Your first appointment
Coming to see a specialist about a men’s health or pelvic health problem can feel unfamiliar, particularly if you have never had this type of assessment before.
Our aim is to make the process straightforward, private and unhurried.
Your appointment is one-to-one with a specialist physiotherapist. We take time to understand what has been happening, assess you properly, explain what we think is going on and agree a clear plan with you.
Nothing is rushed and nothing is done without your understanding and consent.
We start by listening
Every appointment begins with a proper conversation.
We will talk through your symptoms, how and when they started, previous investigations or treatments, your general health and anything that appears to make the problem better or worse.
Just as importantly, we want to understand how the problem is affecting your life.
Depending on your symptoms, this might include:
- Sitting
- Work
- Exercise or sport
- Bladder or bowel function
- Sexual function
- Sleep
- Relationships
- Confidence
- Day-to-day activities
You will have plenty of time to explain what has been happening and ask questions.
A thorough physical assessment
Men’s pelvic health problems rarely exist in isolation.
Your assessment may therefore look beyond the area where you feel your symptoms and include areas such as the abdomen, hips, back, pelvis, nerves and muscles around the pelvic floor and perineum.
The exact assessment is tailored to you and to the problem you have come to see us about.
We will explain what we are assessing and why as we go.
How do you examine the pelvic floor?
Will I need an internal examination?
This is something many men understandably want to know before their first appointment.
An internal examination is not automatic.
We have several ways of assessing the male pelvic floor and normally begin externally.
Ultrasound imaging of the male pelvic floor
We routinely use real-time ultrasound imaging as part of our pelvic floor assessment.
Ultrasound can be performed over the lower abdomen and externally over the perineum. It allows us to observe the pelvic floor while keeping the assessment external.
As our ultrasound colleague Dr Alime Büyük describes it, ultrasound:
“Makes the invisible visible.”
It can help us assess how your pelvic floor is working, including its ability to contract, relax and coordinate with movement and breathing.
It also gives you the opportunity to see your own pelvic floor working on the screen, which can be extremely useful when learning how to control or rehabilitate these muscles.
We routinely start with ultrasound imaging, and this is included within the cost of your appointment.
External perineal assessment
We may also assess the pelvic floor externally through the perineum.
Using gentle palpation or pressure, we can examine the muscles and surrounding tissues for areas of tension, tenderness or sensitivity and assess how the pelvic floor responds.
Again, we will explain exactly what we are doing before we do it.
Internal pelvic floor assessment
For some patients, an internal (rectal) pelvic floor examination can provide useful additional information because it is the most direct way of assessing certain pelvic floor muscles.
However, this is not required for every patient.
If we feel an internal assessment would be clinically useful, we will explain:
- Why we are recommending it
- What the examination involves
- What information it may give us
- How it may influence your treatment
Gerard and the team are highly experienced in male pelvic floor assessment and carry this out gently and sensitively.
An internal examination is only ever performed with your explicit consent.
You are involved in the decision throughout, you can ask questions beforehand, and you can change your mind or ask us to stop at any point.
There is never any pressure to have an internal examination.
We explain what we find
One of the most important parts of the appointment is helping you understand what may be happening.
By the end of your assessment, we want you to have a much clearer picture of:
- What may be contributing to your symptoms
- What we have found during the assessment
- What can be treated or changed
- What you can start doing yourself
- Whether any further medical investigation or specialist opinion may be helpful
We explain things in plain English and encourage you to ask questions.
Your treatment plan
There is no generic pelvic floor programme that is right for every man.
For some people the pelvic floor needs strengthening.
For others, particularly men experiencing pelvic pain, the problem can be quite different and treatment may focus on relaxation, reducing muscle overactivity, improving coordination and calming sensitivity within the pelvic and nervous systems.
Your treatment plan will therefore be built around what we find.
Depending on your condition, treatment may include:
- Pelvic floor rehabilitation
- Pelvic floor relaxation and retraining
- Real-time ultrasound biofeedback
- Hands-on treatment
- Bladder or bowel rehabilitation
- Nerve desensitisation strategies
- Breathing and movement work
- Advice around sitting, exercise and activity
- Sexual and erectile rehabilitation
- Return-to-running or return-to-sport rehabilitation
- A personalised home programme
Where appropriate, we also work closely with urologists, colorectal specialists, pelvic pain consultants, sexual medicine specialists, psychologists and other members of the wider men’s health team.
What happens after the first appointment?
Treatment that changes as you improve
Some men only need a small number of appointments while others benefit from a longer period of rehabilitation.
We review your progress rather than simply repeating the same treatment each time.
As things improve, we adapt your programme and gradually help you return to the activities that matter to you.
That might mean getting back to:
Sitting comfortably. Working normally. Exercising. Cycling. Running. Going to the gym. Sleeping better. Having sex without worrying about symptoms. Or simply feeling like yourself again.
Our aim isn’t to keep you coming to physiotherapy indefinitely.
It is to help you understand your condition, regain confidence in your body and give you the tools to manage independently.
Ready when you are
If you are unsure whether physiotherapy is appropriate for your problem, you are very welcome to contact us first.
Otherwise, you can book your appointment directly.
All enquiries are treated in complete confidence.
Book your appointment Ask Gerard a question in confidence