What will a Pelvic Health Physiotherapy appointment involve?

Your first appointment will be approximately 60 minutes long. Your physiotherapist is Gemma Barnes who is a specialist Pelvic Health Physiotherapist with many years of experience in this field. She will take a detailed history from you to include all of the factors you both think are relevant to your problem. She will discuss with you what she thinks is causing your problem and if physiotherapy could help.  This is usually confirmed with a physical examination which will then further help to guide your treatment programme.

What does the physical examination involve?

A physical examination can involve either a vaginal or rectal examination and often an abdominal examination too. The physiotherapist will use their gloved finger to feel and assess the muscles, ligaments and other tissues of the pelvis. A speculum will not be used.

Why do I need a physical examination?

• To see how well your pelvic floor muscles are working and whether you can work them correctly to control your bladder and/or bowel.
• To set an exercise programme that is the right level of difficulty for your muscles.
• To see if your muscles are working too hard and need help to relax/ let go.
• If there is any scar tissue that is not moving properly, your physiotherapist can perform massage to help the scar tissue move better.
• To see how well you can take a deep breath and how your abdominal muscles feel.

Your physiotherapist will also look at the tissues of the labia, vulva, vaginal entrance and back passage (for a woman) and the penis and back passage (for a man), if they notice anything that is unusual they will let your doctor know.

A physical examination will not be carried out if:

• you have given birth or had pelvic surgery within the last six weeks; you should let your physiotherapist know and a physical examination will not be performed.
• if you have an infection to the area being examined or broken, sore skin of the examination area; an examination will not be performed.
• You are not comfortable with this examination being carried out.

Please do let your physiotherapist know if you are worried or anxious about having an examination. They will be very happy to talk things through and give you plenty of time to consider whether to have an examination or not.

There is a very small risk that having an examination could cause an infection or minor bleeding of the vagina or rectum. Sometimes a bit of discomfort can be felt in the area being examined or the low back or tummy. This should never be very painful or last more than a couple of hours after an examination. If you have discomfort which lasts for more than 24 hours, please contact us.

Chaperone: if you would like a chaperone to be present during the physical examination, please let us know. Ideally, let us know before your appointment so we can ensure we are able to provide you with this service. The physiotherapist may also decide that it would be beneficial to have a chaperone present. If so, she will request a colleague to be present during the examination. The chaperone will be a qualified physiotherapist who understands the procedures used.

At the end of your assessment your physiotherapist will discuss what they think the best course of treatment is and why.

This is likely to include:

• advice on healthy bladder/ bowels.
• your own personal pelvic floor muscle exercise programme and
• advice on how to incorporate your exercises into your daily activities.

In some situations:

• hands on therapy to the pelvic floor muscles,
• electrical stimulation of the pelvic floor muscles or
• biofeedback for the pelvic floor muscles is beneficial.