What to Expect at Your First Pelvic Floor Physiotherapy Appointment

If you’ve been told to see a pelvic floor physiotherapist, you may have a few questions.

What exactly happens during the appointment?

Do I have to undress?

Will there be an internal examination?

Will it hurt?

And perhaps the question you’re a little hesitant to ask: Is this going to be awkward?

It’s completely understandable to feel unsure about what to expect.

Pelvic health involves parts of the body and symptoms we don’t always talk about openly. Bladder leakage, pelvic pressure, painful intercourse, bowel concerns, pregnancy and postpartum changes can all feel very personal.

A pelvic floor assessment is designed to help your physiotherapist understand what is happening in your body and what may be contributing to your symptoms.

And importantly, you should be involved in every decision about your assessment and treatment.

Here’s what you can expect.

What Is Pelvic Floor Physiotherapy?

Pelvic floor physiotherapy is a specialized area of physiotherapy focused on the muscles, tissues, and structures of the pelvis and how they work together with the rest of your body.

Your pelvic floor is a group of muscles located at the bottom of the pelvis.

These muscles help support the bladder, bowel, uterus and other pelvic organs. They also play a role in:

• Bladder control
• Bowel control
• Sexual function
• Core stability
• Breathing and pressure management
• Pregnancy and birth
• Supporting the pelvic organs

Like any other muscles in the body, pelvic floor muscles can experience weakness, tension, pain, coordination difficulties, or changes following pregnancy, birth, surgery, injury, hormonal changes, or simply over time.

Pelvic floor physiotherapy aims to understand how those muscles are functioning and how they may relate to the symptoms you are experiencing.

Why Might Someone Need a Pelvic Floor Assessment?

There is no single reason to see a pelvic floor physiotherapist.

Some people are referred by another healthcare professional. Others seek an assessment because something simply doesn’t feel right.

You may consider pelvic floor physiotherapy if you experience:

• Urinary leakage
• Urinary urgency or frequency
• Bowel leakage or difficulty with bowel movements
• Pelvic pressure or heaviness
• Pelvic organ prolapse symptoms
• Pelvic pain
• Pain during intercourse
• Vaginal or vulvar discomfort
• Pregnancy-related pelvic pain
• Postpartum concerns
• Difficulty returning to exercise after pregnancy
• Pain or symptoms during running or lifting
• Changes associated with perimenopause or menopause

Pelvic floor physiotherapy may also be helpful during pregnancy when preparing for birth or postpartum when returning to movement.

You do not have to wait until symptoms become severe before seeking support.

Your First Appointment Starts With a Conversation

A pelvic floor assessment does not begin with an examination.

It begins with talking.

Your physiotherapist will want to understand what brought you in and what you hope to get out of treatment.

Depending on your concerns, they may ask about:

• Your symptoms
• When your symptoms started
• Bladder habits
• Bowel habits
• Pregnancy and birth history
• Menstrual history
• Sexual health
• Pain
• Previous surgeries or injuries
• Exercise and physical activity
• Your work and daily activities
• Medications and relevant medical history
• Your goals for treatment

Some of these questions may feel more personal than the questions you would normally be asked during a physiotherapy appointment.

There is a reason for them.

Bladder, bowel, sexual, reproductive, and musculoskeletal health can all be connected when it comes to pelvic floor function.

You should also feel comfortable asking questions throughout the appointment.

Will I Have to Talk About Sex, Bladder, or Bowel Symptoms?

Possibly.

Depending on why you are seeking treatment, these topics may be relevant to understanding your symptoms.

For example, someone experiencing pelvic pain may also have discomfort with intercourse. Someone experiencing urinary leakage may notice it only during running or sneezing. Constipation and straining may contribute to pelvic floor symptoms for another person.

These details can help your physiotherapist understand the bigger picture.

That doesn’t mean you need to arrive ready to discuss everything immediately.

Pelvic health conversations can feel vulnerable.

A good assessment should give you space to share information at a pace that feels comfortable while explaining why particular questions may be relevant.

The Pelvic Floor Is Connected to the Rest of Your Body

One thing that surprises many people is that a pelvic floor assessment may involve looking at much more than the pelvic floor itself.

Your physiotherapist may assess areas such as:

• Posture
• Breathing
• Abdominal muscles
• Hips
• Lower back
• Pelvis
• Core strength
• Mobility
• Balance
• Movement patterns

They may ask you to perform movements such as a squat or other simple functional tasks.

Why?

Because your pelvic floor does not work in isolation.

It coordinates with your diaphragm, abdominal muscles, hips, back, and the rest of your body to manage movement and changes in pressure.

If you leak when you run, for example, the answer may involve more than simply making your pelvic floor “stronger.”

Your breathing, strength, impact tolerance, coordination, and how your body manages pressure can all matter.

Does a Pelvic Floor Assessment Include an Internal Examination?

This is often the biggest question.

An internal pelvic floor examination may be recommended because it can provide useful information about how the pelvic floor muscles are functioning.

But an internal examination is not something that should simply happen automatically.

Your physiotherapist should explain why they are recommending it, what the examination involves, and what information they hope to gain from it.

You have the right to ask questions.

And you have the right to decline.

Your consent matters throughout the appointment.

If you are not comfortable with an internal examination, tell your physiotherapist. There may be other parts of the assessment and treatment that can still be completed.

What Happens During an Internal Pelvic Floor Examination?

If an internal vaginal examination is appropriate, recommended, and you consent to it, your physiotherapist should first explain what will happen.

Unlike a routine gynecological examination, a pelvic floor physiotherapy assessment generally does not involve a speculum.

The physiotherapist may use a gloved, lubricated finger to gently assess the pelvic floor muscles through the vagina.

During the examination, they may assess things such as:

• Muscle strength
• Muscle tone
• Coordination
• Ability to contract the pelvic floor
• Ability to relax the pelvic floor
• Endurance
• Tenderness or pain
• Areas of increased muscle tension
• How the muscles respond to breathing or movement

You may be asked to gently contract or relax your pelvic floor during different parts of the assessment.

The goal is not simply to determine whether your pelvic floor is “weak.”

In fact, some pelvic floor problems involve muscles that are too tense or have difficulty relaxing rather than muscles that need more strengthening.

That distinction can make a significant difference in treatment.

Will an Internal Assessment Hurt?

A pelvic floor assessment should not be something you simply have to endure.

If you are experiencing pelvic pain, certain parts of an examination may reproduce some of your symptoms. This can sometimes provide useful clinical information.

But your physiotherapist should communicate with you throughout the assessment.

If something is uncomfortable, you can say so.

If you want to pause, you can pause.

If you want to stop, the assessment stops.

You remain in control of what happens to your body throughout the appointment.

What If I Don’t Want an Internal Examination?

You can say no.

You can also say “not today.”

Consent is not all-or-nothing.

You may feel comfortable with some parts of an assessment and not others. You may want more time to understand what is involved. Or you may simply decide an internal assessment is not something you want.

Your physiotherapist can discuss what information may be gained from an internal examination and what alternative assessment or treatment options may be available.

You can also change your mind at any point.

Feeling safe and comfortable is part of good pelvic health care.

What If I’m on My Period?

It’s okay to attend your pelvic floor physiotherapy appointment while you’re on your period—there’s generally no need to reschedule or prepare any differently.

You may feel a little more tender or sensitive, especially on the first or second day. Let your physiotherapist know so they can adjust your assessment or treatment to keep you comfortable.

An internal assessment is always your choice. Your physiotherapist will discuss what’s appropriate for your symptoms and goals, and you can decide what feels right that day.

If you’re unsure about anything before your appointment, contact the clinic—we’re happy to answer your questions.

Can I Have a Pelvic Floor Assessment During Pregnancy?

Pelvic floor physiotherapy can be useful during pregnancy.

Treatment may help with concerns such as pelvic or back pain, urinary leakage, movement, exercise, and preparation for birth.

Your assessment and treatment will be adapted to your stage of pregnancy, symptoms, medical history, and goals.

Not every prenatal pelvic physiotherapy appointment requires an internal assessment.

Your physiotherapist can explain which assessment options may be appropriate for you.

What About After Having a Baby?

Postpartum is one of the most common times people begin thinking about pelvic health.

Pregnancy and birth can affect the pelvic floor, abdominal wall, hips, back, and overall strength.

You may notice:

• Urinary leakage
• Pelvic heaviness
• Pain
• Changes in bowel function
• Discomfort with intercourse
• Changes around a Caesarean scar
• Abdominal separation
• Difficulty returning to running or exercise
• A general feeling that your core or pelvis feels different

A postpartum pelvic floor assessment can help identify what is recovering well and where you may benefit from additional support.

It can also be useful even if you are not experiencing significant symptoms but have questions about returning to exercise.

Pelvic Floor Physiotherapy During Perimenopause and Menopause

Pelvic health isn’t only a pregnancy and postpartum issue.

Hormonal changes during perimenopause and menopause can affect vaginal and urinary tissues and may contribute to symptoms such as:

• Urinary urgency
• Urinary leakage
• Vaginal dryness
• Discomfort during intercourse
• Pelvic discomfort
• Changes in pelvic floor function

Some women experience pelvic floor symptoms for the first time during this stage of life.

Others notice that symptoms they had after childbirth years earlier begin to become more noticeable.

Pelvic floor physiotherapy can be one part of understanding and addressing these changes.

Depending on your symptoms, your physiotherapist may also recommend discussing hormonal or other medical treatment options with your healthcare provider.

What Happens After the Assessment?

Once your physiotherapist has completed the parts of the assessment that you have agreed to, they will discuss what they found.

This is an important part of the appointment.

Pelvic floor treatment should not feel mysterious.

Your physiotherapist may explain how your muscles are functioning, what may be contributing to your symptoms, and what they recommend as the next steps.

Your treatment plan may include:

• Pelvic floor strengthening
• Pelvic floor relaxation
• Breathing exercises
• Core rehabilitation
• Hip or lower-body strengthening
• Mobility exercises
• Bladder or bowel strategies
• Education about pressure management
• Changes to exercise technique
• Gradual return to running or other activities
• Manual therapy when appropriate
• Strategies for pelvic pain

Your plan should reflect your symptoms and goals.

Someone trying to return to running after having a baby may need something very different from someone experiencing painful intercourse or urinary urgency during perimenopause.

Is Pelvic Floor Physiotherapy Just Kegels?

No.

This is one of the biggest misconceptions about pelvic floor physiotherapy.

Kegels — exercises involving pelvic floor contractions — can be helpful for some people.

But they are not appropriate for every pelvic floor concern.

If your muscles are already very tense or have difficulty relaxing, repeatedly contracting them may not address the actual problem.

Pelvic floor rehabilitation may involve strength, relaxation, coordination, breathing, mobility, pressure management, and movement.

The right treatment depends on what your assessment shows.

What Should I Wear to My Appointment?

Wear something comfortable.

Depending on your assessment, your physiotherapist may want to observe how your hips, back, core, or lower body move, so clothing that allows you to move comfortably can be helpful.

If an internal or external pelvic examination is recommended, your physiotherapist will explain what clothing needs to be removed and provide appropriate privacy and draping.

Again, nothing should happen without your understanding and consent.

How Should I Prepare for My First Appointment?

You don’t need any special preparation before your appointment. There’s no need to shave, wax or change your usual hygiene routine. Wear comfortable clothing that allows you to move easily, and come as you are.

It can be helpful to think about:

• When your symptoms began
• What makes them better or worse
• How often they occur
• Your pregnancy and birth history
• Your bladder and bowel habits
• Your exercise routine
• Your goals

You may also want to write down questions beforehand.

And don’t worry about whether you’ve done anything to “prepare” physically for the appointment.

Pelvic floor physiotherapists work with real bodies every day.

Come as you are.

Frequently Asked Questions About Pelvic Floor Assessments

Do I need a referral for pelvic floor physiotherapy?

In Ontario, you generally do not need a physician referral to see a physiotherapist.

However, some extended health insurance plans may require a referral for reimbursement, so check the details of your individual plan.

Do I have to have an internal examination?

No.

An internal assessment may provide valuable information in some circumstances, but it should only be performed after it has been explained to you and you have provided consent.

You can decline or stop an internal examination at any time.

Does a pelvic floor assessment use a speculum?

An internal pelvic floor physiotherapy assessment generally does not require a speculum.

When an internal vaginal assessment is performed, a physiotherapist typically uses a gloved, lubricated finger to assess the pelvic floor muscles.

Can I bring someone with me?

If having a support person present would make you more comfortable, ask the clinic when booking your appointment about their policies and available options.

Is pelvic floor physiotherapy only for people who have given birth?

No.

Pelvic floor concerns can affect people during pregnancy, postpartum, perimenopause, menopause, and at many other stages of life.

You do not need to have been pregnant or given birth to experience pelvic floor symptoms.

Is leaking urine after having a baby normal?

Urinary leakage is common after pregnancy and birth, but common does not mean it has to become your new normal.

A pelvic health assessment can help determine what is contributing to leakage and whether treatment may help.

Can pelvic floor physiotherapy help with painful sex?

Pelvic floor muscles can sometimes contribute to pain during intercourse, particularly when muscles are tense, sensitive, or have difficulty relaxing.

There can also be other causes of painful intercourse, so appropriate assessment is important.

When should I see a pelvic floor physiotherapist?

You do not need to wait until symptoms become severe.

If bladder, bowel, sexual, pelvic, postpartum, or exercise-related symptoms are bothering you or preventing you from doing things you want to do, an assessment may be worthwhile.

Pelvic Floor Care Shouldn’t Feel Intimidating

It is understandable to feel nervous about your first pelvic floor physiotherapy appointment.

For many people, simply knowing what to expect makes the experience feel much less intimidating.

Your first appointment is an opportunity to talk about what you’re experiencing, understand how your pelvic floor may be contributing, and develop a plan that makes sense for your body and your goals.

Most importantly, you remain part of every decision along the way.

At PUSH Markham, pelvic health care is designed to feel private, supportive, and collaborative.

Whether you’re preparing for birth, recovering postpartum, returning to exercise, navigating perimenopause, or dealing with bladder, bowel, sexual, or pelvic symptoms, you deserve to understand what is happening in your body — and what options are available to help.

Curious whether pelvic floor physiotherapy may be right for you?

Learn more about pelvic health physiotherapy at PUSH Markham or book an assessment when you feel ready.