What to expect during an internal pelvic floor exam and internal manual treatment
If you’ve been referred to pelvic floor therapy or if you know someone who has received this care and you’re wondering what to expect from your first visit, we wrote a blog about everything you can expect here! Recently, we’ve had a lot of questions about the “internal part” of the pelvic floor exam and treatment.
If you’re also wondering what this means, keep reading!
This weekend, I've been hanging out at the clinic with the students of Herman & Wallace Pelvic Rehabilitation Institute Pelvic Floor Level 1 course and felt inspired to write a blog post all about the internal exam and internal treatment. Pelvic floor therapists go through specialized training in addition to entry level PT or OT school and part of this training is learning and practicing internal exams and treatment on each other. It helps us prepare to apply our learned techniques with our future patients and it's also very helpful to experience the internal exams ourselves. We understand the apprehension, nerves and anxiety that often come with the first internal exams. The unknown can be scary and not so great past experiences with pelvic exams can be an understandable barrier to getting the help you need.
When you see your pelvic therapist, you can rest assure we have been in your shoes before. And clinicians that get into this work are SO passionate about helping you feel better.. this is definitely NOT just a job for us.
Why is an internal exam of the pelvic floor important?
An internal assessment of the pelvic floor musculature is important because the pelvic floor muscles live inside the pelvis and the way we can access them best is within the vaginal and rectal region. These tissues, which include muscles, tendons, fascia and bone, are responsible for optimal bladder, bowel, digestive and sexual health as well as provide stability for our hips, pelvis and spine. Since these tissues are located inside the pelvis, the only way to fully appreciate how well they function, is to palpate and feel them both at rest and during various relevant tasks. The internal pelvic floor portion of your evaluation does not need to happen on your first day or even at all and we will make this decision together.
What to expect during your internal exam?
Prior to your internal assessment, your therapist will describe in detail the entire process of the internal exam and ensure you know what to expect and that you know you are in control the entire time. They will ask you if you have any questions and confirm that you would like to move forward with this step. They will then step out of the room and ask you to undress from your waist down and then they will return when you are comfortable lying on the table and under a sheet. Usually, with your legs supported. During the internal exam, your therapist will observe how your pelvic floor muscles move and function. They might ask you to take a deep breath, cough, squeeze, relax, and bare down. Then they will perform a manual assessment of your pelvic floor muscles externally and internally to determine their strength, endurance, and coordination as well as identify any muscle tightness or tenderness. Your therapist will assess your tissues using a gloved finger inserted inside your vaginal opening (or rectum) . We don't use a speculum or stirrups and it is important to us that you are as comfortable as possible.
Dr. Jenn performing internal pelvic floor assessment at Root To Rise in Scarborough, Maine
Is the internal exam painful?
We want your experience to be as pain-free as possible. During the exam you are in complete control and you will be talking with your therapist throughout the process. Your therapist will be asking you if you are experiencing pain or discomfort and will always adjust accordingly. The good news is you get to work with your therapist over several sessions and there is no reason to be pushing through pain. If you are in a significant amount of pain with gentle assessment, we will work on other things to help our symptoms until you and your body are ready for internal therapy.
What can I do to prepare for my first internal pelvic floor assessment?
We recommend connecting with your therapist before your appointment if possible. Communication with your provider and feeling safe is the most important part of this process so if you are feeling nervous or apprehensive about the internal exam, we recommend that you reach out to your provider to share how you are feeling and ask as many questions as you need to feel well informed and prepared. They can talk through their process with you and hopefully help you feel more comfortable. At Root To Rise, we offer free 30 minute consultations and we would love to meet you ahead of time to talk through any questions you have.
What about internal “manual treatment”?
Once you have your internal exam, your therapist might determine that would benefit from internal manual therapy as part of your plan of care. This could include manual soft tissue mobilization/massage to the pelvic floor muscles internally and externally as well as work with you on learning to improve your coordination by providing some biofeedback with your therapist’s finger is inserted vaginally or rectally to help you sense and connect to these muscles. This may also be helpful if you have scar tissue within the pelvic floor to help improve the scar healing and mobility. Internal manual therapy can promote improved overall function of the pelvic floor and over time can also decrease pelvic pain, bladder, and bowel symptoms such as urgency, frequency, leaking, and constipation.
Can I opt out of the internal exam and manual treatment and still see benefits with pelvic floor therapy?
Yes you absolutely can! Although the internal portion of the pelvic floor evaluation is considered the standard of care for pelvic floor dysfunction, there are many other ways for your therapist to evaluate and address your condition and provide you with a treatment plan that does not include internal therapy. As the field of pelvic floor therapy continues to grow, we keep learning more ways to aid in influencing the pelvic floor through addressing other aspects such as the external musculoskeletal system, the nervous system, mental health, movement therapy, lifestyle changes and more! We always work with you to meet you where you are and will help you to reach your goals based on your unique needs.
At Root to Rise Physical Therapy & Pelvic Health, we believe in a holistic approach to physical therapy. Our Doctors of Physical Therapy and Occupational Therapists are specialized in treating both orthopedic and pelvic health conditions. Our practice also integrates acupuncture and yoga and we are always excited to be a resource for the community we practice in. We are located in Scarborough, Saco, and Bath, and are here to support you!
~Dr. Jenn & The Root To Rise Team
