What is internal work and why do we do it?

If you have been referred to pelvic physical therapy, you may have heard that internal exams are an aspect of this care.  It can be useful but it is ALWAYS up to you if and when we do internal work.

We will work with you to understand how this aspect could be helpful to your recovery or give you and your therapist important information to design a rehabilitation plan for you.  

Our therapists all have advanced training in order to perform internal assessments. We have doctorates in physical therapy and we have had hours of advanced training, certifications, mentoring and learning in pelvic floor issues and treatment.

Internal assessments and treatment are not quite the same as having a gynecological exam. During a pelvic exam, it may have felt like you were just there and not an active participant–do the test and tell me when it’s over so I hopefully don’t have to do this again for several years. This can lead to an experience that is anywhere from neutral to annoying to traumatic.

Our work is different. We work WITH you so you understand exactly what the purpose of the exam is, what will happen, and how you may feel. In fact, we need your feedback and communication about how you feel during internal work.  We do not use speculums and at every step of the exam you will be learning and communicating with your therapist. You are always in control and can terminate the exam at any time.

Why do we do internal exams?

The pelvic floor muscles and nerves run along your pelvic bones back to your tailbone.  BY palpating them through the vaginal or rectal canal, we can feel if these muscles are operating the way they should.

There is a normal contraction and relaxation that should occur with the breath and when you move. Is this happening well? At the right time? We can feel if they are thick or thin. You can tell us if they are tender or recreate your symptoms. We want you to be an active participant and we will explain all of our findings to you and why our suggested treatments can help with regards to what we found.

We can gather so many details, just as if you had a shoulder problem we would evaluate your rotator cuff muscles along with your arm, neck and spine movements. 

The pelvic floor is also very connected to the spine and hips and internal exams can help us evaluate how these elements may contribute to your spine or hip symptoms. 

What about internal treatments?

We often see patients who have a pelvic floor that is not working ideally. 

Many people–due to injury, our world, posture, trauma, the list goes on–have “tight” pelvic floor muscles. Imagine your fist is closed all the time. The muscles would get “tight” and blood flow would be compromised. Have you ever held too many groceries and your hand struggles to open after you put down the 5 bags? Now imagine that’s your pelvic floor. This often is a contributing factor to pain, leakage, prolapse and nerve injuries.

It also can happen as a protective response because of an injury or with back pain or hip tension. Just like you have “knots” in your shoulders, you can have these densities in your pelvic floor. We use various strategies to work on these areas and help the muscles and nerves return to a healthy function. We are trained to work internally to help these muscles “calm down.” Our intention is for you to feel your pelvic floor muscles move up and down with your breath and feel a resolution of your symptoms.

You should leave any session like this feeling like you fully understood the purpose of this session and what the plan will be going forward. Your therapist will tell you if they thought it was effective and how they will follow up to monitor if this is a successful strategy for your healing. Within 2-3 sessions, you will know if internal treatments are helpful. We do the same evaluation with any treatment we believe to be helpful.  

Please don’t avoid pelvic floor physical therapy out of fear of this type of treatment. We will always discuss what you need and if internal treatment is not for you, we will still be here for you and come up with a plan that works.  We are here to help you.

Not Sure If Pelvic Floor Therapy Is Right For You?

Schedule a 30-minute consultation with one of our expert therapists to learn more. We’ll hear your story and give you our best advice for moving forward and getting on the path to healing.