Understanding Pelvic Floor Exams: More Than Just Your Annual Check-up

When most people think of a pelvic floor exam, the first image that comes to mind is the annual pelvic floor exam often done in a gynecologist’s office. You may imagine the discomfort of stirrups, the cold touch of the speculum, and the awkwardness of the whole experience. However, a pelvic floor exam is an entirely different assessment that doesn’t involve any of those elements.

What is a pelvic floor exam?

A pelvic floor exam is specifically designed to assess the muscles that make up your pelvic floor. These muscles play a crucial role in supporting your pelvic organs, controlling bladder and bowel movements, and even contributing to intimate function. Consider how you would assess the muscles surrounding your knee if you had knee pain, except we access the pelvic floor internally. The exam typically involves a manual evaluation where a healthcare provider gently assesses the tone, coordination, and strength of these muscles. Can you contract? Can you relax (how?)? Can you coordinate - by providing different cues of function required by the pelvic floor to prevent your symptoms.

How is this different from an annual pelvic exam?

Unlike an annual pelvic exam, which is primarily focused on screening for cancers, infections, and other gynecological issues, a pelvic floor exam is all about understanding the health and function of your pelvic floor muscles. The process is generally less invasive. I can also help assess the support of your pelvic organs, which are largely supported by connective tissue surrounding and think of the pelvic floor as just that, a floor to this region. I am myofascially trained in the pelvis and lower extremity, as well as bladder system - to assess asymmetry of tension which can affect pelvic organ prolapse symptoms, muscle function and pain, as well addressing scar tissue.

So, why should you get a pelvic floor exam?

If you’ve been told to “just do your Kegels,” it’s worth knowing that strengthening exercises like Kegel’s aren’t always the right solution. A pelvic floor exam helps determine whether your muscles are weak, tense, or lacking coordination. I like to think of it as: it can help us be more direct in your exercise plan, instead of throwing a dart at a dart board with eyes closed and hope it sticks at bullseye. Is it possible? Yes, but it might take you multiple more attempts and a little luck.

Assessing Muscle Tone

Often, we think of pelvic floor muscles as being weak, leading to the widespread advice of doing Kegels. However, increased tension in these muscles can sometimes mimic weakness. If your muscle’s can’t fully relax or contract, you might experience symptoms like pain or discomfort. A pelvic floor exam can reveal whether your muscle tension is contributing to your symptoms - such as pain in the hips, tailbone, lower back, or even abdominal cramping.

Coordination and Feedback

Can you actually perform a Kegel correctly? You’d be surprised how common it is for women to struggle with this (especially postpartum). A pelvic floor exam provides real-time feedback, allowing you to understand whether you’re contracting and relaxing your muscles correctly. Sometimes, women may bear down when they think they are contracting, which can contribute to symptoms like prolapse and incontinence. Other times, they may be able to contract strongly, but cannot bear down or reduce tension/lengthen. Think of an elevator. You should be able to go up to first, second, third floor and then relax back to the main level, as well as go down into the basement or to the parking garage.

This exam offers a safe space to learn and practice proper techniques.

Assessing Strength

A pelvic floor exam allows for a more tailored approach to your care instead of assuming your muscles are simply weak. It ensures that your exercises are designed to address your specific needs- whether that’s increasing strength, reducing tension, or improving coordination.

Body Mapping

Lastly, a pelvic floor exam helps you build a connection with a part of your body that many of us rarely think about. Understanding the layout, function, and health of your pelvic floor can empower you to take better care of this essential area.

In summary, a pelvic floor exam is a valuable tool for understanding the unique needs of your pelvic health. Whether you’re dealing with pain, discomfort, or simply want to ensure your muscles are functioning properly, this focused exam offers insights that go far beyond what an annual pelvic exam can provide.