Why Does My Pelvic Physiotherapist Do An Internal Exam?

Your pelvic floor muscles contribute to your core strength, support your bowel, bladder, and sexual function, and they are key factors in reducing lumbopelvic (low back / pelvis) pain.

What is the function of the pelvic floor muscles?

Your pelvic floor muscles work silently to support your bowel, bladder, and sexual function; as well as contribute to your core strength.  Although the pelvic floor and internal pelvic muscles are not often considered when evaluating and training your core strength, recent research has confirmed they are key factors for lumbopelvic (low back / pelvis) pain.  Although pelvic physiotherapy is not the first line of defence or treatment action when you suffer from lumbopelvic pain or dysfunction, perhaps it should be, or at least investigated when conventional physiotherapy treatment stalls.  

When we hear 'core' and 'pelvic floor', the first word that comes to many people's heads is 'Kegel' exercises. Dr. Arnold Kegel, a gynaecologist who had this internal pelvic strengthening exercise named after him, was teaching women to insert their fingers into their vagina and measure muscle strength.  As the years have passed, doctors/physiotherapists/exercise specialists still encourage clients to contract these muscles but without any 'feedback' to assess and confirm muscle contraction. Poor results frequently ensue, as many of us contract the wrong muscles, or in some cases contract muscles that are already strong! 

Diagnosis

An internal exam is considered the gold standard and most accurate way to assess muscle control; teach you about your muscles and their responsiveness/contraction; and ultimately improve your pelvic function.  Although standard in Europe, we still seem timid in Canada to recognize and accept the internal exam as a key element for accurate diagnosis and more successful treatment outcomes.  Think about it .... those muscles are INSIDE the pelvis ... how better to verify/control/feel your muscle control?  We need to touch the muscles involved to best assess them.

Your physiotherapist who carries out your internal exam is registered with the College of Physiotherapists of Ontario, and is rostered for internal palpation and examination. Rostering for a controlled act is the process where physiotherapists add their names to a list indicating they have the required training, education and experience to safely perform the higher risk activity.  

Although an internal exam is the gold standard and should be the first line of defence for pelvic health management, your physiotherapist at Motion Works Physiotherapy Orleans will discuss the internal exam with you at your first visit, and complete it if and when you are ready and comfortable.  Upon receiving your consent, your physiotherapist will leave the room to allow you adequate time to undress and get comfortable on our treatment table, with appropriate sheets for draping.  When the physiotherapist returns they will use a clean, gloved, technique to examine your pelvic floor externally, then internally with a one to two finger insertion to palpate the appropriate muscles (tone, coordination, control, strength) and surrounding structures.  They will also teach you how to identify and feel the proper muscle contractions to help with your self-care exercise routine at home.