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Pelvic Wellness Check: Pelvic Floor Exam 101

Imagine taking your car to the mechanic for a service, and the mechanic hands you the bill without looking under the bonnet. Quite odd, isn’t it?

Guess what—this goes the same if you’re consulting a physiotherapist for a pelvic floor-related concern. We might have to take a closer look—an internal pelvic floor exam.

Before considering the internal examination, your physiotherapist will familiarise themselves and thoroughly understand the reason for your visit, meaning assessing your goals and symptoms. They will review your medical history, inquire about any previous treatments you may have tried, and discuss your overall history to guide the assessment and treatment approach.

Moving beyond the pelvis, your physiotherapist will assess your breathing, posture, joint movements, muscle strength and the relationship of connective tissues to your pelvis—a holistic approach to understanding your condition.

While an internal pelvic exam is not obligatory, it is considered the gold standard for evaluating the function of pelvic floor muscles and connective tissues within the pelvis. Your physiotherapist will discuss and demonstrate the location of pelvic floor muscles using a model, explain the assessment process, and provide information about the pros and cons associated with an internal exam in relation to your specific goals.

WHAT HAPPENS IN AN INTERNAL EXAM?

The patient will disrobe from the waist down, including the removal of underwear, and lie on the plinth draped with a towel. Using lubricant, the therapist will gently part the labia to visually assess the vulva, perineum, and anus. In cases where pelvic pain management is sought, a Q-tip test may be performed at this stage to evaluate tissue sensitivity. For postnatal and prolapse-related concerns, a measurement known as GH + PB (Genital Hiatus + Perineal Body) is conducted to gauge pelvic floor support or tissue distensibility from the urethra to the anus. Measurements are taken both at rest and during strain, simulating a six-second attempt to blow up a balloon.

The exam also involves the insertion of one or two fingers into the vagina to individually assess:

  • Position of pelvic organs
  • Sources of pain or discomfort
  • Integrity of pelvic connective tissue
  • Muscle strength, endurance, coordination, and tone

This is the gold-standard examination and provides us with the most detailed information about your pelvic floor structures.

 

I AM NOT COMFORTABLE WITH AN INTERNAL VAGINAL EXAM, WHAT ARE MY OPTIONS?

Alternatives, such as real-time ultrasound (trans-abdominal or trans-perineal) and external palpation (with and without clothing), are available if you prefer not to undergo an internal pelvic exam. However, it’s important to note that these alternatives may not offer the same level of detail, regarding pain and muscle performance.

Before any assessment or treatment, your consent should and will be asked for. Do remember that you always have the right to withdraw your consent at any time. 

If you wish to learn more about the pelvic floor exam or address your pelvic floor concerns, please call or WhatsApp us at 9780 7274, or get in touch by email at help@embracephysio.sg.

Feel free to look through our website, where you can learn about other women’s health conditions we treat. This is a safe space where we can discuss how we can help you with physiotherapy.

Note: While I am a physiotherapist, I am not your personal physiotherapist. The contents of this website are for informational purposes only and are not intended to serve as personal medical advice.

References:

  1. https://www.embracephysio.sg/what-is-the-pelvic-floor/
  2. https://pelvichealthsolutions.ca/knowledge-base/why-do-we-do-an-internal-exam
  3. https://www.mayoclinic.org/tests-procedures/pelvic-exam/about/pac-20385135
  4. https://inajog.com/index.php/journal/article/view/540/581
  5. https://www.wmhp.com.au/blog/transperineal-ultrasound-tpus-exciting-technology#:~:text=Transabdominal%20vs%20Transperineal%20Ultrasound&text=The%20transabdominal%20approach%20gives%20a,of%20pelvic%20floor%20muscle%20assessment.
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My healing journey at Embrace started exactly 2 years ago, Jan 2021. I saw Preet for DR and other pelvic matters. Preet had excellent bedside manners and I was always comfortable with her. Shortly after, I was able to join the pilates group class taught by Brenda. As I was already a patient, Brenda had access to my condition and was able to check on me each class. Slowly but surely, I was given the go ahead to start running. I felt safe in all my exercise classes at Embrace because Brenda is attentive and had my progress in mind. Even my recent classes with Deborah are just as thoughtful and beneficial. When I had a bad fall late October 2022, Alex helped me through the months of recovery. She identified my "moving injuries" and explained clearly what I had to do to get better. She also has a great sense of humour! My 2 favourite ladies, Su and Alicia, are super cheerful and helpful in scheduling appointments and texting reminders. They are superstars! It's always comforting to step into Embrace. Thanks guys!

May Leung Avatar May Leung
January 14, 2023

Love EmbracePhysio team and Preet. From the initial physio sessions for my Dysmenorrhoea issue to current pre-natal sessions, Preet has always been so encouraging and patient with me. Exercises are customised based on my body condition and ability. Always feel welcome for every single follow up. Highly recommended! 🥰

Ong Mei Ping Avatar Ong Mei Ping
June 12, 2023

Great service and superior expertise at Embrace Physio! From the moment that you walk in you're greeted with top notch service. Preet and her team of physiotherapists are warm and welcoming, and their knowledge has undoubtedly helped me to treat my post-natal symptoms. My only regret is not knowing about Embrace earlier!

Dione Mayuko Harrison Avatar Dione Mayuko Harrison
September 28, 2021

Embrace life. Embrace Physiotherapy.

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