Firstly the physiotherapist will take a thorough history asking personal questions about bladder and bowel habits, menstruation and kind of delivery as well as the duration of the delivery and your sex health. She may also ask you questions about your pain, when you notice it the most, how it affects your daily life and what your goals might be.
The more information you can give, the better the physical therapist can help determine the right course of treatment for you.
Education will be done on:
• Bladder and bowel function in relation to the pelvic floor muscle
• Optimize breathing, core function and muscle condition around the pelvis
After a conversation, there will be an external and internal exam to asses range of motion and strength of different muscle groups.
External Examination:
- Soft-tissue structures:
- Connective tissue evaluation of the abdomen, trunk, bony pelvis, legs
- Myofascial trigger point evaluation of the pelvic girdle muscles
- Neural testing
- Skeletal structures:
- Sacroiliac joints
- Hip joint
- Lumbar Spine
- Biomechanics/Motor Control evaluation
Internal examination and skin inspection
- Skin inspection:
- Vulva skin colouring, atrophic or dermatologic changes, fissures to determine if the patient needs a referral to a vulvovaginal dermatologist or a gynaecologist.
- Mobility of clitoral hood, size of clitoris. Abnormalities can be indicative of hormonal insufficiencies, dermatological diseases, infection or connective tissue issues.
- Perineal movement
- Vestibule inspection and Q-tip test
- Reflex testing: anal wink, clitoral
- Internal pelvic floor muscle examination of the vulvar and peri-urethral connective tissue, palpation of all pudendal nerve branches, the coccygeus, and a more involved investigation of a patient’s motor control, muscle length, and strength and endurance. Healthy muscles do not hurt when they are palpated!
