Why Do We Do an Internal Exam?

Our pelvic floor muscles silently do their job, allowing us to function without interruption to assist with bowel function, bladder function, and sexual function. They also contribute significantly to our core strength which allows our low back to function without difficulty. However, most of us do absolutely nothing to ensure the good health of these very important muscles. On top of that, many do not even know that these muscles exist, let alone how to keep them healthy and use them appropriately during our daily activities.


Most of us (especially women) have heard the term Kegels. Dr. Arnold Kegel was the first person in the 1940’s to teach women how to strengthen these important muscles. He was a gynaecologist, and he has had the honour of having pelvic floor strengthening exercises named after him for his significant contribution to our understanding of these muscles. Dr. Kegel taught all of his patients to do these exercises by inserting a finger into the vagina to assess their muscle strength, and to give the patient feedback about how she was performing the exercise. These are internal muscles. We cannot see them because they are hidden inside the pelvis.


As time passed on, Kegels have continued to be honoured as an important way of keeping these muscles strong; however, most physiotherapists, urologists, nurses and gynaecologists who teach women how to do Kegels no longer do an internal exam to assess these muscles to ensure proper contraction of these muscles. This has led to a very poor success rate and significant frustration for women trying to do these exercises preventatively or therapeutically.


Assessing the pelvic floor without doing an internal exam is like an orthopaedic 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.


In Europe, internal examination of the pelvic floor has been the gold standard by which treatment of the pelvic floor has been carried out for more than 30 years. In Canada, we are a more puritanical society, and it seems “weird” or “strange” to assess the pelvic floor by completing an internal exam of the vagina or rectum. However, when the pelvic floor muscles are assessed this way, the research has shown that the treatments carried out by a physiotherapist for pelvic floor problems are highly successful, and should be the first line of defense (before surgery or any other medical intervention) for both pelvic pain and incontinence.


The physiotherapist who carries out this work is a highly trained, sensitive professional who will discuss these issues with you thoroughly before carrying out the treatment. Internal palpation is an integral part of treating the pelvic floor and is the gold standard. Accept nothing less.