What to Expect at Your Appointment
A pelvic assessment is by its nature a fairly intimate process. At Arcadia we aim to make it as professional as possible, while making you comfortable and relaxed in a pleasant environment.
Pelvic related issues will take some time to resolve, dependent on their complexity and how long you have been suffering them. The NICE guidelines state that 3 months is a reasonable timescale to see some significant difference. This does not necessarily mean a session every week, and in many cases you will see good improvements much sooner than this. However, please do be aware that committing to a series of sessions, with active input of homework from you as the patient, is really important to fully resolve the issue.
The Initial Assessment
We start with a full subjective consultation, which is a chat to find out more about your particular symptoms, concerns and goals. It will cover topics such as your bladder and bowel health and habits, any childbirths you have had, and your lifestyle. This may include your sexual activity, if you find you are having any issues with this.
We understand these may be difficult or personal topics for you, but please rest assured we are very used to hearing about them, and nothing is ‘odd’ to us.
You’ll be amazed at how common some problems are… and what a difference physiotherapy can make.
Of course all information is confidential – with the exception of our legal duty to report issues of child and vulnerable adult safeguarding, infectious diseases and FGM.
This part of the session will also involve an explanation of the pelvis and the muscles and structures involved to help you understand the physical context of your situation.
This will be followed by a physical assessment to find out what you specifically need – everyone is different and sometimes similar symptoms can have very different causes. This is why ‘just doing Kegels’ may not be doing you good.
The assessment may include:
- Back, hip and gluteal (buttock) palpation and muscle testing to assess the condition and action of muscles in these areas that may be contributing to your pain or symptoms. This is done clothed, with your top tucked up at the back into your bra so we can see how your lower back moves.
- Abdominal palpation – a gentle feel of the tummy and abdomen, which may also include an assessment of any diastasis rectus (tummy muscle separation after childbirth). This will be done lying down with your top tucked up to your ribs.
- Pelvic floor assessment – this is an internal vaginal examination. It requires you to undress from the waist down within a private cubicle. The therapist will ask you to squeeze your pelvic floor muscles against pressure from their finger in a range of ways to assess their function, strength and ability to relax, and evaluate how these muscles work when you cough or sneeze.
Your consent will be checked at every stage of the assessment and you are of course free to stop the session at any time.
The End of the Session
This is where we help you make a plan. You will have your individual situation explained to you and we will discuss and agree actions going forward. Women’s health, possibly more than any other area of physiotherapy, is an active approach – and research shows that the process to make significant, lasting change in symptoms is usually at least 3 months for stress incontinence and at least 6 weeks for urgency. This of course will depend on the individual. Please feel free to ask any questions you like!
You may be sent home with tasks to complete in preparation for the next session. These will likely include a selection of:
- Bladder diary
- Relaxation strategies
- Nutritional advice
In certain cases, it may be clear after the assessment that physiotherapy is not the best course of action for you at this time. You may require a referral on to another health professional, which we will do for you as quickly as possible to ensure your health is prioritised. Again, your consent is paramount and the reasons for referring on will be fully explained to you.
You may consider bringing a supportive partner or friend with you if you would like – they would be very welcome. Please pass on the information above to them so that they also know what to expect (otherwise it might be a bit of a surprise!), and please ensure you are comfortable discussing personal issues with them before your appointment.
As a small clinic we are unable to offer a qualified and trained chaperone / impartial observer (please see the guidelines we aim to adhere to, within the limits of our small practice). If you have any concerns about the assessment please do raise them to your therapist and remember that at any stage you can remove your consent.
Follow Up Sessions
Follow up sessions may be an hour or half an hour, depending on your individual situation. The content of these depends on your particular issues and rehabilitation programme.
Is This Right for Me?
Not sure whether you need a physiotherapy assessment? Please read our Women’s Health Page to see whether you identify with any of the common symptoms of urinary incontinence, or are suffering from any of the other conditions we treat in women.