WHAT TO EXPECT ON YOUR FIRST WOMEN’S HEALTH INITIAL EVALUATION AT BODY GEARS PHYSICAL THERAPY
To all the women who are scheduled to come in for an initial evaluation with a Body Gears Women’s Health Specialist – congratulations! You have taken a big step towards restoring your quality of life regarding incontinence, prolapse, pelvic pain, painful sex, and any other symptoms you may be having. It’s absolutely normal to feel nervous, curious, scared, excited, or any other combination of emotions. You may also have countless questions floating in your mind: •How is thiskindofPTgoing tobedifferent thanwhen IhadPTformysprainedankle? • Are they going to look inside my vagina? • How is this different than a pelvic exam I get from my OBGYN? • I don’t know what to expect – is anything going to be really painful? • I really don’t want anyone looking at or touching my vagina. Can I tell them I don’t want that? To help you feel more relaxed when you come in for your initial evaluation, we want to share the framework of the initial evaluation process with you. Discussing Your History: Our first job is to listen, as we ask some questions along the way that can help us form a few hypotheses on what may be going on. Here are some of the rather “odd” questions we may ask you: Whatdoyoudo fora living? (Occupationcanhaveahuge impactonhowyourpelvic region is being stressed) Whatdoyoueatanddrink?(Typeoffoodandfluid intakecancausefrequenturination, constipation, and bladder irritation) Do you have pain with sex, and if yes, what kind of positions are more painful? (Regardless of your complaint, such as having to frequently go to the bathroom, your therapistmaystillask thisquestionas themuscles thatsupportbladder/bowel function also support sexual function) Are you able to use a tampon or does it seem to just slip out? (Gives us a clue on muscle tightness or looseness of your pelvic floor) Doyougetpainatyourvaginawhenyouwearyourskinny jeansor tightunderwear? (Even something like tight clothes can clue us in on the possibility of soft tissues, joints or nerves being compressed and causing your pain) Taking Measures: By the time you and your therapist are done chatting, she will have a good idea of what may be going on.The goal of the next part is simply a way for us to confirm or deny our hypotheses and determine a diagnosis.. This is where we actually put our hands on you and ask you to do certain movements. Posture: With your permission, your therapist will take photos of your posture from the back, side, and the front, as well as take a video of you walking. Your therapist willview these images tofigureouthowyourpostureaffectsyourcurrentsymptoms. When your rib cage and pelvis are not well-aligned on top of each other, it can put unnecessary tension or pressure into your pelvic floor muscle and organs. Core activation and postural alignment tests: Your therapist will do three tests to assess how well you stand and how well your core muscles kick in automatically. Since your pelvic floor muscles are core muscles, we can get a good sense of how strong they are with these tests too. Lumbar spine motion and hip strength: Your therapist will ask you to bend forward, bend side to side, and to rotate at your back while standing. Assessing your lumbar spine is important since sometimes you can feel pain around your groin or vaginal area but it’s actually caused by something going on in your lumbar spine. This is
called referred pain and it’s fairly common. The strength of your hip muscles can also provide a lot of clues, such as whether your pelvic floor muscles might be over- activating tocompensate forweakhipmuscles, leading to tightnessanddiscomfort in your pelvic floor region. Pelvic Floor Assessment Based on Necessity and Consent: The important thing toknow is thatby thisstage,your therapistwillhaveaverygood idea of whether an internal pelvic exam is needed today. She will ALWAYS ask for your consent. You can always say no at any time. Your therapist will prep a private room before beginning your pelvic floor exam. She will drape a sheet over the table, and have another sheet ready for you. Before your therapist leaves the room, she will ask you to undress everything your bottoms and underwear and to lie on the table with the second sheet draped over you. When you are ready, your therapist will come back into the room. Observation and external palpation: Your therapist will first perform an external observation while you perform pelvic floor muscle contractions (also known as Kegels), in order to assess how efficiently your muscles are working together. She will then feel your pelvic floor region externally, looking for any areas of tenderness or soft tissue tightness. Internal palpation and strength assessment: Your therapist will then proceed to feeling the three layersofyourpelvicfloormuscles from the inside.Shewillproceed from the superficial layer (layer 1) to the deep layer (layer 3) one at a time, as she asks you for feedback on pressure and how you are feeling. Even before she asks, you can ask your therapist to stop at any time if it is too uncomfortable or you are simply not feeling like it today! If you choose to continue, your therapist will ask you to perform different types and holds of Kegel contractions so she can feel for your muscle strength and endurance. Internal assessment for prolapse: Your therapist may assess for signs of prolapse, a condition where pelvic structures, such as the uterus or bladder, slip out of their usual position. While your therapist maintains her finger internally in the vaginal canal, she will ask you to perform a Kegel contraction followed by a ‘bearing down’ action. Your therapist is feeling for any organ positional changes. Plan of Care: Once the examination is over, your therapist will summarize the findings, explain the factors driving your symptoms, and explain what can be done to make it better! TheWomen’sHealthSpecialistsatBodyGearsPhysicalTherapyarehere toempower, educate and help you feel better about a variety of pelvic symptoms that you don’t have to put up with anymore.
By: Dr. Toshi Odaira, PT, DPT, Women’s Health Specialist, Oak Park Clinic
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