Core Focus DPT

Deciding to seek care for pelvic floor concerns is a meaningful step toward greater comfort, function, and long-term wellness. At Core Focus DPT, we know that understanding the evaluation process ahead of time eases anxiety, equips you to participate fully in your care, and helps you feel respected in every step of the journey.

We prioritize your comfort and education throughout this process. Here’s a comprehensive guide to what typically happens during a pelvic floor physical therapy evaluation.

What Is a Pelvic Floor Evaluation?

A pelvic floor physical therapy evaluation is a detailed, individualized assessment designed to understand how your pelvic muscles, movement patterns, postural control, core stability, and lifestyle habits contribute to your symptoms.

It is not a one-size-fits-all exam. We look at the whole body, how you breathe, how your core and hips support movement, how you stand and move through your day, and how your pelvic floor coordinates with all of it. Often, symptoms show up not because one muscle is “weak,” but because parts of the system are compensating for each other.

This evaluation goes beyond a check-box approach — it seeks to uncover meaningful patterns so your care plan is personalized and purposeful. 

Step 1: Detailed Medical History Review

The first part of the evaluation involves thoroughly discussing your medical history. Your physical therapist will ask questions about the following:

• Past Medical and Surgical History: Any surgeries, chronic conditions, or significant medical events.
• Obstetric and Gynecologic History: For those who have given birth, details about pregnancies, deliveries, and postpartum recovery.
• Symptoms and Concerns: This includes incontinence, pelvic pain, sexual dysfunction, or other issues.
• Lifestyle Factors: Information about your physical activity, diet, and stress levels can provide insight into contributing factors.

Expect topics like:

• bladder: leakage, urgency, frequency, nighttime waking, “just-in-case” peeing
• bowel: constipation, straining, incomplete emptying, hemorrhoids
• pelvic pressure/heaviness (including prolapse symptoms)
• pain: pelvic pain, tailbone pain, hip/back pain, pain with sex, tampon use, or exams
• pregnancy/postpartum history, surgeries, injuries, training history, and stress load
• what you want back: running, lifting, comfortable intimacy, confident travel, no leaks at school pickup, etc.

This discussion helps your therapist understand the broader context of your symptoms, setting the foundation for a personalized treatment plan.

Step 2: External Examination

After reviewing your history and goals, we move into an external examination. This is where we start putting the story together and learn how your body moves, supports itself, and manages load throughout the day. Pelvic floor function is influenced by far more than one muscle group, so this portion of the evaluation looks at the body as an integrated system.

Postural assessment

I observe how you naturally stand and sit, and how your posture changes when you’re relaxed versus when you’re trying to “hold yourself up.” Alignment of the rib cage, pelvis, spine, and head affects how pressure is managed through the core and pelvic floor. Patterns like rib flare, pelvic tucking, over-arching, or habitual glute clenching can all alter how the pelvic floor responds to daily demands.

Movement analysis

Next, we watch how you move through basic functional tasks such as bending, squatting, sitting, standing, stepping, or balancing. We’re looking at how force is transferred through your body, how your hips and spine contribute, and whether your system moves smoothly or relies on compensation. Symptoms often show up during movement, and these patterns give valuable insight into why.

Joint and soft tissue mobility

We assess the mobility of key joints and tissues that influence pelvic floor mechanics, including the hips, lumbar spine, sacroiliac joints, rib cage, and surrounding soft tissues. Restrictions in these areas can change movement options and increase strain elsewhere. When joints don’t move well, the pelvic floor often has to absorb forces it wasn’t designed to handle alone.

Strength and control testing

Strength testing helps me understand not just how strong a muscle is, but how well it works with others. I assess the abdominal wall, hips, glutes, and deep stabilizers for strength, endurance, and coordination. I’m paying close attention to how you generate force, how you breathe during effort, and whether tension shows up where it doesn’t need to.

Special orthopedic testing

When appropriate, I use orthopedic special tests to rule in or rule out contributors such as hip pathology, low back involvement, nerve irritation, or pelvic girdle dysfunction. Pelvic floor symptoms often overlap with orthopedic issues, and this step helps ensure we’re addressing the true drivers rather than just treating symptoms.

External pelvic floor evaluation

An external pelvic floor assessment may also be included. This can involve observing pelvic floor movement with breathing, gentle external palpation, and coordination testing and can be done without internal examination. This provides important information about how the pelvic floor responds to relaxation, contraction, and pressure changes, and it is often a helpful starting point before considering any internal assessment.

Step 3: Internal Examination (Optional and With Consent)

With your consent, the next step may involve an internal pelvic exam. This is typically conducted vaginally for females or rectally for males. The purpose of this examination is to:

• Evaluate Muscle Strength and Tone: Assess how well the pelvic floor muscles can contract, relax, and sustain activity.
• Identify Trigger Points: Areas of tightness or discomfort within the pelvic floor muscles.
• Assess Structural Integrity: Check for conditions such as prolapse or scar tissue from surgeries or childbirth.

It is important to note that patients can decline an internal pelvic floor examination. Therapists can still gather valuable information through the history-taking process and external observations. These may include assessing the pelvic floor during activities such as contracting, holding, relaxing, or bearing down. At Core Focus Physio & Wellness, we respect your comfort and decisions at every step.

Your therapist will explain each step of the process and ensure your comfort throughout. It is important to communicate openly about any discomfort or concerns during this part of the evaluation.

Step 4: Assessment of Muscle Function

Your pelvic floor muscles are critical in various bodily functions, including bladder and bowel control, sexual health, and core stability. Your therapist will evaluate:

• Coordination: How well your muscles work together during activities like coughing or lifting.
• Endurance: The ability of your pelvic floor to maintain a contraction over time.
• Relaxation: Ensuring the muscles can fully release after contraction is just as important as strength.

This part of the evaluation helps pinpoint whether muscle weakness, overactivity, or coordination issues contribute to your symptoms.

Step 5: Discussion of Findings

After completing the evaluation, your therapist will explain their findings in detail. This discussion typically covers:

• Key Observations: Specific issues identified during the assessment.
• Connections to Symptoms: How these findings relate to the symptoms you’re experiencing.
• Treatment Plan: A tailored approach to address your unique needs, which may include:
  • Pelvic floor exercises to improve strength and coordination.
  • Manual therapy techniques to release tight muscles or scar tissue.
  • Biofeedback to enhance awareness and control of pelvic floor muscles.
  • Education on lifestyle changes to support long-term pelvic health.

Step 6: Questions and Collaboration

At Core Focus Physio & Wellness, we believe in a collaborative approach to care. Your therapist will encourage you to ask questions and share your goals and concerns. Together, you will create a roadmap for recovery that aligns with your lifestyle and priorities.

Why Pelvic Floor Evaluations Are Important

Pelvic floor dysfunction can significantly impact your quality of life, but it is highly treatable with the right approach. Common conditions addressed through pelvic floor therapy include:

• Urinary or fecal incontinence
• Pelvic pain
• Pain during sexual activity
• Postpartum recovery challenges
• Prolapse management

An evaluation is the first step in identifying the root cause of these issues and developing an effective treatment plan.

Preparing for Your Evaluation

To make the most of your appointment:

• Wear Comfortable Clothing: Choose clothing you can easily move in, such as leggings, athletic pants, or shorts with a comfortable top. This allows me to observe posture, movement, and functional tasks without restriction. You don’t need to dress “for an exam” the goal is to see how your body moves in real life, not to look a certain way.
• Bring Relevant Medical Records: If you’ve had surgeries, imaging, prior physical therapy, or medical treatments related to pelvic health, pregnancy, childbirth, orthopedics, or abdominal issues, bring any records you have or be prepared to talk through them. This information helps me understand your history and avoid unnecessary repetition, while also making sure your care is appropriate and individualized.
• Write Down Questions: It’s very common to forget questions once the appointment starts. Writing things down ahead of time helps ensure we cover what matters most to you whether that’s leaking during workouts, pain with certain activities, returning to running, intimacy concerns, or simply understanding what’s happening in your body. There are no “too small” or “too personal” questions here.
• Other Considerations: You don’t need to change your routine before your visit. Don’t try to hold your bladder longer than usual, overcorrect your posture, or practice squeezing your pelvic floor ahead of time. Showing up as you normally function gives us the most accurate picture of how your system is working.

FAQs

Is an internal exam required?
No — it’s always optional and discussed in advance. Your comfort and choice guide every part of your evaluation. 

Will the evaluation hurt?
Your experience should not be painful. If anything feels uncomfortable, you communicate that, and your therapist will adjust the approach. 

How many sessions will I need?
Every plan is unique. Some people see changes within a few weeks, others need longer depending on their goals and symptoms.

Take the First Step Toward Better Pelvic Health

At Core Focus DPT, we believe that your body is not a problem to be fixed — it is a partner in your life’s work. Our evaluation isn’t a checklist; it’s a conversation with your body. We seek not just relief, but understanding, confidence, and stewardship of your movement.

If you’re ready to begin with clarity and compassion, we’re honored to guide you.

Schedule a free discovery call or book your evaluation today.
Your journey toward comfort, control, and confidence begins with understanding — and you deserve clarity every step of the way.

Disclosures & Disclaimers

Some of the links I share are affiliate links, including Amazon and select brand partners. If you choose to make a purchase through one of these links, I may earn a small commission—at no extra cost to you. This never influences my opinions. I only recommend products I’ve personally used, carefully researched, and genuinely love.

** The views and opinions expressed on this site belong to Vigeo Ergo Consulting LLC. Any advice or suggestions offered herein are not a replacement for medical advice from a physician or other healthcare professional. My blogs are for informational and entertainment purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment.