Why Do We Do an Internal Exam?
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Why Do We Do an Internal Exam?
Our pelvic floor muscles sit inside of our pelvis and silently do their job, allowing us to function without interruption to assist with bowel, bladder, and sexual function. They also contribute significantly to our core strength. Many people don’t know that these muscles exist (because you can’t see them), let alone do any regular exercise to ensure they stay healthy.
Most people are familiar with the term “Kegels.” Dr. Arnold Kegel was a gynaecologist and pioneer in the field of pelvic health. He was the first person to teach women how to strengthen their pelvic floor muscles. He was honoured for his significant contribution to our understanding of these muscles by having the pelvic floor strengthening exercise named after him. Dr. Kegel assessed his patient’s pelvic floor strength by inserting a finger into their vagina to give them feedback about how well they were performing this exercise.
As time passes, Kegels have continued to be acknowledged as an important way of keeping these muscles strong. However, most physiotherapists, urologists, nurses, and gynaecologists who teach women how to do Kegels do not do an internal exam to assess these muscles. If you lack proprioception (awareness) of where these muscles are or have pelvic floor muscle over-activity/tension, verbal and/or written instruction can lead to very poor success rates and significant frustration.
Assessing the pelvic floor without doing an internal exam is like an orthopedic surgeon or a physiotherapist doing a knee exam through a pair of jeans. Treating any other part of the body without touching the affected body part to see which muscles are tight or weak and how the joints move and glide would be completely unacceptable.
It may seem strange or uncomfortable to assess the pelvic floor by completing an internal exam of the vagina or rectum, however internal examination of the pelvic floor is the international gold standard by which assessment and treatment of the pelvic floor is carried out.
The physiotherapist who carries out this work is a highly trained, sensitive professional who will maintain your comfort and dignity at all times. They will thoroughly explain what the assessment and treatment will involve (including proper draping), give you alternative options, and obtain your consent before proceeding. You may withdraw your consent at any time. When the pelvic floor muscles are assessed this way, the research has shown that the interventions carried out by a physiotherapist for pelvic floor problems are highly successful and should be the first line of treatment for incontinence, pelvic organ prolapse, and pelvic pain.
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Incontinence: Urinary and Fecal
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Facts and Myths About Pelvic Floor Dysfunction
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Pelvic Floor Muscle Weakness
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Pelvic Floor Muscle Strengthening (Kegels) for Females (Or If You Have a Vulva/Vagina)
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Pelvic Floor Muscle Strengthening (Kegels) for Males (or if you have a Penis)
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The Knack
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Pelvic Floor Muscle Tightness
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Bladder Irritants
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Bowel Dysfunction
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Pelvic Floor Muscle Weakness
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Pelvic Floor Muscle Strengthening (Kegels) for Females (Or If You Have a Vulva/Vagina)
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Pelvic Floor Muscle Strengthening (Kegels) for Males (or if you have a Penis)
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Pelvic Floor Muscle Tightness
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Constipation
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
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Persistent Pelvic Pain
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
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Sensitive Nervous System
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Types of Pain
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Understanding Pain Better
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Laughter
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Sleep
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Nutrition and Persistent Pain
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Connective Tissue Dysfunction
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What Are My Myofascial Tender Points?
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Pudendal Nerve Irritation
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Self-Treatment Techniques for Foam Rolling
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Pain Education in a Nutshell
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Catastrophization
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Endometriosis
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
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Sensitive Nervous System
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Types of Pain
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Understanding Pain Better
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Laughter
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Sleep
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Nutrition and Persistent Pain
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Connective Tissue Dysfunction
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What Are My Myofascial Tender Points?
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Self-Treatment Techniques for Foam Rolling
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Pain Education in a Nutshell
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Catastrophization
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Dysmenorrhea (Painful Periods)
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
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Sensitive Nervous System
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Types of Pain
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Understanding Pain Better
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Laughter
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Sleep
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Nutrition and Persistent Pain
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Connective Tissue Dysfunction
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What Are My Myofascial Tender Points?
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Self-Treatment Techniques for Foam Rolling
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Pain Education in a Nutshell
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Catastrophization
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Vaginismus
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Accommodators and Dilators
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Pelvic Floor Muscle Tightness
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Lubricants and Moisturizers
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Vulvar Care
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Pelvic Tissue Dysfunction
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
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Sensitive Nervous System
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Sleep
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Types of Pain
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Understanding Pain Better
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Laughter
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Nutrition and Persistent Pain
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Connective Tissue Dysfunction
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What Are My Myofascial Tender Points?
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Self-Treatment Techniques for Foam Rolling
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Pain Education in a Nutshell
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Catastrophization
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Vulvodynia
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Vulvar Care
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Pelvic Tissue Dysfunction
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Deep Breathing Exercises
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Pelvic Floor Muscle Tightness
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Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Laughter
-
Sleep
-
Nutrition and Persistent Pain
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Connective Tissue Dysfunction
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What Are My Myofascial Tender Points?
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Self-Treatment Techniques for Foam Rolling
-
Pain Education in a Nutshell
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Catastrophization
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Dyspareunia
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Vulvar Care
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Accommodators and Dilators
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Lubricants and Moisturizers
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
-
Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Laughter
-
Sleep
-
Nutrition and Persistent Pain
-
Connective Tissue Dysfunction
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What Are My Myofascial Tender Points?
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Self-Treatment Techniques for Foam Rolling
-
Pain Education in a Nutshell
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Catastrophization
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Interstitial Cystitis (IC) and Bladder Pain Syndrome (BPS)
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Diet Modification for IC/BPS
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
-
Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Laughter
-
Sleep
-
Nutrition and Persistent Pain
-
Connective Tissue Dysfunction
-
What Are My Myofascial Tender Points?
-
Self-Treatment Techniques for Foam Rolling
-
Pain Education in a Nutshell
-
Catastrophization
-
-
-
Pudendal Nerve Irritation
-
Pelvic Tissue Dysfunction
-
Pelvic Floor Muscle Tightness
-
Deep Breathing Exercises
-
Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Laughter
-
Sleep
-
Nutrition and Persistent Pain
-
Connective Tissue Dysfunction
-
What Are My Myofascial Tender Points?
-
Self-Treatment Techniques for Foam Rolling
-
Pain Education in a Nutshell
-
Catastrophization
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-
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Tailbone (Coccyx) Pain
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Sleep
-
Connective Tissue Dysfunction
-
What Are My Myofascial Tender Points?
-
Pain Education in a Nutshell
-
Catastrophization
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Persistent Genital Arousal Disorder (PGAD)
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Sleep
-
Connective Tissue Dysfunction
-
What Are My Myofascial Tender Points?
-
Pain Education in a Nutshell
-
Catastrophization
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Chronic Nonbacterial Prostatitis
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Bladder Irritants
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
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Deep Breathing Exercises
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Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Laughter
-
Sleep
-
Nutrition and Persistent Pain
-
Connective Tissue Dysfunction
-
What Are My Myofascial Tender Points?
-
Self-Treatment Techniques for Foam Rolling
-
Pain Education in a Nutshell
-
Catastrophization
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- Articles coming soon
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Lichen Simplex, Sclerosis, and Planus
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Accommodators and Dilators
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Lubricants and Moisturizers
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Vulvar Care
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Pelvic Tissue Dysfunction
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Pelvic Floor Muscle Tightness
-
Deep Breathing Exercises
-
Reverse Kegels (Pelvic Floor Drops)
-
Sensitive Nervous System
-
Types of Pain
-
Understanding Pain Better
-
Laughter
-
Sleep
-
Nutrition and Persistent Pain
-
Connective Tissue Dysfunction
-
What Are My Myofascial Tender Points?
-
Pain Education in a Nutshell
-
Catastrophization
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