What to expect at your first appointment
Seeing a pelvic health physiotherapist for the first time can feel daunting, especially if you’re not sure what the appointment will involve, what questions you’ll be asked, or whether an internal assessment is expected.
This page is designed to walk you through exactly what typically happens during an initial pelvic health physiotherapy appointment, so you know what to expect, feel prepared, and can arrive feeling as comfortable as possible.
Every appointment is individual and tailored to you. Nothing is ever rushed, and nothing is done without your understanding and consent.
A safe, supportive space
First and foremost: pelvic health physiotherapy is about listening, understanding, and working with you, not just treating symptoms.
Many people come to pelvic health physio feeling nervous, embarrassed, or worried that their concerns are “not bad enough” or that they should have dealt with them sooner. Please know that these feelings are incredibly common and you do not need to minimise your experience.
Our initial appointment is about building a clear picture of what’s going on for you, in a way that feels respectful, collaborative, and safe.
The initial conversation: your history and your goals
A large portion of your first appointment is spent talking.
This is known as the subjective assessment, and it’s one of the most important parts of pelvic health physiotherapy.
We’ll spend time discussing:
The history of your symptoms
When they began and how they’ve changed over time
Any triggers or factors that worsen or ease them
What treatments or strategies you’ve already tried
Relevant medical, surgical, pregnancy or birth history
Just as importantly, we’ll talk about how your symptoms are impacting your life.
This might include:
Exercise and physical activity
Work or daily tasks
Sleep
Confidence and mental wellbeing
Relationships or intimacy
You’ll also be asked about your goals.
What would improvement look like for you?
What are you hoping to get back to doing?
This helps guide a treatment plan that fits your priorities, not a one-size-fits-all approach.
Bladder, bowel and sexual health questions
Pelvic health physiotherapy involves discussing areas of the body and function that we don’t often talk about openly, but they provide essential information.
Depending on your presentation, I may ask detailed questions about:
Bladder function
How often you pass urine
Urgency or difficulty delaying
Leakage (when, how often, and in what situations)
Night-time waking to urinate
Any pain or discomfort
Bowel function
Frequency and consistency
Straining or difficulty emptying
Urgency or leakage
Feeling of incomplete emptying
Use of laxatives or stool softeners
Sexual function (only if you feel comfortable)
Pain with intercourse or penetration
Changes in sensation
Concerns following pregnancy, birth or surgery
You are always in control of how much you share.
If there are topics you’re not ready to discuss, that’s completely okay, we can return to them later if and when you feel comfortable.
Discussing a home exercise program (if appropriate)
For most people, pelvic health physiotherapy involves some form of home exercise or self-management program.
If I feel this would be beneficial for you, we’ll talk through it together in a very practical way.
I’ll ask questions such as:
How much time you realistically have to dedicate to exercises
What equipment you already have at home (if any)
What barriers you might foresee to completing exercises
What has or hasn’t worked for you in the past
This helps ensure that any program we create is realistic, achievable, and sustainable, not something that looks good on paper but doesn’t fit into your life.
Physical assessment (outside the pelvis)
Pelvic health conditions are rarely just about the pelvic floor muscles alone.
As part of your assessment, I will often examine areas that commonly influence pelvic health, including:
The thoracic (upper) spine
Lumbar (lower) spine
Pelvis and hips
This may involve looking at:
Posture in sitting and standing
Breathing patterns
Movement patterns
Strength, mobility, and coordination
These factors can play a significant role in symptoms such as pelvic pain, prolapse, incontinence, and pregnancy or postnatal concerns.
Pelvic floor assessment: external or internal (only if appropriate)
A pelvic floor assessment is not automatic, and it is never mandatory.
If a pelvic floor assessment is clinically appropriate, we will discuss:
Why it may be helpful
What information it can provide
What your options are
External assessment
An external assessment may involve observing and palpating muscles externally and provides some information, though it is more limited.
Internal assessment
An internal pelvic floor assessment can provide more detailed information about muscle tone, strength, coordination, and pain. This may be performed vaginally or rectally (or both) depending on your symptoms and presentation.
However
It is always optional
It is only performed with your informed consent
You can change your mind at any time
For people with pelvic pain conditions, a history of trauma, or high levels of anxiety, an internal assessment is rarely performed at the first appointment. In many cases, it may take several appointments, or may not be required at all.
There is no “right timeline”. We go at your pace.
Take-home tasks (if needed)
Sometimes, understanding pelvic health conditions requires a little more information than we can gather in one appointment.
You may be asked to complete things at home such as:
A bladder diary
A bowel diary
A symptom diary
These can help identify patterns, triggers, and contributing factors, and allow us to tailor your management plan more accurately.
Education and understanding your condition
Before the appointment ends, I will explain:
- What I think is happening with your condition
- The likely contributing factors
- How these factors may be interacting
Understanding why symptoms are occurring is a crucial part of pelvic health physiotherapy. Education empowers you to make informed decisions and feel more confident in your body.
Your management plan and next steps
We’ll finish by discussing:
The management plan I recommend
What treatment may involve
What you can expect to work on at home
An estimated timeframe to start seeing improvement
Where appropriate, this may include:
Hands-on treatment
A personalised home exercise program
Strategies for symptom management
Lifestyle or behavioural modifications
Every plan is tailored to you and reviewed regularly as things change.
Communication with your GP or specialist
With your consent, I will always send a letter after your initial appointment to:
Your GP, and/or
Any relevant specialist involved in your care
This helps ensure clear communication and coordinated care across your healthcare team.
A final word
Pelvic health physiotherapy is not about doing everything at once, and it’s not about pushing through discomfort.
It’s about:
Understanding your body
Addressing contributing factors
Moving at a pace that feels safe and manageable
Working together toward meaningful change
If you have any questions before your appointment, you’re always welcome to get in touch. We’re here to support you every step of the way.