What to Expect with an Internal Pelvic Floor Exam?
What Is an Internal Pelvic Floor Exam and Why Is it Helpful?
Scheduling your first pelvic floor physical therapy appointment is an amazing first step to take care of your pelvic health, but you’re curious and maybe nervous about what the exam entails. It might feel vulnerable enough discussing your bladder, bowel, and sexual health to a new practitioner, but being prepared for the exam can help calm any anxieties when coming into the clinic.
After a thorough discussion of your symptoms, your PT may suggest an internal pelvic floor assessment. This type of exam can provide you and your PT more answers as to why you’re experiencing those symptoms. As PTs, we don’t want to play a guessing game with your care. An internal exam can give us a lot of information and help to better tailor your treatment specifically to you.
After suggesting an internal exam, your PT will explain the pelvic floor anatomy with a 3D model of the pelvis. We want to show you what we’ll be doing first before you provide consent or decide you’d prefer to decline the internal exam! It’s important to remember that this is not like an exam at the gynecologist or OB: no stirrups or speculum in sight.
If you provide consent: (note: consent can be revoked at any point during the exam)
Your PT will step out of the room while you undress from the waist down, lie down on the table, then place a sheet over your lower half. The PT will knock prior to coming back in the room and then put on gloves. Usually she will start with an external exam to observe any skin or structural changes, and if the patients would prefer, she will provide a handheld mirror so that you can visualize your own anatomy while she points out various structures. Then, the PT will change gloves and place fragrance-free lubricant on one finger. She will then ask for your consent again and insert her finger vaginally or rectally (depending on your symptoms).
Your PT will first gently feel the pelvic floor muscles for any tightness - as the patient you will update the PT with any sensations of tightness, tenderness, soreness, pain, etc. Then the PT will ask you to contract your pelvic floor (“pretend like you’re stopping the flow of pee”), cough, and bear down (“pretend like you’re about to pass gas”). This allows the PT to assess your pelvic floor muscle strength and coordination, then give you cues on how to adjust your form as necessary. Your PT will next step out of the room, allowing you to get dressed. Tissues and wipes are provided in the room.
We will then discuss the findings of the exam and how it relates to your symptoms before making a detailed plan of action. The muscles may be tight, weak, uncoordinated - or a combination!
If you don’t feel comfortable with an internal exam:
If you don’t feel comfortable with an exam, we won’t do it - no questions asked! Internal exams can be performed at future visits if or when you feel more comfortable, or your PT can assess your pelvic floor muscles externally.
Some frequently asked questions:
What if I’m on my period? Can I decline an internal exam for just that visit?
Great question - of course! First off, your pelvic floor PT does not care at all - many of our patients menstruate, and we understand that you may not feel comfortable having an internal exam during your cycle. There are many other tools and techniques your pelvic floor PT can utilize to help with your symptoms during your appointment that day. However, for the people who have increased pain or symptoms during menstruation, an internal assessment at that time can be helpful to further guide your care - your pelvic floor may feel different due to hormonal fluctuation or cramping.
Is an internal assessment painful?
Many may associate a vaginal assessment with a painful speculum exam at your gynecologist, but this is not the case with pelvic floor PT. We do not use a speculum, just one lubricated finger to assess. For those with pelvic pain, an internal assessment may be uncomfortable, but pain or discomfort should not persist past the appointment or later that day. Your PT will be consistently checking in with you to gauge how you’re feeling during the entire exam! This is never a ‘no pain, no gain’ situation - if you’re feeling pain, that’s when we stop or change what we’re doing during the exam.