What is an Internal Pelvic Floor Exam
What is an internal pelvic floor exam?
If you’re considering pelvic floor therapy, you may have heard about internal pelvic floor examinations. While the idea of an internal exam might feel unfamiliar or even intimidating, understanding what it entails can help ease concerns and empower you to make informed decisions about your pelvic health. Here’s what to expect during an internal pelvic floor assessment here at Moms in Motion, how it might differ from other clinics, and why it can be a valuable tool in your care.
Why Is an Internal Pelvic Floor Exam Performed?
An internal pelvic floor examination allows your pelvic floorl therapist to assess the function, strength, coordination, and mobility of your pelvic floor muscles and surrounding structures. It provides essential information that can guide your treatment plan, whether you are experiencing symptoms like pelvic pain, incontinence, prolapse, or discomfort during pregnancy and postpartum.
What Happens During the Exam?
Since all our care is in the comfort of your own home, you can pick the space where you feel the most comfortable for the internal exam. We just need a spot for our treatment table, which is about 3ft by 6ft and a little wiggle room for us to stand next to the table. We have done internal exams in the living room, bedrooms, basements, and office spaces. Your therapist will bring her pelvic model and describe in detail what everything looks like and what she will be assessing.
The assessment includes:
External Assessment
We typically do the internal examination on the second visit in your plan of care. For this reason, your therapist has already assessed your posture, breathing patterns, and functional movements. This will help her connect the dots as she performs the internal exam since we always want to come back to the root cause for symptoms and not just chase the symptoms around. So when beginning the pelvic floor exam, your therapist will begin with an external examination which includes a visual inspection to check for any scars or tissue damage. Then she will palpate (touch) lightly with her fingertips along the skin of your labia majora to assess the outermost pelvic floor muscle layer through the skin. She will check for tissue tension and any pain or discomfort. She may also observe for muscle engagement.
Internal Assessment
If you consent, your therapist will proceed with an internal vaginal or rectal examination, depending on your concerns and needs. The steps include:
Evaluation of the Layers of the Pelvic Floor Muscles
The pelvic floor consists of three layers of muscles:Superficial perineal muscles: These include the bulbocavernosus, ischiocavernosus, and superficial transverse perineal muscles, which help with sexual function and support.
Urogenital diaphragm (middle layer): This includes the deep transverse perineal muscle and sphincters responsible for urinary and fecal control.
Pelvic diaphragm (deepest layer): This consists of the levator ani muscles (pubococcygeus, puborectalis, and iliococcygeus) and coccygeus, which provide core stability and organ support.
Your therapist will assess for muscle tone, tension, asymmetry, and any areas of tenderness.
Internal Pelvic Organ Position and Mobility
Through gentle palpation, your therapist can assess the position and mobility of the bladder, uterus, and rectum. This helps identify concerns such as organ prolapse, adhesions, or restricted movement that could contribute to symptoms.Muscle Strength and Coordination Testing
Your therapist will guide you through:Pelvic floor contractions (Kegels): Testing how well you can contract, relax, and hold a contraction.
Coordination: Evaluating the ability to coordinate with breathing and movement.
Reflexive engagement: Checking whether the pelvic floor muscles respond appropriately to pressure changes (such as coughing or lifting).
Assessment of Pain and Tension
Some individuals experience tightness, trigger points, or discomfort in the pelvic floor muscles. Your therapist will check for:Hypertonicity (excessive tension): Which can contribute to pelvic pain, pain with intercourse, constipation, or difficulty with urination.
Trigger points: Areas of localized muscle tightness that can refer pain to other regions.
Hypotonicity (weakness or lack of engagement): Which can contribute to urinary incontinence, prolapse, or lack of support for the pelvic organs.
Since our goal is to leave you feeling better than when we started, we do our best to address issues as we find them. This means we might do a partial examination and some treatment during one visit and we might not complete a full examination in one sitting. We will come back and finish the remainder of the examination the next time!
What Happens After the Exam?
Following the assessment, your therapist will discuss the findings with you and develop a personalized treatment plan. This may include:
Pelvic floor relaxation exercises or pelvic floor strengthening exercises
Manual therapy techniques to release tight areas
Breathwork and core coordination exercises
Education on posture, movement strategies, and daily habits
Does everyone need an internal exam?
While an internal exam can be valuable to gain a full picture of your body and its functioning, we believe in care that supports you as an individual and your body. If you don’t feel comfortable with an internal exam, we will never pressure you into one! We can gain a lot of information through external examination alone and will do our best to address the root cause of your symptoms with the information we do have.
Final Thoughts
An internal pelvic floor examination is a valuable tool in understanding and addressing pelvic health concerns. It is always performed with your consent, and you have the right to stop or modify the exam at any time. If you have questions or concerns, don’t hesitate to discuss them with your pelvic floor therapist.
By taking the step to have an assessment, you are advocating for your well-being and taking control of your pelvic health journey!
Want to work with us? Fill out our appointment request form and our team will be in touch with your shortly!