Hayley Kava, MPT, specializes in pelvic floor physical therapy and has extensive experience with pelvic floor conditions from continence, to pelvic pain, exercise in pregnancy and post partum and diastasis recti.
Instead of describing it for her, we thought it would be best for Hayley to tell you herself how she treats the pelvic floor:
“Dear Future Pelvic Floor PT Patient,
My name is Hayley Kava and I am the physical therapist that you will be working with when you arrive for your Pelvic Floor PT appointment. I am so thankful you are here and I am honored that I to get to work with you!
It is not uncommon for people to be worried or confused about what is going to happen at a pelvic floor PT evaluation and I wanted to write this little blurb to you to help provide you with as much information as possible to help you feel as comfortable and prepared in order to have the best experience as possible. Often not knowing is the worst part!
As a physical therapist with special training in the pelvic floor I work with all sorts of different types of people and conditions. Our pelvic floor has many really important functions, that help support our activities of daily living as well as high performance movements. The pelvic floor is like “sling” of muscles from our tailbone on the back to our pubic bone on the front and our “sit bones” on each side. These muscles are critical for : Support (of our pelvic organs), Stability (of our bony pelvis and skeleton), Sphincter control (bowel and bladder control) , Sub-Pump (blood flow/circulation), and Sexual function (achieve/ maintain arousal).
Peeing, pooping, having sex, and keeping our organs inside of us are pretty important functions don’t you think! Our pelvic floor also can play a huge role in back pain, hip pain, pelvic pain, abdominal pain due to their relationships in our body. Our pelvic floor really is our “foundation” and they work together in system with the rest of our body. I don’t like to think of these muscles in isolation, but how they interact and optimize the rest of your body’s function.
I always want to make it abundantly clear that you may stop this assessment at any time or refuse any assessment/movement you would not like to. I will be constantly checking in with you throughout to ensure your informed consent.
You are always entitled to a “Chaperone” to sit in the room when with a health care provider in a private room if that is what you would like. You may provide your own or we can provide one for you.
I next want to go over every aspect of our evaluation so you know what to expect at this first visit.
You may notice that the history form that you received was very detailed and asked a lot of personal questions (about bladder, bowel, sexual function, pregnancy, stress, diet, water intake ect) . I know this may seem overwhelming or uncomfortable to fill out. Feel free to put as much or a little information into these forms as you would like. We will always discuss more when you arrive and when/if you feel comfortable.
When you arrive we will come back into my office and we will review items from your intake form as well as many others. While we always want you to feel comfortable, and you have every right not to share, often symptoms related to the bladder, bowel or sexual function seem embarrassing. It is often helpful for patients to know that in this specialty we have heard it all! Often the symptoms you are experiencing are very common and we hear them all the time. As always, as long as you are comfortable, I encourage you not to hold back.*
*There are circumstances in which I as a healthcare provider am obligated to report items told to me by a patient to the appropriate authorities. In cases of active physical or sexual abuse or imminent suicide I am obligated to reports to the appropriate authorities. I always share this with clients so you can choose if you are ready to disclose this information to me or not.
This part of the exam you will be fully clothed.
Global Movement Exam: Since our body is a system we begin by looking at how you move. Sometimes, depending on your history we will also assess various functional tasks like squatting to jumping to running.
Special Tests: We will then assess some more specific mobility and strength tests of your global muscles and joints as well as some special tests to help us understand your unique patterns/compensations
Palpation: We may feel your abdomen and rib cage to assess thoracic and abdominal mobility as well as your breathing patterns.
We often can gain plenty of valuable information from this much of our exam. If this is all we have time for or all you are comfortable with the first day that is 100% ok!
PELVIC FLOOR MUSCLE ASSESSMENT:
At this section of the exam if you would like to proceed, you will undress from the waist down and will be provided with a sheet for over your waist and will lay on a soft table covered in a sheet. We don’t use stirrups (which people are often happy about)!
I will then look at the muscles and the outer structures of your pelvis. I may ask you to contract, relax or gently bear down with these muscles to assess their mobility. I will then lightly touch the outside muscles on the surface to see if they are tender or in pain and how certain tissues move.
I next can assess these muscles in more detail by inserting a gloved lubricated finger into your vagina in order to assess for tenderness, pain, as well as the strength, endurance and coordination of these muscles. This internal exam should NOT be painful. We gather a lot of helpful information from this internal assessment but some people are not ready for this and that is OK. My goal is for you to leave this appointment confident and comfortable, not flared up or in pain.
After the assessment I will have a fairly good idea of the areas we need to work on in order to help you reach your goals. We often providing education to you all along the assessment but we will use this time to discuss any further questions you have We will also discuss your PT activities which you will complete on your own which are very important!
We will then discuss how often you will need to see me and start to estimate how long it will take to meet these goals. Sometimes our timelines and our expectations change but this provides us a rough guide.
I really hope this helps you understand what to expect at this first appointment and has calmed any worries you may have had. Office staff or myself are always available to answer any questions you may have prior to your appointment.
I look forward to working with you!
Hayley Kava, MPT”
Frequently Asked Questions
- What is Pelvic Floor PT?
Pelvic Floor PT or pelvic floor rehabilitation is a non-surgical approach to rehabilitation of dysfunctions of the pelvis that contribute to bowel, bladder, sexual health and pain complaints. We may use stretching, strengthening or other modalities to help with your condition.
- What conditions do pelvic floor PT’s treat?
We treat bladder, bowel and sexual dysfunction as well as pain in the bladder, pelvic floor, pelvis or back. Some specific conditions/symptoms that we see frequently include , but are not limited to: pregnancy, pelvic girdle pain, pubalgia, SIJ dysfunction, endometriosis, vaginismus, diastasis recti, stress incontinence, urgency incontinence, interstistial cystitis (painful bladder syndrome) ect.
- What should I wear to my appointment?
You want to be as comfortable as possible. Shorts are often helpful for our movement screens and external tests.
- Will I have to undress for my appointment?
If you are comfortable with a pelvic floor muscle assessment you will undress from the waist down and will be provided with a sheet as a drape. This is only one aspect of our evaluation and so if you are not ready for this that is ok!
- Will I have to put my feet in stirrups like at the Doctor?
No. We use a soft PT table and have sheets over the table in a calm, quiet and private environment.
- Will pelvic floor PT hurt?
Pelvic PT should never hurt. There may be times during your assessment or treatment that we may identify painful or tender muscles or structures but it should never be a matter of “toughing it out” or “just do what you have to” this can actually be counter productive to our progress as you may increased tension in the pelvic floor muscles and increase symptoms. We will always keep our lines of communication open.
- What if I am on my period?
This is no problem for us as long as it is no problem for you. If you have a heavy flow or it is the first day of your cycle and you are more tender during this time we can modify our assessment. You may also use a menstrual cup (we have some disposable ones you are free to try).
- When should I not attend pelvic floor PT?
If you have not had a pelvic exam or your annual check-up in the past year or since these new symptoms have occurred. If you have a current infection, less than 6 weeks post-operative or post partum (and do not have your doctors approval)
- Can I have pelvic floor PT while pregnant?
Pregnancy is not a contraindications to internal pelvic floor PT but the involvement of your OB in your plan of care is critical. This being said there are many things we can do to help manage any symptoms you may be have in pregnancy and to prepare for childbirth and the post partum period.
- How soon after my baby is born can I start pelvic floor PT?
In general, for internal pelvic floor PT we will wait 6 weeks to assess the pelvic floor muscles internally. But we may begin gentle rehabilitation as soon as you have stopped bleeding and your OB is ok with you beginning some gentle pelvic floor and core exercise.