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What Should I Expect with a Pelvic Floor Exam?

The topic of pelvic floor symptoms is always a sensitive one. It’s not super comfortable to talk about peeing your pants, that heaviness or bulging sensation you feel down there, or pain with intercourse. The symptoms can be embarrassing, and it can be scary thinking about how someone might EXAMINE down there! For some women, apprehension about a pelvic floor exam may even prolong them from getting treatment and resolving their issues.

Even as a pelvic floor physical therapist, I was also nervous the first time I experienced a pelvic floor exam. (Yes, even I have had pelvic floor physical therapy!) Knowing what to expect and having someone explain each step along the way can really help make the experience less nerve-wracking. Let me give you the lowdown on what occurs during these exams to help put your mind at ease!

Step 1: Talking

The first step of a pelvic floor exam starts out like any other physical therapy exam – we talk! We discuss your symptoms, limitations, pregnancy and birth history, bladder and bowel habits, activities, and goals. We figure out where you are and where you want to go! It is often during this discussion that we start to connect the dots and get a better understanding of what may be going on in your pelvic floor and core system.

Step 2: Examining Mobility, Strength, and Function

We never solely focus on your pelvic floor when you come in with complaints of leaking, bladder urgency, heaviness, tailbone pain, etc. We need to look at you as a whole person! There are SO many other factors that directly affect how our pelvic floor functions.

This brings us to step 2 – we look at how you move! Depending on your symptoms, we may examine your hip and back mobility, core strength, leg strength, breathing, balance, and we may even have you demonstrate how you squat, lift, etc. Any limitations we find may help explain WHY you are experiencing your symptoms.

Step 3: Pelvic Floor Exam

Now comes to the step that may make you a little nervous – examining the pelvic floor. The only way to truly know what is going on in your pelvic floor muscles is to examine them directly. We wouldn’t recommend it if it wasn’t so helpful!

We ALWAYS start a pelvic floor exam with a clear explanation. First, we show you a pelvic floor model. We talk about where the pelvic floor muscles are located and discuss the important jobs that our pelvic floor muscles have. Then, we THOROUGHLY explain every step of what a pelvic floor exam entails. We will ALWAYS ask if a pelvic floor exam is something you feel comfortable doing. You are in control – you NEVER have to say yes to an exam if you are not comfortable with it, and you can ALWAYS stop the exam at any point.

So What Does the Pelvic Floor Exam Entail?

The exam is very gentle in nature. We start by examining the more superficial pelvic floor muscles externally. These muscles are located between your pubic bone and tailbone and span the width between your sit bones. We then insert one gloved finger into your vagina. This allows us to directly examine the deeper pelvic floor muscles that we cannot examine externally.

During both an external and internal pelvic floor exam we assess your muscles for:

• Tightness
• Strength
• Endurance
• Coordination (what do your muscles do when you cough, sneeze, laugh, brace, etc)
• Scar tissue sensitivity or tightness (such as from a tear during birth or from an episiotomy)

Again, while the internal pelvic exam is the best way to figure out what is going on in your pelvic floor muscles, it is never a mandatory procedure. If you’re uncertain or apprehensive, we will do our best to make you feel relaxed. At any point in time we can stop an internal exam or alter exam techniques to make you feel more comfortable.

Step 4: Treatment to Start Resolving Your Symptoms

Now that we know exactly what is going on in your pelvic floor muscles and what may be contributing to your symptoms, it’s time to get to the fun stuff – treatment! We begin resolving your symptoms right away during that first visit. You may be given a few pieces of homework, or we may even start with some manual work.

Feel Confident, Heard, and Validated

Your pelvic floor muscles are like every other muscle in your body – they are just in a more private and sensitive area. Just like seeing clients with symptoms in the knee, back, or shoulder, it’s important to examine that specific area, as well as the surrounding structures that may be impacting it, in order to know how to resolve symptoms.

We often see the lightbulb go off in clients’ heads throughout our pelvic floor exam. The dots are getting connected – symptoms are validated and explained. Our goal with a pelvic floor exam is that you leave feeling heard, confident, and excited to resolve your symptoms through pelvic floor physical therapy pelvic floor physical therapy!