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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.