Pelvic Floor: Understanding Internal Assessments

When discussing pelvic health, particularly with a physiotherapist, you might hear about internal assessments. These examinations can sometimes cause apprehension, but understanding their purpose and process can alleviate any concerns. This article aims to provide a comprehensive overview of internal vaginal or rectal assessments, explaining what they involve, why they are performed, and the benefits they offer in diagnosing and treating a range of pelvic floor dysfunctions.

What is an Internal Pelvic Floor Assessment?

An internal pelvic floor assessment is a hands-on examination conducted by a trained physiotherapist. It involves the gentle insertion of a gloved and lubricated finger into the vagina or rectum. This is not a speculum-based examination like a cervical smear; it’s a direct assessment of the pelvic floor muscles and surrounding structures. The primary goal is to gain valuable insights into the function and condition of your pelvic floor.

Why are Internal Assessments Performed?

The pelvic floor is a complex group of muscles that form a sling at the base of your pelvis. They support your pelvic organs, control bladder and bowel function, and play a crucial role in sexual health. When these muscles are not functioning optimally, it can lead to various issues such as:

• Urinary incontinence (stress, urge, or mixed)
• Bowel incontinence or difficulty with bowel movements
• Pelvic organ prolapse (when an organ, like the bladder or uterus, drops or sags)
• Pelvic pain
• Pain during or after intercourse
• Scarring from childbirth or surgery

An internal assessment allows the physiotherapist to directly evaluate:

• Muscle Tone and Strength: Are the muscles too weak, too tight (overactive), or do they have a normal resting tone?
• Muscle Activation: Can you effectively contract and relax your pelvic floor muscles?
• Coordination: Do your muscles work in a coordinated way to support function?
• Endurance: How long can you maintain a contraction?
• Prolapse: The extent to which pelvic organs may have descended.
• Scar Tissue: The presence and quality of scar tissue, for example, from an episiotomy or tear during childbirth.
• Rectal Sphincter Function: In rectal assessments, the integrity and function of the anal sphincter muscles are evaluated.

This detailed information is crucial for developing a personalised and effective treatment plan. Without this direct assessment, a physiotherapist might be guessing about the underlying issues, leading to less targeted and potentially less successful treatment.

What to Expect During the Assessment

Your physiotherapist will always explain the procedure thoroughly before it begins. You will have ample opportunity to ask questions and express any concerns. Your comfort is paramount. Here’s a general idea of what happens:

• Discussion: The physiotherapist will discuss your symptoms and medical history.
• Explanation: They will explain what they are going to do and why.
• Positioning: You will be asked to lie on an examination couch, usually on your back with your knees bent, or sometimes on your side. You will be provided with a drape for privacy.
• External Assessment: Sometimes, an initial external assessment of the muscles and surrounding areas might be performed.
• Internal Examination: A gloved, lubricated finger is gently inserted into the vagina or rectum. The physiotherapist will ask you to perform specific actions, such as contracting your pelvic floor muscles, bearing down, or coughing, to observe how your muscles respond.
• Feedback: You will be encouraged to provide feedback throughout the examination.
• Duration: The internal examination itself is typically brief, often lasting only a few minutes.

It is important to remember that you are in control. If at any point you feel uncomfortable or wish to stop, you have the right to do so. You can also choose to delay the internal assessment until a later appointment or bring a trusted friend or family member for support if that makes you feel more at ease.

Is it Painful?

For most women, the internal assessment is not painful. It is performed gently and with lubrication. Discomfort can sometimes arise if the pelvic floor muscles are very tense (overactive) or if there is significant scar tissue. If you anticipate pain or have a history of trauma, it is vital to communicate this to your physiotherapist beforehand. They can adapt their approach, use different techniques, or focus on external methods if an internal assessment is not feasible or comfortable for you at that time.

Benefits of Internal Assessment

The insights gained from an internal assessment are invaluable for effective treatment. They allow the physiotherapist to:

• Accurately diagnose the specific nature of your pelvic floor dysfunction.
• Tailor treatment strategies to address your unique muscle patterns (e.g., strengthening weak muscles, releasing tight muscles, improving coordination).
• Monitor your progress over time by reassessing muscle function.
• Provide specific advice on exercises and self-management techniques.

Alternatives and Considerations

While internal assessments provide the most comprehensive information, they are not always compulsory. If you are uncomfortable undergoing an internal examination, discuss this with your physiotherapist. They can often still make significant progress with external assessments and by observing how you move and function. However, for certain conditions, an internal assessment may be the most direct way to understand the problem.

Here's a table summarising key aspects:

Frequently Asked Questions

Q1: Do I have to have an internal assessment?
No, internal assessments are not compulsory. You can discuss your comfort levels with your physiotherapist, and alternative assessment methods can be used.

Q2: Will it hurt?
It is usually not painful. If you experience pain, it might be due to very tight muscles or scar tissue. Your physiotherapist will be gentle and can adjust their approach.

Q3: Can I bring someone with me?
Yes, many clinics allow you to bring a friend or family member for support if it makes you feel more comfortable.

Q4: What if I've had a bad experience before?
Communicate your previous experiences to your physiotherapist. They are trained to be sensitive to these situations and will work with you to ensure you feel safe and respected.

Q5: How is this different from a doctor's internal exam?
While both involve internal examination, a physiotherapy pelvic floor assessment is specifically focused on the detailed assessment of the pelvic floor muscles and their function, often involving specific muscle testing that a routine gynaecological or rectal exam may not cover.

Conclusion

Internal pelvic floor assessments are a vital tool for physiotherapists to accurately diagnose and treat a wide range of pelvic health conditions. While the idea might seem daunting, understanding the process, the benefits, and your rights regarding comfort and consent can help demystify the procedure. Remember, open communication with your physiotherapist is key to a positive and effective treatment journey. By addressing your concerns and working together, you can achieve better pelvic health and improved quality of life.