Benefits of Internal Assessment for Pelvic PT - Episode 13
In this episode, I discuss what an internal assessment is at pelvic PT, why it's needed, how it benefits your plan of care, where it's completed, and what happens if you opt to not have an internal assessment.
Check out episode 8 to find out the 5 functions of the pelvic floor.
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Welcome to the Morone Pelvic Health Podcast. Hi, I'm your host, Dr. Kari Roberts. On this show, we will be discussing a variety of things regarding your Pelvic health. These conversations will be a mix of education, personal experiences, and a blend of tips you can apply to have a healthier Pelvis. The goal of this show is to normalize conversations around Pelvic health and help women stop suffering in silence. Let's talk about what an internal assessment for Pelvic physical therapy is. Okay, first, when you think about going to physical therapy, really put simply, we are muscle and joint specialists in the rehab world. We like to know how strong a muscle is, how much tension it has, how long it is, how tight it is. Does it need to be strengthened? Does it need to be stretched out? Does it attach properly? Is it working when it's supposed to? All things related to the muscle. And that's easy to understand. Why? Someone might want to assess, let's say, your quadriceps muscle, your thigh muscle, if you have a knee injury or if you have an ankle injury, someone might want to assess the muscles in your foot or the muscles in your shin. So that makes sense, right? But the pelvic floor is so interesting because those muscles, you can't see them. You can't see them and you can't really touch them because they live on the inside of our pelvic girdle or the inside of our pelvis. Kind of like if the pelvis is a bowl, they are on the inside of the bowl. Whereas your hip muscles, like the glutes, the quadricep muscles, the abdominal muscles, all of those live on the outside of the bowl. So when you go to physical therapy and someone says, I want to assess your knee muscles, you're like, okay, fine. Or someone says, I want to assess your shoulder muscles, you're like, okay, fine. No big deal. As a provider, we're thinking the same thing. I need to know more about that muscle. I need to know why. I was supposed to be talking about the what, but I'm seeing I'm slipping right on into the why. So we'll go to the why. First. We need to know what's the state of those muscles. Are they stretched really thin and not working too hard? Are they really tight and don't have enough range of motion? Are they too tight? Are they too weak? Are they the perfect length and the perfect strength? But they're just not coordinated. All of those things we need to know. And just like we don't truly get a sense of what those knee muscles or what those shoulders muscles are doing without touching and feeling it when we're asking you to move, looking at it when we're asking you to do things, we need to do those same things for the pelvic floor. So that's the why. That's why we need it, to get more information. Because we are treating you as a whole person and we don't want to leave something out. We want to do a thorough assessment. And since the pelvic floor is responsible for so many things, if you go back a couple of episodes, I talk about the five s's or the five functions of the pelvic floor, but it does so many things, we want to get an idea for what those muscles are doing. That's the why. Now, what is the pelvic health physical therapy internal assessment? Well, just like I mentioned, all of those other muscles live on the outside of the bones. So those are external assessments. In comparison, an internal assessment is when we are actually going inside of your body to feel how those muscles are working. And so since those muscles are on the inside of your pelvis, it makes sense that that exam will be on the inside of your pelvis, right where those muscles live. So that's what it is. Now how does it happen, our pelvic floor? If you are a woman, your pelvic floor has three openings. It has an opening for your urethra where you empty out bladder or urine. It has an opening for your vagina where your sexual organs reside in sexual activity and birthing babies and all of that stuff through the vagina. And then the third opening or, orifice if you want to be technical, the third orifice is your anus, which is where we have bowel movements and relieve fecal waste. So those are the three openings. For a woman, the urethra is extremely too tight, it's too small, it's very painful if something has to go in it, even for medical procedure. So that's a no go. The vagina is interesting because it is designed to stretch. There's lots of folds in it, kind of like an accordion. It can accordion out or stretch out to receive penetration, like a penis. It can stretch out to let things pass through it like a baby. So the vagina is actually a very well suited opening for pelvic physical therapy to do an internal assessment. Also, the anus is also another opening that does have some stretch and give. It doesn't have the same sort of stretch and give as a vagina, but it does have some stretch and give. And so the anus is another way that a pelvic physical therapist can do an internal assessment on a female. Now, for a male, their sexual organs and their urethra live on the outside of their body. And just like with women, the urethra, it's a one way exit. You don't really want to go up the urethra. It's extremely painful. They don't have vaginas. So the only orifice for a male patient that needs an internal assessment is through the anus, just for the same reasons that I just mentioned, for the woman. So that's how it happens. That doesn't need any sort of equipment. It doesn't need like if you are a woman and you go to the doctor, the OBGYN and they've got a speculum and they put this cold thing in there and they kind of crank it open, click it open so they can see what's going on. No, we don't do any of that in public. Physical therapists, our main tool for physical therapy. I don't care if you are specializing in athletes, you're specializing in mothers, you're specializing with women with pelvic floor dysfunction. Our hands are our most important asset. We get so much information from feeling, feeling your posture, feeling how things are moving, feeling how when muscles are turning on and turning off. And that's the same thing we do with the internal assessment. So we glove up. If you're like me, you put double gloves on. You glove up. You use a moderate amount of lubrication, and then you use one finger to enter into that opening, to feel around at those muscles that are in the inside of that bowl so we can get an idea of how strong they are, how weak they are, how long they are, how short they are, and how coordinated they are. A pelvic internal exam can take usually just a couple of minutes, poke around, ask you to do a couple of things. We might ask you to squeeze like you're stopping the flow of urine. We might ask you to bear down like you're forcing out gas. We might even ask you to squeeze repeatedly like you're trying to do kegels. Or we might even ask you to just take some deep breaths and maybe even cough. We just want to see what those muscles are doing. So that is how we do an internal exam, what an internal exam is and why we do it. So the where I kind of threw that in there. For men, it would only be done at the anus, but then for women, it could be done through the vagina, the anus, both. Or depending on what we find, if you've got more symptoms towards the back of the pelvis for a woman, maybe dealing with some bowel habits and rectus seal and things like that, you might have a little bit more work done for the rectum. But if you're having more bladder and sexual function issues, sometimes you can have that with just the vagina. But the pelvic floor muscles kind of wrap from front to back. And so some therapists might feel like during their assessment, they need to do both to get a really good, well rounded picture of what's going on with those muscles. So what's the benefit? What's the benefit of even enduring an internal exam? Because it could be I mean, I'm going to be honest, it could be a little intimidating, could be a little bit weird. But what's the benefit? The benefit is we are muscle experts and we need to know what's going on with those muscles. We need to know how they're feeling, how they're working. And you can deal with their neighbors like let's say you've got knee issues. We could look at what's going on at the abdomen and infer of what's going on at the knee. Or we could just have you pull up your pants or wear some shorts and look at the knee and see what's going on. Looking at the knee is going to give us the best information of what's going on at the knee so that we can write the appropriate plan of care for you. Same thing with the pelvic floor, since it's on the inside of the girdle, the pelvic girdle, there is no way to see what's going on because like I said, we use our fingers to see, so we have to feel in touch. But with feeling and touching as an expert the way that we're supposed to, we can get the information we need to create a proper plan. Now, some clients might find that they need manual internal work for most of their visits to deal with whatever they've got going on. Other patients come in and it's like, you know what? I don't really need everything's good. We're dealing with some other issues. Thank you for allowing me to do the exam. But the full assessment is leading us in another direction. And then there's different combinations in between. You might start with needing a little bit more internal, and as you're progressing, you could get away from it, or you could start with some other things. And then as you progress, we move into internal. It just kind of depends. Every patient is different. Every clinician is different. Now, a question that I get asked often. What happens if you choose to say no? Yes, you want to go to pelvic physical therapy, but no, the internal isn't for you. Just like everything else in physical therapy, you are the patient. You have the right to choose. You have the right to say yes or no. You have a right to say yes today and no tomorrow. You have a right to say no today and yes tomorrow. You are in complete control with what you consent to. That's number one. I want to put that out there. You're never going to be forced into doing something that you don't want to do, especially if it makes you feel uncomfortable. You might have a history of trauma or some other things, and that's just not really the bridge you're trying to cross right there. That's completely okay. There are other things we can do. We can feel around close to the pelvic girdle. We can feel around those sit bones around the back. We can feel around the pubic synthesis in the front. We can feel with our fingers through those external muscles and infer what's going on with the internal muscles. We can get a really good idea of what's going on. We can feel those bones. We can feel the tailbone and the coccyx and the hips and the femur and get an idea of what's really going on with the pelvic floor. We can also look and touch and feel the muscles that attach to the pelvic floor, the muscles that share connective tissue with the pelvic floor so that's your deep hip rotators, your deep hip flexors, your abdominal muscles, your low back muscles. So we can take all of that information and kind of say, okay, when we look at it from these four angles, we know that the pelvic floor has got to be doing this. Then again, it's not 100%, but it's definitely something that gives us options. So we can still work with you and still help you if that's something that you decide that you're not that comfortable with. But we're going to ask because that's just how important it is. It's like going to the therapy, going to a therapist for your hand and not ever letting the physical therapist touch your hand or look at your hand. We can still get a lot of information based off of what happens at the wrist, but we get the best information if we see what's happening at the hand. And it's just one of our tools in our toolbox. Physical therapist, pelvic physical Therapist there are so many things that we can do when you come to work with us. I am a Pelvic health physical therapist and I learn these new things still daily, weekly. There's tons of things that people in our profession can do. So if you do need pelvic physical therapy, I encourage you to at least be open to the concept of what happens for an internal assessment. So that if you are asked to do one, then you can at least it might still be a little scary, but, you'll know, it's not as bad, it's not as weird, and it's really to help us get the information that we need to write your plan. And if you think about it and you say, no, it's not for me, that's okay because we still have other things that we can do to help you with your plan. So just as a quick review, what is an internal assessment for? What is an internal assessment for Pelvic physical therapy? It is using our fingers to feel those pelvic floor muscles and get an idea of how long they are, how tight they are, how weak, how strong, and how coordinated they are. Why? We do this to get as much information as we can so that we can write your specialized plan of care. How does this happen? This happens with the use of our finger lubrication and using our finger to enter one of your entrances or openings at your pelvic floor. Where does it happen? For a male, it happens through your rectum. For a female, it could be through your vagina, through your rectum, or both. What is the benefit? It gives us the most information that we need so that we can write the most specific plan for you and your pelvic floor. And what happens if you choose? You don't want to. We have other tools in our toolbox, so don't fret. It'll be okay. Thank you so much for coming to my channel and listening to this podcast. Please leave a review and share with your friends if you're enjoying this. And I will be back next week with another episode. Thank you for listening to this episode of The Moron Pelvic Health podcast. Please do me a favor and leave a review so that more people can find this content and make sure you like and subscribe yourself so you never miss another episode.