what is a pelvic floor exam?
In an initial appointment with a pelvic health physiotherapist you can expect to discuss your pelvic health or pelvic floor concerns, be asked about your bladder and bowel habits, history of pelvic pain, gynaecological and other medical history, any previous or current injuries and lifestyle habits and receive education on the likely cause of your symptoms alongside exploring potential assessment or treatment plan approaches. This history taking process can be quite time intensive, and is often challenging for patients, but is an important step to developing a comprehensive understanding of your experience and symptoms. At Embrace Physio + Pilates, our pelvic health physio’s always treat you with the utmost dignity and respect, are trauma informed and offer warmth and compassion when discussing these concerns.
Depending on the length of the consultation and your comfort levels, we may also perform a pelvic floor examination on the same day or postpone this to the next appointment. Sometimes the concept of a pelvic health physio performing a pelvic floor examination can come as a surprise to patients, or feel daunting, and we are more than willing to allow you time to think over your options for assessment and prepare mentally before undergoing one. It is however important to have a pelvic floor assessment so that we can confirm whether the pelvic floor muscles, connective tissue, skin, nerves and/ or blood vessels are contributing to your symptoms and include that in your treatment plan or refer onwards if appropriate for gynaecological, urologist or gastroenterologist review.
The gold standard for a pelvic floor assessment is an internal vaginal exam, whereby your pelvic health physiotherapist palpates the pelvic floor tissues with a single gloved finger via the vagina and asks you to bear downwards and contract and relax the muscles at different points of the assessment. Throughout this, we can ascertain whether you have conscious control and coordination of your pelvic floor muscles, if they are tender or have altered tone, require more relaxation or more strengthening and how they respond to changes in pressure. From there, we can also provide real time feedback on how to improve your pelvic floor contraction and breath mechanics. In conjunction (or alternatively if you aren’t comfortable with an internal pelvic floor exam), we perform a visual assessment of the external tissues when you bear downwards, cough and contract and relax and determine if any skin irritation or anatomical variances are contributing to your symptoms. A third option is to use a real time ultrasound machine which observes the movement of your bladder when you try to contract and relax your pelvic floor muscles. This assessment allows us to determine how much range of movement you have available and can also be a great teaching tool, but does not provide us with the same amount of information regarding tissue tone, tenderness or variances between the strength, relaxation and coordination of your superficial and deep layers of muscle as an internal pelvic floor examination. You do also need a reasonably full bladder to be able to perform this assessment. Regardless, your pelvic health physio will also look at your posture, breathing patterns and jaw, mid- back, ribcage, lower back and hip strength and overall flexibility and any injuries you may have as these areas can all contribute to your pelvic health symptoms too.
Regardless of whether a pelvic floor examination is conducted on the same day of your initial appointment or not, you will walk away from your first experience with a pelvic floor physio feeling enlightened to the world of pelvic health and with an understanding of how your pelvic floor compares to optimal pelvic floor function. We will always aim to provide practical changes to bladder or bowel habits, lifestyle advice and/ or set you up with some therapeutic exercises where appropriate in that first session. Or sometimes, we simply focus on the treating surrounding musculoskeletal areas until you feel comfortable exploring the pelvic floor further- and often this forms a part of our long- term management plans anyway. And then, if and when we are able to perform an internal pelvic floor examination your pelvic floor physio can then teach and add in specific pelvic floor exercises and also the potential use of internal pelvic floor muscle release, at home use of vaginal dilators, vibrators and pelvic wands and vulval care advice when appropriate.
If you are ready to explore and improve your pelvic health, you can read about our physiotherapists’ experience and qualifications here and book an initial pregnancy, postnatal or pelvic health appointment here.
Author: Jessica Adams, 2024