Pelvic floor therapy internal exam and treatment - the why and what to expect at your appointment
If you have been to pelvic floor therapy before, you may be familiar with what a pelvic floor therapy internal muscle assessment is. If you haven’t, maybe you have heard about pelvic floor therapy on social media or from a friend. Or maybe you have no idea what a pelvic floor muscle assessment is. No matter which of these categories you fall into, this blog post is for you!
(I do want to quickly note that this blog post is directed towards women and vulva owners, not men and penis owners).
First, what is the pelvic floor?
The pelvic floor is a bowl of muscles at the bottom of the pelvis. It has attachments to the pelvis, sacrum and tailbone, and femur (thigh bone), as well as fascial connections to the low back and abdomen, and neural connections to the neck and jaw. The pelvic floor muscles play an important role in bowel, bladder, and sexual function. They also support the pelvic organs, including the bladder, uterus, and rectum.
How does the pelvic floor work (and how to know if you have pelvic floor dysfunction)
The pelvic floor muscles should have a nice resting tone and be able to both lengthen and lift. Imagine your pelvic floor muscles as being a trampoline. A trampoline has enough tension to support you if you are standing on it. If you jump on a trampoline, it is able to lengthen to absorb your landing and lifts to support you as you jump. When you sneeze, cough, or jump, your pelvic floor muscles lengthen to absorb the force down, then are able to reascend when the pressure subsides.
Now imagine the springs of the trampoline are pulled tight and the trampoline itself is taut. If you tried to jump on it, it would not be able to lengthen to support you the same way. This is a great way to think about a more tense, or hypertonic, pelvic floor. If the muscles are in a shortened position and aren’t able to lengthen, they can’t absorb force well. If you cough, sneeze, or jump, it is more like your pelvic organs are hitting a concrete slab rather than a trampoline.
Now imagine that a few of your springs are cut off or loose, and your trampoline has less tension at baseline. If you tried to jump, it wouldn’t support your impact or reascend well. This is how a weak and disconnected, or hypotonic, pelvic floor functions. The muscles simply aren’t firing well to respond to impact or movement.
What symptoms might you experience if you have pelvic floor dysfunction?
There are quite a few symptoms that can be associated with pelvic floor muscle dysfunction. If you experience any of the following symptoms, I recommend consulting with a pelvic floor therapist.
Pelvic pain, such as pain with pelvic exams or using menstrual products
Pain with intimacy or difficulty achieving orgasm
Back, hip, tailbone, and/or SI joint pain
Leaking with coughing, sneezing, or jumping
Urinary urgency
Urinary frequency, difficulty fully emptying your bladder, or pain with urination
Constipation, straining to have a bowel movement, difficulty initiating a bowel movement, and/or feeling like you are unable to fully empty your bowels
Difficulty controlling gas and/or bowels
Now that you know more about the pelvic floor - how does a pelvic floor therapist assess your pelvic floor function?
Your pelvic floor therapy evaluation should include a thorough subjective assessment, including questions about bowel, bladder, and sexual function. This conversation will help your therapist determine what may be contributing to your symptoms, what symptoms to assess throughout your plan of care to track your progress, and what treatments may be most helpful to you.
If your pelvic floor therapist has completed the necessary training in order to complete an internal pelvic floor muscle exam, they will likely recommend it. You can absolutely decline to have an internal pelvic floor muscle assessment if you are not comfortable. However, it does provide your therapist with a lot of information about how your muscles are functioning, how you are managing pressure, and the best way to help you reach your goals.
Internal pelvic floor muscle assessments are very different from pelvic exams you may have with an OBGYN. The goal is to determine how the muscles are functioning. Your therapist will use one gloved finger inserted into your vaginal canal to assess each side of your pelvic floor muscles. They will gently palpate the muscle tone, assess any scar tissue that may be present, and will ask for your feedback on if the muscles feel tender to touch. Your therapist will also ask you to take some deep breaths and will feel how your pelvic floor responds, and will also assess your pelvic floor muscle coordination with core muscle activation.
Additionally, your pelvic floor therapist may recommend a standing assessment, especially if your symptoms are primarily with standing activities. When you stand your pelvic floor muscles have to work harder against gravity, so it is important to assess the difference between pelvic floor function lying down vs standing.
There are also some symptoms that indicate a rectal exam may be beneficial. Because of the anatomy of the pelvic floor, it can be difficult to assess and treat the posterior muscles effectively through a vaginal exam. Your therapist will be able to discuss the benefits and indications for both a vaginal and rectal exam.
I want to reiterate that it is always your choice to have an internal pelvic floor muscle exam. I also want to note that your pelvic floor therapy assessment and treatment should involve a lot more than just internal manual therapy. Your therapist should be discussing lifestyle and habit changes that could improve your symptoms, they should be assessing your posture, rib cage mechanics, pelvis, hips, and feet, and should be giving you home exercises (which should not just be doing kegels!!).
If you are local to the Memphis area and looking for pelvic floor therapy, I would love to support you in your health journey. You can schedule a free 15 minute phone consult or an evaluation with me here.
Blog post written by Dr. Alexis Hutchison, PT, DPT, OCS, PCES