An Internal Pelvic Floor Assessment…Not As Scary As You Think
Going to a pelvic floor therapist is a pretty unique experience.
You’re talking to someone about topics that you may not even talk about with your best friend.
You’re trusting someone with arguably the most intimate and sensitive part of the body.
It makes sense that there’s a little hesitancy and even fear around a pelvic floor evaluation, specifically the internal assessment.
The pelvic floor muscles are just that…muscles. If you went to a PT/OT for your shoulder or knee they’d take a look at the range of motion, strength, and tone. The difference is that the pelvic floor musculature can’t be seen. An internal assessment is the gold standard to determine the coordination of your pelvic floor muscles and the muscle tone, which is the tension of the muscle at rest and how responsive it is to changes/movement. It is the only way to truly assess the resting tone of the pelvic floor muscles.
That said, an internal exam is not required, on the first visit or ever. There are other ways to assess for range of motion, coordination and strength such as external assessment, observation, or a hands-off assessment led by the client. It is based on the comfort level of the client, and a fluid conversation between you and your therapist.
At Functional Wellness the client is provided step-by-step explanations, clear expectations, as well as regular check-ins and requests for consent throughout the entire experience.
Following an observation and external assessment, a therapist performs an internal exam by placing a single gloved finger into the vaginal opening to no further than the 2nd-3rd knuckle. Similar to the way a physical/occupational therapist checks for your range of motion and strength of a hand, knee, or shoulder, your pelvic floor therapist will do the same.
You’ll be asked to contract and lengthen your pelvic floor muscles. Your therapist will assess for any trigger points or knots. You’ll be asked to participate in sharing what sensations come up. Similar to the way a massage therapist may find a knot, your therapist may come across these points of tension in your pelvic floor muscles that may be contributing to functional impairments. There could be sensations that come up, but sustained discomfort should be no more than a 1/10.
Following your internal assessment, you may or may not benefit from continued internal work. Once again, this is optional and part of a discussion as you and your therapist create a treatment plan.
Your pelvic floor therapist will likely restrain from performing an internal assessment during the first trimester of pregnancy or during the first 6 weeks postpartum. If pregnant and interested in internal assessment/treatment to manage symptoms, you will want to ask your provider for a script clearing a therapist for this kind of work.
An internal pelvic floor assessment can be a fantastic tool and create a deeper sense of awareness in your body, but it’s only beneficial if the you, the client, are part of the process.
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