I tell patients all the time, it may be common, but it’s not ‘normal,’ and many of these issues are addressable through pelvic floor therapy.

Some examples include, but are not limited to:

  • Pelvic Pain
  • Vulvodynia
  • Painful Intercourse
  • Urinary and Fecal Incontinence
  • Urinary Urgency/Frequency
  • Prolapse
  • Pregnancy Preparation and Pain Management
  • Postpartum Recovery
  • Endometriosis
  • Post-Prostatectomy Urinary Incontinence
  • Erectile Dysfunction
  • Chronic Pelvic Pain
  • Scrotal, Testicular, and Penile Pain
  • Constipation
  • Low Back Pain and Sacroiliac Dysfunction
  • Sciatica
  • Hip Pain

Individuals can come to us directly if they are dealing with any of these areas, even without a referral from their doctor or gynecologist in most cases. You should always check with your insurance provider, but most allow direct bookings without referrals. We work hand in hand with the other members of your medical team and will be sure to collaborate to ensure that we are all working from the same page to provide the best care for our clients.

Schedule Your Appointment Today

If you’d like to book an appointment with Dr. Williams, call the office at 704-541-1191 or click here to Request an Appointment.