An Overview of Physiotherapy Assessment and Treatment of the Pelvic Floor
Top Contributors - Jess Bell, Kim Jackson, Nupur Smit Shah, Tarina van der Stockt and Carin Hunter
Clinic Environment[edit | edit source]
Before discussing the actual assessment and treatment of women’s pelvic health patients, it is useful to consider the environment where you will be conducting your sessions.
Where possible, it is important to be mindful of the clinic environment. The treatment setting has been shown to have an impact on a client’s health outcomes.[1][2][3] The physical environment can help a client feel relaxed, safe and empowered or, conversely, feel stressed, threatened and tense.[4][5] For instance:
- Daylight and windows have been shown to reduce fatigue and depression. Where this is not possible, indoor plants, aquariums, or artwork with a nature theme can help to reduce stress[3][5]
- The colour scheme can also have an impact:[5]
- Blue and green can promote relaxation and balance
- Yellow and orange can energise or activate a space
For more information on evidence-based design in healthcare settings, please have a look at the following articles:
- Environmental needs, barriers, and facilitators for optimal healing in the postoperative process: a qualitative study of patients' lived experiences and perceptions
- A review of the impact of physical environmental factors on users
- Creating optimal healing environments in a health care setting
Creating a healing environment can be particularly important for women’s health clients as they may present with trauma, shame, embarrassment or other emotions associated with their condition.[4]
The Initial Assessment[edit | edit source]
Prior to the initial assessment, it can be helpful to collect some initial information about your client by sending them:[4]
- Forms and questionnaires
- Validated outcome measures
- Psychosocial inventories
Subjective Evaluation[edit | edit source]
Like any physiotherapy session, you must first complete a subjective assessment of your patient. During this assessment, it is important to actively listen to the client and gain an understanding of why she is coming to see you.[4]
It has been suggested that motivational interviewing techniques may be beneficial for pelvic physiotherapy patients.[6] Motivational interviewing is defined as:
'a collaborative conversation style for strengthening a person's own motivation and commitment to change.'[7]
It is an evidence-based intervention that helps encourage health behaviour change. It has been used in areas such as weight loss, smoking cessation, alcohol consumption, and blood sugar control.[8] It is also becoming more popular in physiotherapy practice.[9] To learn more about motivational interview, please click here.
Other techniques that can be helpful during the subjective interview include:[4]
- Asking open-ended questions
- Being curious
- Reflecting back to the client
- Summarising what has been said
- Listening without judgement
- Aiming to understand goals and what success would mean for the client
- Finding out about the impact of the condition on life, work, relationships, emotions etc
- Asking about the client’s theories in order to gain insight into her beliefs about her condition
Establishing rapport, cultivating trust and safety and allowing the patient to feel heard are key goals of the initial assessment.[4]
Objective Evaluation of the External Body[edit | edit source]
The external evaluation helps you to understand how the wider systems or structures may relate to pelvic floor dysfunction. It can also help you to increase your client’s trust in your physical handling of her body.
While you may not be able to do everything in one session, you may choose to evaluate:[4]
- Alignment
- Posture
- Movement patterns
- Breathing strategies
- Neural screen
- Abdominal wall function
- Abdominal viscera
- Spinal, hip, pelvic movements and range of motion
- Muscle strength and endurance
- Thorax
- Myofascial quality
- External scars
- The pressure system
- Motor control strategies
- Pelvic floor muscle function (externally) etc
Objective Evaluation of the Pelvic Floor[edit | edit source]
Please note that each country / state will have different rules and regulations about who can perform internal examinations. Many areas will require specific post-graduate training. Please make sure you are familiar with the regulations / requirements in your own area before performing an internal examination and make sure you complete the necessary training.
The most common method of evaluating the pelvic floor muscles is digital vaginal penetration,[10] which will be discussed below. Other methods include:[4]
- Real-time ultrasound - a safe, simple, cheap, and readily accessible technique,[11] that can be used to assess pelvic floor contractions[12]
- Perineometer - a simple, minimally invasive, low-cost tool that is used to measure pressure changes in the vagina after a voluntary contraction of the pelvic floor muscles[13]
References[edit | edit source]
- ↑ Hesselink G, Smits M, Doedens M, Nijenhuis SMT, van Bavel D, van Goor H et al. Environmental needs, barriers, and facilitators for optimal healing in the postoperative process: a qualitative study of patients' lived experiences and perceptions. HERD. 2020 Jul;13(3):125-39.
- ↑ Huisman ERCM, Morales E, van Hoof J, Kort HSM. Healing environment: A review of the impact of physical environmental factors on users. Building and Environment. 2012;58:70-80.
- ↑ 3.0 3.1 Zborowsky T, Kreitzer MJ. Creating optimal healing environments in a health care setting [Internet]. Minnesota Medicine [cited 9 January 2022]. Available from: https://www.minnesotamedicine.com/clinical-health-affairs/creating-optimal-healing-environments-in-a-health-care-setting/
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 Afolabi I. Physiotherapy Assessment and Treatment of the Pelvic Floor Course. Physioplus, 2022.
- ↑ 5.0 5.1 5.2 La Torre MA. Creating a healing environment. Perspectives in psychiatric care. 2006;42(4):262-4.
- ↑ Navarro-Brazález B, Vergara-Pérez F, Prieto-Gómez V, Sánchez-Sánchez B, Yuste-Sánchez MJ, Torres-Lacomba M. What influences women to adhere to pelvic floor exercises after physiotherapy treatment? A qualitative study for individualized pelvic health care. J Pers Med. 2021;11(12):1368.
- ↑ Miller WR, Rollnick S. Motivational interviewing: helping people change. 3rd ed. New York: Guilford Press, 2013.
- ↑ Kopp SL, Ramseier CA, Ratka-Krüger P, Woelber JP. Motivational Interviewing As an Adjunct to Periodontal Therapy-A Systematic Review. Front Psychol. 2017;8:279.
- ↑ Lindson‐Hawley N, Thompson TP, Begh R. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews. 2015(3).
- ↑ Abe-Takahashi Y, Kitta T, Ouchi M, Okayauchi M, Chiba H, Higuchi M et al. Reliability and validity of pelvic floor muscle strength assessment using the MizCure perineometer. BMC Womens Health. 2020;20(1):257.
- ↑ Dietz HP. Pelvic floor ultrasound. Curr Surg Rep. 2013;1:167-81.
- ↑ Thompson JA, O’Sullivan PB, Briffa K, Neumann P. Assessment of pelvic floor movement using transabdominal and transperineal ultrasound. International Urogynecology Journal. 2005 Aug 1;16(4):285-92.
- ↑ Angelo PH, Varella LRD, de Oliveira MCE, Matias M, de Azevedo M., de Almeida et al. A manometry classification to assess pelvic floor muscle function in women. PLoS One. 2017;12(10):e0187045.
