A pelvic floor exam is a physical assessment that evaluates the muscles, ligaments, and connective tissues supporting the pelvic organs. This examination helps healthcare providers understand their condition and identify potential issues causing symptoms.
Understanding the Pelvic Floor
The pelvic floor is a complex network of muscles, ligaments, and connective tissues located at the base of the pelvis. These structures form a sling-like support system, stretching from the pubic bone at the front to the tailbone at the back, and extending between the sitting bones on either side. This anatomical arrangement creates a “floor” that separates the pelvic cavity, which contains organs like the bladder, intestines, and for females, the uterus and vagina, from the perineum below.
The pelvic floor muscles are primarily composed of the levator ani and coccygeus muscles. These muscles play a role in several bodily functions, including supporting the pelvic organs against gravity and intra-abdominal pressure. They also contribute to bladder and bowel control by encircling the urethra and anus, allowing for voluntary control over urination and defecation. Furthermore, the pelvic floor muscles have a role in sexual function and support during childbirth.
Purpose of a Pelvic Floor Exam
A pelvic floor exam diagnoses and evaluates conditions related to pelvic floor dysfunction. Providers often recommend it to identify underlying causes of symptoms like pelvic organ prolapse, where organs such as the bladder or uterus may descend. The exam helps determine prolapse type and severity by assessing supportive tissue integrity.
The exam also diagnoses different types of urinary incontinence, including stress (leaking with cough or sneeze) and urgency incontinence. By evaluating muscle strength and coordination, the provider can pinpoint weaknesses or imbalances contributing to bladder control issues. Similarly, the exam can help assess fecal incontinence by examining the muscles involved in bowel control.
For chronic pelvic pain, a pelvic floor exam can reveal muscle tension, spasms, or trigger points contributing to discomfort. The assessment helps differentiate pain sources, including musculoskeletal issues within the pelvic floor. Identifying these muscle dysfunctions guides targeted treatment plans to alleviate pain and improve function.
What to Expect During the Exam
A pelvic floor exam typically begins with a discussion of your medical history and current symptoms. Your provider will ask about any pain, discomfort, or functional issues, along with your general health and lifestyle. This conversation helps them understand your concerns and tailor the examination.
The physical exam usually involves both an external and internal assessment. Externally, the provider visually inspects the genital area for irritation, skin changes, or muscle imbalances. They may ask you to cough or bear down to observe how superficial pelvic floor muscles respond.
For the internal assessment, the provider typically uses one or two gloved, lubricated fingers, either vaginally or rectally, depending on symptoms and the area being evaluated. This part of the exam does not typically involve a speculum, as the focus is on muscle evaluation rather than cervical visualization.
During palpation, the provider assesses muscle strength, tone, endurance, coordination, and identifies any tenderness or tightness. You may be asked to gently squeeze, relax, or bear down to gauge muscle response. The entire physical examination is generally brief, often lasting about five minutes. The provider will communicate each step to ensure your comfort and allow you to stop the exam at any point.
Preparing for Your Exam
To prepare for a pelvic floor exam and ensure a smooth experience, consider these steps. It is often beneficial to schedule your exam when you are not menstruating, though this depends on the specific reason for your visit. You may find it more comfortable to empty your bladder before the appointment.
Wearing comfortable, loose-fitting clothing to your appointment is advisable. Many find it helpful to write down any questions or concerns beforehand, ensuring all topics are addressed during the consultation. Open communication with your provider about any anxieties or past experiences can also contribute to a more positive experience.