** note this is an outline of a typical women’s health consult. Consults for men and children may look slightly different
Where to begin
Firstly, we want to get to know you and your story, so we start with a chat. We know you are sharing something uncomfortable, but keep in mind that we talk about these problems all day every day and we have heard it all before. Our consults are always in a quiet environment where we will not be overhead, and like any physio consult our discussions are 100% confidential.
What we will ask
Once we know the reason for your visit, we will follow up with some questions. We will likely ask about your bladder and bowel function, your obstetric history, surgical history, mental health and general health. We will ask you what medications or supplements you are taking. We might also ask about your menstruation and/or menopause experience, your fluid intake each day and what your diet is like. We will ask if you are experiencing any problems with sexual intercourse, such as pain or bladder leakage. We know this covers a lot, but the pelvic organs sit so close together that if one isn’t working well, it can impact the others.
What we will assess
Some people will be asked to fill out a bladder or bowel diary when they go home. In clinic we might use an ultrasound machine to check that your bladder is emptying properly. We might look at how you breathe, sit and move.
Vaginal Exams
For some problems, it can be helpful for us to assess your pelvic floor. A vaginal exam tells us how well the pelvic organs are supported and how well the muscles are functioning. This assessment is the best way to check your muscle function, but it is always optional and we can talk you through the alternatives. It is important to know that if you become uncomfortable during the examination, it can be stopped at any time.
If you choose to have a vaginal examination, it starts with a visual assessment of the vulva. We may ask you to contract and relax your pelvic floor, and you may be asked to have a cough or try to push down. This tells us what the pelvic floor support looks like from the outside, if you are contracting the muscles correctly and if the vulva looks healthy.
With your consent, an internal exam can follow this, which involves putting one or two gloved and lubricated fingers inside the vagina and palpating the pelvic floor muscle. Again, we ask you to do some pelvic floor contractions, to push down and to cough. This is typically done lying down, but sometimes we may assess you in standing (if this is when you have your symptoms). During this assessment we are checking your pelvic floor muscle function, checking for prolapse or any areas of pain. It gives us a really good idea of what is going on and why you are experiencing your symptoms.
We are very aware that people often feel uncomfortable having a vaginal examination, so we tailor your assessment to what you’re comfortable with.
Treatment
Treatment can look very different depending on your symptoms and assessment findings but absolutely everyone will receive some education, to help you understand why you have symptoms, and how to manage them.
You will likely go home with some exercises, aiming to strengthen or to relax your pelvic floor. We might also ask you to modify your fluid intake and diet and monitor your symptoms. We might teach you some strategies to improve the way you empty your bladder and bowel. We might talk to you about adjusting your usual exercise routine or teach you some stretches. With your permission we may write to your GP to suggest another referral, or a medication that might be helpful.
Do I need to book more appointments?
Not everyone will need a follow up appointment, but most of our patients benefit from 2-3 follow up visits.
Have some more questions about a women's health consult? You can email Chelsey at chelsey@goodcountryphysio.com.au or call us on 8767 4600.