Most people who need pelvic health physiotherapy wait far longer than they should before booking. Surveys of women with urinary incontinence repeatedly find average delays measured in years, and the reasons given are consistent: embarrassment, not knowing what the appointment involves, and a fear of being examined without warning.
So here is the whole thing in advance. Nothing on this page is a surprise you will encounter on the day.
Before you arrive
Your first appointment lasts 60 minutes. Wear whatever is comfortable — you will not need to change into a gown, and there is no need to dress up or down for it.
It helps to bring a list of your current medications, any letters or scan results from a GP, urogynaecologist, colorectal surgeon or midwife, and — if you have one — a few days of a bladder diary. If you do not have a bladder diary, that is fine; one may be given to you to complete afterwards.
You are welcome to bring a partner, friend or family member into the appointment. Babies and small children are welcome at postnatal appointments, and you do not need to arrange childcare.
Periods are not a reason to cancel. If you would rather reschedule an internal assessment, the rest of the appointment can go ahead as planned and the examination can be moved to your next visit.
The appointment, step by step
1. Talking — roughly 20 minutes
The longest part, and the most important. You will be asked about your symptoms and when they started, your bladder and bowel habits, your pregnancies and births if relevant, your periods and menopause status, past surgery, your pain, your exercise, and what you are finding hardest day to day. Some of these questions are personal. They are asked because the answers change the diagnosis — not out of curiosity.
2. Movement and posture assessment
How you stand, breathe, bend and lift. Your therapist will look at how pressure travels through your abdomen during effort, and at your hips, back and abdominal wall. This is done fully clothed.
3. Explanation before any examination
Before anything else happens, your therapist explains what she would like to assess, why, exactly what it would involve, and what the alternatives are. You then decide. This is not a formality — nothing proceeds without your explicit agreement.
4. Physical assessment — with your consent
Depending on your symptoms this may include abdominal assessment, scar assessment, external pelvic assessment, and/or an internal vaginal or rectal examination. Each is optional and each is explained first. You undress only from the waist down, you are covered with a sheet throughout, and you can stop at any point.
5. Findings, explained plainly
Your therapist tells you what she found, in ordinary language, and what it means. If a diagnosis is unclear or you need investigations or onward referral, you are told that too rather than being given a plan that does not fit.
6. Your plan, and starting it
You leave with a written, individualised programme — the specific exercises, how often, how to progress them, what to avoid for now, and what improvement should look like and by when. You will usually practise the key exercise in the session so you know you are doing it right.
The internal examination — the honest answer
An internal vaginal examination is the most accurate way to assess pelvic floor strength, endurance, coordination, prolapse grade, muscle tone and scar tissue. There is no external test that matches it for precision, which is why it is offered.
It is performed by a single gloved, lubricated finger. There is no speculum. It is not a smear test and it should not be painful — if it is uncomfortable at any point, tell your therapist and it stops. It usually takes only a few minutes.
It is entirely optional. You can decline it at your first appointment and change your mind later, or never have one at all. Many patients begin with external assessment and real-time biofeedback and progress well; some choose an internal assessment at a later visit once they feel more comfortable. Declining does not limit the care you receive.
You can ask for a chaperone, bring your own, or ask for the examination to be scheduled at a different appointment. If you have experienced sexual trauma, please say so if you feel able — it changes how the assessment is approached, and it is far more common among patients than most people assume.
Rectal examination is sometimes appropriate for bowel symptoms or posterior prolapse. The same rules apply: explained first, optional, stoppable at any moment.
Common worries — answered
"It will be embarrassing"
This is routine clinical work carried out many times a week. Whatever your symptom is, it will not be new or shocking to your therapist — and it is far more common than you think.
"I should have come sooner"
Very common, and not useful. Pelvic floor muscle training works whether your symptoms began six months or twenty years ago, because muscle responds to load at any age.
"I should shave or prepare"
No preparation of any kind is needed or expected. Come exactly as you are.
"What if I leak during the assessment"
It happens, it is expected, and it is clinically useful information. There are facilities available and nobody will react.
"Will I be judged for my weight or fitness?"
No. Your therapist needs an accurate picture in order to build a programme that fits your actual life, not an idealised one.
"Will it hurt?"
Assessment should not be painful. Some findings can be tender — that tenderness is often part of the diagnosis. You control the pace throughout.
After your first appointment
Follow-up appointments are usually 30 to 45 minutes and typically spaced two to four weeks apart at first. That spacing is deliberate: muscle takes weeks to adapt, so reviewing sooner rarely shows change, and reviewing much later means errors go uncorrected for too long.
Most patients notice meaningful improvement within six to twelve weeks of consistent work. Full programmes commonly run three to six months. Pelvic floor training is strength training — the results come from what you do between appointments, and the appointments exist to make sure that work is correct and progressing.
If you are not improving as expected, that is a signal to reassess rather than to try harder. Sometimes the diagnosis needs revisiting, and sometimes onward referral is the right next step.
Frequently Asked Questions
How long is the first appointment?
Sixty minutes. That includes a detailed history, physical assessment, an explanation of the findings, and time to start your programme so you leave knowing exactly what to do. Follow-up appointments are usually 30 to 45 minutes.
Do I have to have an internal examination?
No. It is offered because it is the most accurate way to assess pelvic floor function, prolapse grade and scar tissue, but it is entirely optional and requires your informed consent. External assessment and real-time biofeedback are effective alternatives, and you can change your mind in either direction at any appointment.
What should I wear?
Ordinary comfortable clothes. You will not be asked to change into a gown. If a physical assessment is carried out you undress only from the waist down and are covered with a sheet throughout.
Can I bring someone with me?
Yes. You are welcome to bring a partner, friend or family member into the appointment, and you can request a chaperone. Babies and young children are welcome at postnatal appointments and you do not need to arrange childcare.
What if I am on my period?
You do not need to cancel. The history, movement assessment, explanation and programme all go ahead as normal. If you would prefer to postpone an internal assessment it can simply be done at your next visit.
Do I need a GP referral?
No. You can book directly as a self-referring patient. GP and consultant referrals are welcome, and if you are already under a urogynaecology, colorectal or midwifery team it is helpful to bring any letters or results with you.
How many appointments will I need?
Most patients see meaningful improvement within six to twelve weeks, with appointments spaced two to four weeks apart, and complete programmes typically run three to six months. The exact number depends on your diagnosis, your starting point and your goals — you will be given a realistic estimate at your first appointment rather than an open-ended commitment.
Clinically reviewed by Jency Sudha, Consultant Pelvic Health Physiotherapist & Biofeedback Specialist — last updated 26 July 2026
The information on this page is for general guidance and does not replace individual clinical assessment. If your symptoms are new, worsening, or accompanied by bleeding, fever or severe pain, contact your GP or NHS 111.
No Surprises. Book When You Are Ready.
You now know exactly what the appointment involves. If anything is still unclear, call or email first — questions before booking are completely normal.
Book Your ConsultationOr contact us directly: 07999 996926 | info@zylohphysio.com