July 2, 2017

Pelvic Rehabilitation: Visit #1 for Men

Pain and other disorders of the pelvis can affect males as well as females and children. Learn what the first Pelvic PT visit will be like for men.
  • Amanda Moe photo
    Amanda Moe

    Amanda Moe, DPT, is a former employee of Restorations PT. She currently practices in Texas.

Man with fist on chin looking worried with tie and collared shirt

As previously mentioned in Part 1 of the “Pelvic Rehabilitation: Visit #1” blog series, pain and other disorders of the pelvis can affect males as well as females and children. Fortunately, Restorations PT has a trained Pelvic Physical Therapist that provides individualized and compassionate care in a private setting. The goal of pelvic rehabilitation is to find a solution to your problem as well as set you up with the tools necessary to have lasting relief of your symptoms. The purpose of today’s blog post is to tell you what the first Pelvic PT visit will be like—for the male population.

What to Expect During Your First Visit

First you will sit down with the Physical Therapist and talk about what brought you to Pelvic Physical Therapy. This is a great opportunity to tell “your story” about your complaint or condition. The Physical Therapist will then ask questions about your symptoms and medical history. Questioning will include bowel, bladder, and sexual functioning as these may affect the symptoms of your pelvic floor. The purpose of this questioning is to obtain as much pertinent information about your condition so the Physical Therapist is best able to determine the appropriate treatment approach and interventions to get you better.

Next, the Physical Therapist will then examine your sitting and standing posture, how you move, and how you walk. The way you hold your body and move your body may affect your symptoms in the pelvic floor region. She will assess your hips, low back, abdominals and pelvic girdle---paying special attention to alignment, range of motion, strength, and mechanics. Dysfunction at the hips, pelvis, low back, and abdominal region can contribute to pelvic floor dysfunction.

Next, depending on your chief complaint, an internal pelvic evaluation may be indicated. This can be done via the vagina or rectum---for men the obvious route is through the rectum. Let me preface this by saying---not everyone needs or gets an internal evaluation on the first visit! There are some diagnoses that do not require an internal evaluation or are contraindicated (i.e.- immediately post-surgery, shoulder pain, etc.). There are even instances when patients who are referred for significant pain may be unable to tolerate an internal assessment on the first visit. Thus, the internal pelvic floor evaluation will only be performed with your informed consent and will be dictated individually by patient’s discomfort/pain level and tolerance.

What to Expect During an Internal Evaluation

The internal assessment will take place in a private room on a high-low mat--much like those that are used if you were getting a massage. The Physical Therapist will show you a model of the pelvis and pelvic floor muscles and describe first how the internal assessment will take place. She will then get your consent to proceed and give you an opportunity to ask questions before starting.

The Physical Therapist will then step out of the room and have you remove your clothing from the waist below, cover yourself up with a sheet, and sit on the treatment mat. For males, you will cover your penis and testicles with a towel unless it needs to be moved depending on your symptoms. You will have the choice of using a hand-held mirror or looking at a pelvic model so that you can follow along with the examination if you prefer. Your Physical Therapist will explain the “pelvic clock” so that you can have a reference of which area she will be assessing during the internal and external examination. The Physical Therapist will first start with an external observation of the pelvic and anal region. She will palpate externally for bony landmarks and pelvic floor muscles to feel for tightness as well as map out your area of pain/discomfort. She will visually observe the perineum region and have you contract your pelvic floor muscles, relax, and bulge or push out to assess your coordination.

The internal component of the evaluation will then proceed depending on tolerance to external assessment. The internal exam is usually not as uncomfortable as people expect it to be. There are several things that reduce discomfort during the internal assessment which the Physical Therapist will implement (adequate lubrication, gradual yet deliberate approach, adjusting position of patient/perineal region, etc.). The internal examination of the male pelvic floor via the anus is assessing many of the same things as with a woman. The Physical Therapist will palpate the pelvic floor muscle layers internally using her finger and assess length, tension, ability to contract/relax, as well as map out pain internally. Again, the Physical Therapist will make reference to the “pelvic clock” to guide you through the internal assessment. If indicated, the Physical Therapist may also grade the strength of your pelvic floor muscles. The Physical Therapist will then step out of the room and allow you to get dressed and use the restroom if desired.

When you are ready, the physical therapist will discuss what she found through her assessment as well as how physical therapy may or may not help you. You will discuss your goals for physical therapy and the therapist will give you information on typical interventions used, length of sessions, as well as answer any questions you have. The Physical Therapist may then give you “homework” for you first visit that will be tailored to your assessment findings, chief complaint, and learning style.

The most important thing to understand is that you run the evaluation. You have the choice to proceed or terminate at any time. The Physical Therapist can get a lot of information from an external exam and she does not have to do an internal exam if you choose to not undergo this part of the evaluation on the first day. Remember the physical therapist does this for a living---seeing men, women, and children with pelvic-health related complaints daily. It is her goal to provide you with a safe and comfortable environment to seek treatment for these sensitive issues. You are always free to ask your therapist if you have any questions before, during, or after your Pelvic Physical Therapy examination.

Stay tuned for part 3 of this Pelvic Rehabilitation series: Visit #1 for Children.