Pelvic floor physical therapy is a specialized, non-surgical treatment addressing muscle dysfunction within the pelvis to restore function and alleviate discomfort. It focuses on the complex group of muscles and connective tissues supporting the bladder, uterus, prostate, and rectum. The specific “internal” approach is a method of assessment and treatment that allows for direct interaction with these deeper muscles. This direct evaluation is often necessary because these muscles are otherwise difficult to analyze or treat effectively.
Defining Internal Pelvic Floor Physical Therapy
Internal pelvic floor physical therapy is distinct because it involves manual assessment and treatment performed directly through the vagina or rectum. This approach allows the therapist to precisely evaluate the condition of the muscles, including the levator ani and coccygeus. The therapist uses a single, gloved, and lubricated finger for this detailed examination and subsequent manual therapy. While external methods are part of a complete treatment plan, they cannot provide the same direct access to the internal muscle layers.
The internal technique identifies specific areas of weakness, excessive tightness (hypertonicity), or painful knots known as myofascial trigger points. Assessing the muscles internally is the most accurate way to gauge their strength, endurance, and coordination. This direct input helps the therapist understand how the muscles contribute to the patient’s symptoms. The manual treatment applied internally releases tension, improves blood flow, and enhances overall muscle function.
Conditions Addressed by Internal Pelvic PT
The internal approach treats a wide range of conditions rooted in pelvic floor muscle dysfunction, whether the muscles are too weak (hypotonic) or too tight (hypertonic). Weakness can lead to stress urinary incontinence, where urine leaks during activities like coughing or jumping. Hypotonicity also contributes to pelvic organ prolapse, where supportive structures allow organs to shift downward.
Muscles held too tightly may cause chronic pelvic pain syndrome (CPPS) or contribute to dyspareunia (pain during sexual intercourse). Internal physical therapy targets these hypertonic muscles and trigger points, which can refer pain to the lower back, abdomen, or inner thighs. Post-partum recovery issues, including pain from scarring, also benefit from internal techniques. Difficulties with bowel movements, such as chronic constipation or fecal incontinence, can also be addressed by improving muscle coordination.
The Internal Examination and Treatment Process
The internal session begins with a comprehensive intake where the therapist reviews the patient’s medical history and current symptoms. Before any physical assessment, the therapist obtains informed consent, explaining the procedure and confirming the patient can stop the process at any point. The patient is typically positioned lying on their back with knees bent, often draped for privacy; no stirrups or speculums are used.
The therapist first performs an external assessment, checking posture, breathing patterns, and the external muscles of the hips, lower back, and abdomen. The internal assessment begins only after the patient is ready, using one gloved and lubricated finger inserted into the vagina or rectum. This allows the therapist to palpate the three layers of the pelvic floor muscles, checking for resting tone, tenderness, and the ability to contract and relax. The therapist may ask the patient to perform specific actions, like a gentle squeeze, to gauge muscle function and coordination.
The treatment phase involves manual techniques, such as sustained pressure or myofascial release, applied directly to identified areas of tension or trigger points. The therapist maintains constant communication, checking on the patient’s comfort level throughout the process. This direct manual therapy is effective for releasing deep muscle knots that contribute to pain and dysfunction. The patient remains in control, and the therapist respects any request to discontinue the internal portion of the session.
Preparing for and Maximizing Treatment
Patients should seek a specialized physical therapist who has received dedicated training in pelvic health. Before the initial appointment, patients should wear comfortable clothing and be ready to discuss their symptoms and medical history thoroughly. Preparing a list of questions can also help address any anxieties about the internal exam.
Treatment frequency typically involves one session per week, with the duration of care often ranging from six to twelve visits depending on the condition. Maximizing the benefits of in-clinic treatment relies heavily on the patient’s commitment to home exercises, which may include strengthening, stretching, or relaxation techniques. Open communication with the therapist about pain levels and progress is essential for tailoring the treatment plan and achieving the best outcome.