Hello Everyone — Resident pelvic floor specialist here!
I was recently thinking about evaluation and treatment for pelvic floor therapy so that our patients know what to expect. On the day of the evaluation, I like to explain how treatment will go in order to ease anxiety.
Treatment begins with the therapist asking questions about what brings the patient in, what activities are difficult to do (including questions about bowel, bladder and sexual activity), and what goals they want to get out of treatment.
After getting all of the subjective information, the objective testing starts with a screen of the low back and pelvis, strength testing, stability, and mobility testing. The next part, after our patients give consent to do so, is the internal exam. The internal aspect of the exam consists of the therapist placing a lubricant covered digit into either the rectal or vaginal canal to assess the musculature of the pelvic floor.
Those two options evaluate the pelvic floor, but what are the reasons we would evaluate each area?
Intravaginal Pelvic Floor Exams
We would use this approach for someone with a vaginal canal who is undergoing incontinence, vulvar pain, or pain with penetration or other sexual activity. We are able to easily assess the bony prominences of the pelvis, as well as see the pelvic floor contracting and relaxing. This treatment approach can also be helpful to complete if there is any perineal tearing post vaginal delivery during childbirth in order to assess scar tissue.
Intrarectal Pelvic Floor Exams
This approach can be efficient for those with GI problems such as constipation, incontinence, or orthopedic problems such as tailbone or hip pain, as the musculature of the hip that makes up the pelvic floor are easily accessed through the rectal canal. This could also be a good approach for those who are unable to tolerate any insertion into the vaginal canal due to increased muscle tightness of the pelvic floor or pain.
The great thing about pelvic floor physical therapy is that everyone of all genders and genitals have a pelvic floor, and thus can benefit from treatment if there is dysfunction present. Both treatments are good ways to reduce tension through the pelvic floor to aide with improving function and overall quality of life!
